健脾益气中药联合化疗治疗晚期非小细胞肺癌临床疗效

目的探讨健脾益气中药联合化疗治疗晚期非小细胞肺癌临床疗效。方法选取72例晚期非小细胞肺癌患者,根据密封信封法分为A组(n=36)和B组(n=36)。A组采用多西他赛+顺铂化疗治疗,B组在A组治疗基础上辅助中药治疗,记录两组患者治疗总有效率(RR)、疾病控制率(DCR)、疾病进展时间(TTP)、生存时间(OS)、1年存活率、卡氏评分(KPS)改变情况及不良反应,并进行对比分析。结果 A组RR为36.1%(13/36)、DCR为69.4%(25/36),B组RR为38.9%(14/36)、DCR为77.8%(28/36),两组间比较,差异均无统计学意义(P>0.05)。A组中位TTP为6.3(4.5~8.7)个月,中位OS为8.9(5.9~12.3)个月,1年存活率30.5%(11/36);B组中位TTP为7.1(5.2~9.1)个月,中位OS为9.3(5.7~12.6)个月,1年存活率33.3%(12/36),两组TTP、OS、1年存活率比较,差异无统计学意义(P>0.05)。两组患者治疗后,A组KPS评分升高12例,稳定9例,降低15例,改善率为58.3%(21/36);B组KPS评分升高19例,稳定12例,降低5例,改善率为86.1%(31/36),B组改善率明显高于A组,差异有统计学意义(P<0.05)。B组各不良反应发生率均较A组低,其中,B组恶心呕吐、疲劳乏力、腹泻发生率显著低于A组,差异有统计学意义(P<0.05)。结论健脾益气中药联合化疗在改善患者的生活质量、减少化疗不良反应方面有较好辅助作用。     

多西紫杉醇联合沙立度胺片二线治疗晚期非小细胞肺癌的疗效分析

目的分析多西紫杉醇联合沙立度胺片二线治疗晚期非小细胞肺癌的疗效及安全性。方法选取我院于2008年12月—2010年7月收治的晚期非小细胞肺癌患者106例,并在知情同意的前提下将其随机平均分组,对照组53例,行多西紫杉醇二线治疗,观察组53例,接受多西紫杉醇联合沙立度胺片二线治疗,比较两组患者治疗的有效率、局部控制率、2年生存率及不良反应。结果观察组治疗总有效率为98.1%,局部控制率为94.3%,对照组分别为86.8%和73.6%,观察组疗效及局部控制率均优于对照组;两组患者不良反应发生率均为100.0%,均出现粒细胞下降,治疗结束后症状自行缓解,不良反应发生情况比较,无明显统计学差异;观察组2年生存率为79.2%,对照组为50.9%,两组比较,差异有显著统计学意义(P<0.01)。结论多西紫杉醇联合沙利度胺片对晚期非小细胞肺癌的二线治疗具有良好的治疗效果及局部控制率,且不增加明显不良反应,疗效安全可靠。     

HAIC序贯TAE治疗不可切除肝细胞癌的安全性和有效性北大核心CSCD

目的 评估肝动脉灌注化疗(HAIC)序贯肝动脉栓塞术(TAE)治疗不可切除肝细胞癌的安全性及有效性。方法 收集2020年4月至2021年4月采用HAIC序贯TAE治疗的25例肝癌患者的临床资料,以ALBI评分评估患者肝功能变化情况,记录术后出现的不良反应。根据改良实体瘤疗效评价标准(mRECIST)评估肿瘤客观缓解率(ORR)、疾病控制率(DCR),并随访患者的疾病进展时间(TTP)和生存时间(OS)。结果 患者首次治疗后3个月ALBI评分(-2.29±0.53)与术前(-2.32±0.44)相比,差异无统计学意义(t=-0.223,P=0.825)。主要不良反应包括肝功能损伤、骨髓抑制、腹痛、恶心呕吐、发热等,4例患者出现Ⅲ级不良反应(3例ALT升高,1例骨髓抑制),其余均为Ⅰ~Ⅱ级不良反应。术后6周ORR、DCR分别为68%、92%,术后12周ORR、DCR分别为72%、88%,中位TTP为271 d(95%CI:115.9~426.0),中位OS为510 d(95%CI:491.5~528.5)。结论 HAIC序贯TAE治疗不可切除肝癌临床疗效显著,具有良好的耐受性,是安全可行的。     

