Two cycles of cisplatin-vindesine and radiotherapy for localized nonsmall cell carcinoma of the lung (stage III). Results of a prospective trial with 149 patients

One hundred forty-nine patients with localized nonsmall cell carcinoma of the lung (Stage III A and B) were treated with two monthly cycles of initial chemotherapy that included vindesine-cisplatin followed by 6000 cGy of thoracic irradiation. Patients with complete, partial, and minor response after initial chemotherapy were randomized into groups to receive either maintenance chemotherapy (four cycles) after radiotherapy or radiotherapy alone. The objective