氟尿嘧啶、亚叶酸钙和奥沙利铂联合贝伐单抗治疗转移性结肠癌疗效观察

 目的 评估氟尿嘧啶、亚叶酸钙和奥沙利铂(FOLFOX)方案联合贝伐单抗(Bevacizumab)在转移性结肠癌(MCRC)治疗中的疗效和不良反应.方法 回顾分析我院2004年5月到2007年6月间接受FOLFOX联合贝伐单抗一线解救方案的32例MCRC患者的疗效和不良反应数据.Kaplan-Meier法计算生存曲线.结果 共有32例MCRC患者接受了FOLFOX联合贝伐单抗一线解救治疗,其中21例中途停用奥沙利铂.全组患者总体有效率为40%.生存分析估计中位TTP为9.8个月,中位OS为22.9个月.3级神经病变、中性粒细胞减少症和腹泻的发生率分别为15.6%、9.4%、9.4%.结论 使用FOLFOX联合Bevacizumab一线解救治疗MCRC患者有效,不良反应可以耐受.     

厄洛替尼治疗动脉灌注化疗后进展的肺腺癌脑转移的临床分析

目的观察厄洛替尼治疗动脉灌注化疗后进展的肺腺癌脑转移患者的疗效及安全性。方法 2008年11月至2011年1月,20例初治的肺腺癌脑转移患者接受动脉灌注化疗,化疗药物为替尼泊苷、尼莫司汀、吉西他滨、卞铂等,每4周治疗1次,直至颅内病灶进展,停止动脉灌注化疗,行厄洛替尼150 mg/d治疗,直至疾病进展或发生不可耐受性药物不良反应,评价缓解率、无进展生存时间(PFS)、总生存期(OS)及药物不良反应。结果 20例患者均接受2次以上动脉灌注化疗,中位治疗次数3次。20例患者均可进行厄洛替尼治疗近期疗效评价,治疗总有效率(ORR)为75%(15/20),疾病控制率(DCR)为90%(18/20)。中位PFS为9个月[95%可信区间(CI)为7.65～10.35个月],中位总生存期15个月(95%CI为11.48～18.53个月),6个月生存率90%(18/20),1年生存率为75%(15/20)。厄洛替尼最常见的不良反应是皮疹和腹泻,发生率分别为90%(18/20)和75%(15/20),不良反应多为1～2级,3～4级不良反应发生率仅为10%(2/20)。结论厄洛替尼二线治疗肺腺癌脑转移的疗效确切,患者耐受性良好,可作为动脉灌注化疗失败后肺腺癌脑转移的治疗选择。     

信迪利单抗一线治疗晚期胃癌或胃食管结合部腺癌的疗效分析

目的 回顾性分析信迪利单抗联合化疗一线治疗晚期胃癌或胃食管结合部腺癌的疗效。方法 收集2019-01至2022-10解放军总医院第一医学中心收治的信迪利单抗联合化疗一线治疗晚期胃癌或胃食管结合部腺癌患者临床资料，分析入组患者中位无进展生存期(mPFS)、客观缓解率(ORR)及疾病控制率(DCR)。结果 共纳入71例患者，中位年龄60岁，男53例，女18例，其中45例给予信迪利联合以奥沙利铂为基础方案的治疗，26例给予信迪利联合以紫杉醇(白蛋白结合型)为基础方案的治疗。全组患者的ORR为67.6%,DCR为97.2%,mPFS为11.2个月(95%CI 9.7～12.8)。联合奥沙利铂为基础方案组的ORR为73.3%,DCR为97.8%,mPFS为11.3个月(95%CI 5.5～17.2)。联合紫杉醇(白蛋白结合型)为基础方案组的ORR为57.7%,DCR为96.2%,mPFS为10.9个月(95%CI 9.0～12.9),两组ORR及mPFS差异无统计学意义。结论 在晚期胃癌或胃食管结合部腺癌中，一线应用信迪利单抗联合化疗，患者无进展生存期明显获益。信迪利单抗联合以紫杉醇(白蛋白结合...     

晚期非小细胞肺癌 EGFR敏感突变型患者酪氨酸激酶抑制药的疗效和安全性

 目的 观察晚期非小细胞肺癌表皮生长因子受体(EGFR)敏感突变型患者酪氨酸激酶抑制药(EGFR-tyrosine-kinase inhibitor,EGFR- TKI)的疗效和安全性。方法 32例EGFR敏感突变型晚期非小细胞肺癌患者一线化疗后给予EGFR- TKI维持治疗。观察近期疗效、无进展生存期(progression-free-survival, PFS)、总生存期(overall survival, OS)及不良反应。结果 全组CR 3例,PR 7例,SD 18例,PD 4例。有效率 RR 31.3%,疾病控制率DCR 87.5 %;中位PFS 14.9个月(95% CI:11.93 ~17.87个月);中位OS 25.1个月(95% CI:20.8~29.3个月)。全组无重度不良反应发生,治疗耐受良好。皮疹发生率37.5%,腹泻发生率15.6%。结论 晚期非小细胞肺癌 EGFR敏感突变型患者EGFR- TKI维持治疗安全有效。     

经导管动脉化疗栓塞术治疗局部复发乳腺癌的疗效与安全性

目的探讨经导管动脉化疗栓塞术治疗局部复发乳腺癌的疗效与安全性。方法 回顾性分析2018年1月至2020年12月复发乳腺癌患者57例,接受经导管动脉化疗栓塞术治疗24例为A组,化疗药物为多柔比星12 mg/m2、紫杉醇45 mg/m2,化疗药物采用微导管于肿瘤靶血管局部灌注方式完成,靶血管栓塞材料为Embosphere栓塞微球,栓塞终点为肿瘤靶血管主干闭塞。选择同时段全身化疗患者33例为B组,化疗药物为多柔比星40 mg/m2、紫杉醇135 mg/m2,比较两组间6个月疾病控制率、无进展生存时间、总体生存时间差异。结果 A组24例患者均成功实施经导管动脉化疗栓塞术,技术成功率100%,6个月疾病控制率87.50%,中位无疾病进展生存期（PFS）12个月,中位总生存期（OS）22个月;B组6个月疾病控制率63.63%,PFS 9个月,中位OS 20个月;两组间6个月疾病控制率、中位无疾病进展生存期差异有统计学意义（P=0.04,P=0.03）,两组间中位总生存期差异无统计学意义（P=0.21）;A组患者栓塞术后综合征发生率为75%(18/24),胸壁疼痛、低热经止痛、退热等对症治疗3d后症...     

紫杉醇联合氟尿嘧啶或亚叶酸钙治疗晚期胃癌疗效研究

 目的 观察紫杉醇(PTX)联合氟尿嘧啶(5-Fu)或亚叶酸钙(CF)持续滴注14 d方案治疗晚期胃癌的疗效、临床受益反应和不良反应.方法 对23例晚期胃癌患者采用PTX 90 mg/m2静脉滴注3 h,用药前均予预处理;CF200 mg/m2静脉滴注;2 h后5-Fu 500 mg静脉推注;5-Fu 2 250 mg/m2持续48 h静脉泵内注入.14 d为1周期,2周期为一疗程.2疗程评价疗效.结果 21例可评价疗效,其中完全缓解2例,部分缓解11例,总有效率为61.9%;临床受益反应有效16例,占76.2%,其中疼痛缓解明显,Karnofsky(KPS)评分化疗前后比较存在显著差异(P＜0.01);不良反应主要为剂量限制性毒性,表现为骨髓抑制.结论 紫杉醇联合5-Fu或亚叶酸钙持续滴注14 d方案有助于改善晚期胃癌患者的生活质量.     

FOLFOX4化疗联合全身热疗治疗晚期大肠癌的临床观察

目的观察FOLFOX4方案化疗联合太空舱全身热疗治疗晚期直肠癌的近期疗效及安全性。方法将2008年1月—2010年12月收治的38例晚期结、直肠癌患者,分为两组,观察组20例在深度镇静下行FOLFOX4方案化疗联合太空舱全身热疗仪进行全身热化疗,对照组18例采用FOLFOX4方案进行化疗。结果观察组有效率(RR)60.0%,疾病控制率(DCR)80.0%;对照组RR 27.8%,DCR 44.4%。两组间RR、DCR比较差异均有统计学意义(P<0.05)。观察组与对照组的主要化疗毒副反应为骨髓抑制及恶心、呕吐等,两组间比较差异无统计学意义(P>0.05)。观察组中出现Ⅰ～Ⅱ度皮肤烧伤4例,无一例出现急性心肺功能衰竭。结论采用太空舱全身热疗系统联合FOLFOX4方案进行全身热化疗治疗晚期结、直肠癌安全有效。     

Transarterial Hepatic Yttrium-90 Radioembolization in Patients with Unresectable Intrahepatic Cholangiocarcinoma: Factors Associated with Prolonged Survival

Introduction

In unresectable intrahepatic cholangiocarcinoma (ICC), systemic chemotherapy often is viewed as the only option, although efficacy is limited. Radioembolization (RE) using yttrium-90 (⁹⁰Y) microspheres is an accepted therapy for patients with hepatocellular-carcinoma or metastatic liver tumors. However, there are limited data on the value of RE in patients with ICC and few data on factors influencing prognosis. The purpose of our retrospective analysis was to establish which factors influenced time-to-progression (TTP) and overall survival (OS).

Methods

Patients with unresectable ICC were treated with ⁹⁰Y resin-microspheres and assessed at 3-monthly intervals. Radiologic response was evaluated by using Response Criteria in Solid Tumors (RECIST). Baseline characteristics, biochemical/clinical toxicities, and response were examined for impact on TTP and OS.

Results

Thirty-four treatments were administered to 33 patients without major complications. By RECIST, 12 patients had a partial response, 17 had stable disease, and 5 had progressive disease after 3?months. The median OS was 22?months posttreatment and 43.7?months postdiagnosis. Median TTP was 9.8?months. Survival and TTP were significantly prolonged in patients with ECOG 0 (vs. ECOG 1 or 2; median OS: 29.4, 10, and 5.1?months; TTP: 17.5, 6.9, and 2.4?months), tumor burden ??25% (OS: 26.7 vs. 6?months; TTP: 17.5 vs. 2.3?months), or tumor response (PR or SD vs. PD; OS: 35.5, 17.7 vs. 5.7?months; TTP: 31.9, 9.8 vs. 2.5?months), respectively (P?<?0.001).

Conclusions

Radioembolization is an effective and safe option for patients with unresectable ICC. Predictors for prolonged survival are performance status, tumor burden, and RECIST response.     

雷替曲塞联合槐耳颗粒二线治疗晚期胃癌临床观察

目的探讨雷替曲塞联合槐耳颗粒二线治疗晚期胃癌的疗效与安全性。方法回顾性分析2014年1月至2015年12月收治的二线给予雷替曲塞联合槐耳颗粒治疗的21例患者临床资料。治疗方法为第1天雷替曲塞3 mg/m~2静脉滴注;第1天至第21天槐耳颗粒20 g,每日3次口服,21 d为1周期。每周期评价不良反应,直至疾病进展或出现无法耐受的不良反应。每2个周期评价疗效,随访患者的生存状况。结果 21例患者共完成114周期化疗,平均5.4周期。所有患者均可评价疗效。其中,部分缓解(PR)3例,疾病稳定(SD)10例,疾病进展(PD)8例,有效率(RR)为14.3%,疾病控制率(DCR)为61.9%。中位无进展生存期3.1个月,中位总生存期5.2个月,无治疗相关性死亡。不良反应主要为血液学毒性,其中,中性粒细胞减少5例(23.8%),血红蛋白减少3例(14.2%),粒细胞缺乏性发热1例(4.8%)。结论雷替曲塞联合槐耳颗粒治疗晚期胃癌疗效较好,且耐受性良好。     

聚焦超声消融联合TACE治疗10 cm以上大肝癌的临床效果分析

目的：初步评价聚焦超声消融（Focused ultrasound ablation,FUA）联合肝动脉化疗栓塞（Transcatheter arterial chemoembolization,TACE）治疗最大径10 cm以上大肝癌的临床效果及安全性。 方法：回顾性分析近5年在我院接受FUA联合TACE治疗的原发性肝癌患者19例（34个病灶）,肿瘤最大径10 cm以上,BCLC分期为B期8例,C期11例。术后通过增强MRI评价局部病灶消融效果,定期复查评价血清甲胎蛋白（AFP）下降效果,应用MRECIST标准评价治疗并发症,随访统计总生存率、中位生存时间(OS)、肿瘤进展时间(TTP)及局部复发时间(TTR)。 结果：（1）所有34个病灶治疗后均达到完全消融（CR）或部分消融（PR）,CR 2例（10.5%）,PR 17例（89.5%）;（2）17例血清AFP升高病例中,治疗后1月AFP均不同程度降低,降至正常2例,11例下降超过50%,4例下降低于50%;（3）患者总OS8～69个月,中位OS 16个月;TTR3～34个月,中位TTR 6个月;TTP2～34个月,中位TTP 5个月。1年、2年、3年的累积生存率分别为：63.2%、26.3%和15.8%;（4）主要并发症包括：发热、皮肤损伤、治疗术区区部疼痛、肝功能损伤、肋骨病理性骨折等,84.4%（38/45）为轻度,未出现治疗相关性死亡等严重并发症。 结论：FUA联合TACE治疗最大直径10 cm以上原发性肝癌,能使患者够获得较好的生存获益,安全性可控,值得深入探讨。     

Yttrium-90 Radiation Segmentectomy in Oligometastatic Secondary Hepatic Malignancies

PurposeTo evaluate the safety and efficacy of yttrium-90 (⁹⁰Y) radiation segmentectomy (RS) in the treatment of oligometastatic secondary hepatic malignancies.Materials and MethodsThis institutional review board–approved retrospective study evaluated 16 patients with oligometastatic secondary hepatic malignancies who were treated with RS. The median patient age was 61.9 years (range, 38.6–85.7 years). Of the 16 patients, 11 (68.8%) presented with solitary lesions. The median index tumor size was 3.1 cm (95% CI, 2.3–3.9). Primary outcomes were evaluation of clinical and biochemical toxicities using National Cancer Institute Common Terminology Criteria for Adverse Events, version 5.0, and imaging response using Response Evaluation Criteria in Solid Tumors, version 1.1. Secondary outcomes were time to progression (TTP) and overall survival (OS) as estimated by the Kaplan-Meier method.ResultsClinical Grade 3 toxicities were limited to 1 (6.7%) patient who experienced fatigue, abdominal pain, nausea, and vomiting. Biochemical Grade 3 toxicities occurred in 1 (6.7%) patient who experienced lymphopenia. No Grade 4 clinical or biochemical toxicities were identified. Disease control was achieved in 14 (93.3%) of 15 patients. The median TTP of the treated tumor was 72.9 months (95% CI, 11.2 to no estimate). The median OS was 60.9 months (95% CI, 24.7 to no estimate).Conclusions⁹⁰Y RS displayed an excellent safety profile and was effective in achieving a high disease control rate in the treatment of oligometastatic secondary hepatic malignancies.     

CT-guided radiofrequency ablation after with transarterial chemoembolization in treating unresectable hepatocellular carcinoma with long overall survival improvement

Purpose

To assess the time to disease progression (TTP), long-term survival benefit and safety of patients with unresectable hepatocellular carcinoma (HCC) treated with computed tomography (CT)-guided radiofrequency ablation (RFA) with transarterial chemoembolization chemoembolization (TACE).

Methods

This study was approved by the institutional review board. We reviewed the records of patients with intermediate and advanced HCC treated with CT-guided RFA with TACE between January 2000 and December 2009. Median TTP, overall survival (OS) and hepatic function were analyzed with the Kaplan–Meier method and log-rank tests.

Results

One hundred and twenty-two patients (112 men and 10 women, mean age 53 years, range 18–86 years) were included in the study. The median follow-up time was 42 months (range 6–89 months), TTP was 6.8 months, the median OS was 31 months, and the 1-, 3-, and 5-year OS were 88.5%, 41.0%, and 10.7%. The results of the univariate analysis revealed that intrahepatic lesion, AJCC stage, and Child-Pugh stage were predictors of OS (P < 0.01). In the multivariate analysis, the AJCC stage system showed a statistically significant difference for prognosis. Procedure-related death was 0.21% (1/470) within 1 month, and a statistical difference was found between the TACE and RFA of liver decompensation and Child-Pugh stage (P < 0.05).

Conclusions

The survival probabilities of OS increased with CT-guided RFA with TACE, as observed in randomized studies from Europe and Asia. The longest TTP was observed for the intermediate stage HCC. The procedures were well tolerated with acceptable minor and major complications in unresectable HCC patients.     

Value of CT-Guided Percutaneous Irreversible Electroporation Added to FOLFIRINOX Chemotherapy in Locally Advanced Pancreatic Cancer: A Post Hoc Comparison

PurposeTo compare survival after CT-guided percutaneous irreversible electroporation (IRE) and folinic acid, fluorouracil, irinotecan, and oxaliplatin (FOLFIRINOX) chemotherapy versus FOLFIRINOX only in patients with locally advanced pancreatic cancer (LAPC).Materials and MethodsA post hoc comparison was performed of data derived from a prospective IRE-FOLFIRINOX cohort and a retrospective FOLFIRINOX-only cohort. All patients received a minimum of 3 cycles of FOLFIRINOX for LAPC and were considered eligible for CT-guided percutaneous IRE. Endpoints included overall survival (OS), local and distant progression-free survival, and time to progression (TTP) and were compared using stratified Kaplan-Meier analysis. Patients who received > 8 cycles of FOLFIRINOX before IRE and who had tumors > 6 cm in the FOLFIRINOX-only group were excluded.ResultsOf 103 patients with a diagnosis of LAPC, 52 were deemed eligible (n = 30 IRE-FOLFIRINOX and n = 22 FOLFIRINOX-only). Patients in the FOLFIRINOX-only arm had larger tumors (53 mm ± 19 vs 38 mm ± 7, P = .340), had more locoregional lymph node metastases (23% vs 7%, P = .622), and more often received radiotherapy (7 patients vs 2 patients, P = .027); all other baseline characteristics were comparable. Median OS was 17.0 months (range, 5–35 mo; SD = 6) for IRE-FOLFIRINOX versus 12.4 months (range, 3–22 mo; SD = 6) for FOLFIRINOX-only (P = .038). After sensitivity analyses, median OS was 17.2 months (range, 6–27 mo; SD = 6) versus 12.4 months (range, 7–32 mo; SD = 10) (P = .05). Median TTP was longer in the IRE-FOLFIRINOX group: 14.2 months (range, 5–25 mo; SD = 4) versus 5.2 months (range, 2–22; SD = 6) (P = .0001).ConclusionsIn patients with LAPC after FOLFIRINOX chemotherapy, CT-guided percutaneous IRE may improve OS and TTP. This study may facilitate the design of randomized controlled trials to compare survival after IRE-FOLRINOX versus FOLFIRINOX-only.     

Intra-arterial Infusion Chemotherapy for Advanced Non–Small-Cell Lung Cancer: Preliminary Experience on the Safety,Efficacy, and Clinical Outcomes

PurposeTo investigate the effectiveness and toxicity of intra-arterial infusion chemotherapy as a therapeutic modality for advanced non–small-cell lung cancer (NSCLC).Materials and MethodsIn a retrospective study, 40 patients with stage III NSCLC received intra-arterial infusion chemotherapy with gemcitabine and cisplatin. Tumor staining was graded based on angiography, and the number of NSCLC feeding arteries detected was recorded. Toxicity was assessed according to National Cancer Institute Common Toxicity Criteria for Adverse Events. The response to treatment was evaluated per Response Evaluation Criteria In Solid Tumors (RECIST). Efficacy was assessed based on time to tumor progression (TTP), and survival was estimated by Kaplan–Meier analysis. Prognostic factors influencing TTP and overall survival rate were evaluated by Cox regression analysis.ResultsThe most frequent drug-related adverse events were cough (n = 17; 42.5%), anorexia (n = 14; 35%), and pain (n = 9; 22.5%). Evaluated per RECIST, a total of 47.5% of patients (n = 19) exhibited response to therapy after completion of the first three cycles of intra-arterial infusion chemotherapy. The median TTP was 5 months. Patients had a median life expectancy of 9 months. By Cox regression analysis, tumor staining was shown to be an independent prognostic factor for TTP (relative risk, 0.405; 95% confidence interval, 0.216–0.760) and overall survival (relative risk, 0.348; 95% confidence interval, 0.185–0.656).ConclusionsIntra-arterial infusion chemotherapy for advanced lung cancer has the potential to reduce the size of tumors and has no severe adverse effects.     

不同组合化疗方案治疗肝母细胞瘤的疗效比较

 目的 比较不同化疗方案治疗肝母细胞瘤(hepatoblastoma,HB)的临床疗效。方法 分析并总结我院2007-08至2016-02收治的23例HB患儿资料,比较不同治疗方案的疗效,其中2007-08至2013-03的12例为A组,2013-03至2016-02的11例为B组。两组均采用化疗联合手术治疗方案。采用美国儿童肿瘤协会(COG)临床分期将肿瘤分为Ⅰ、Ⅱ、Ⅲ、Ⅳ期;可早期切除肿瘤者先行手术,其余病例给予术前化疗1～3周期后再行影像学检查评估切除可能性。A组Ⅰ、Ⅱ、Ⅲ期的化疗方案为长春新碱+表阿霉素+环磷酰胺,Ⅳ期为顺铂+表阿霉素;B组Ⅰ、Ⅱ期的化疗方案为顺铂+长春新碱+氟尿嘧啶,Ⅲ、Ⅳ期为顺铂+表阿霉素。对两组资料总体及各分期两两进行疗效比较。结果 23例患儿均完整切除肿瘤。截止至随访时间(2016-02-01),A、B两组患儿无进展生存时间达1年的例数分别为5和10,其1年无进展生存率分别为41.7%和90.9%。B组1年无进展生存率高于A组(P=0.023)。A、B两组患儿总生存时间达1年的例数分别为7和10,其1年总生存率分别为58.3%和90.9%。B组1年总生存率高于A组(P=0.040),差异有统计学意义。两组资料中相同分期资料进行两两疗效比较,其结果差异无统计学意义。两组患儿均有不同程度的化疗后骨髓抑制及脏器有不良反应。结论 顺铂+表阿霉素/顺铂+长春新碱+氟尿嘧啶较长春新碱+表阿霉素+环磷酰胺治疗HB疗效较好。两组资料中分期两两比较后,与长春新碱+表阿霉素+环磷酰胺方案相比,顺铂+表阿霉素/顺铂+长春新碱+氟尿嘧啶治疗HB的疗效无明显差异;可能由于此组资料中病例数较少原因所致,但仍需进一步验证。
     

Metabolic response assessment with 18F-FDG-PET/CT is superior to modified RECIST for the evaluation of response to platinum-based doublet chemotherapy in malignant pleural mesothelioma

PurposeEfficient monitoring of tumor responsiveness to chemotherapy is essential to mitigate high mortality risks and cytotoxic effects of chemotherapeutics. However, there is no consensus on the most suitable diagnostic technique/parameters for assessing response to chemotherapy in malignant pleural mesothelioma (MPM). We compared the tumor responsiveness of MPM patients as assessed using modified RECIST (mRECIST) criteria and integrated 18F-FDG-PET/CT.MethodsHistologically confirmed MPM patients (N = 82) who were treated with three cycles of cisplatin and pemetrexed, or carboplatin and pemetrexed, were included. mRECIST and integrated 18F-FDG-PET/CT were used to evaluate MPM tumor response to chemotherapy. Metabolic non-responders were defined as those with a 25% or greater increase in SUVmax compared with the previous value. Time to progression (TTP) and overall survival (OS) were compared between metabolic-responders and non-responders.ResultsAfter three cycles of chemotherapy, 62(75.6%) of the patients were classified as having SD, 15 (18%) with partial remission (PR), and 5 (6%) with progressive disease (PD), based on mRECIST criteria. The cumulative median OS was 728.0 days (95% confidence interval [CI]: 545.9–910.1) and cumulative median TTP was 365.0 days (95% CI: 296.9–433.1). For the 82 patients, the disease control rate was 93.9%, whereas the metabolic response rate was only 71.9% (p < 0.001). All PD and PR patients were found to be metabolic responders on 18F-FDG-PET/CT; however, among the 62mRECIST SD patients, 18 (29%) were classified as metabolic non-responders. The median TTP for metabolic responders was 13.7 months, while it was 10.0 months for non-responders(p < 0.001). Metabolic responders had a trend toward longer OS, although the difference did not reach statistical significance (metabolic responders:33.9 months; non-responders: 21.6 months; p > 0.05).ConclusionSeveral mRECIST-confirmed SD MPM patients may be classified as metabolic non-responders on18F-FDGPET/CT. Metabolic response is significantly correlated with the median TTP, suggesting it should be included in the evaluation of the response to chemotherapy in MPM patients classified as mRECIST SD, to identify non-responders.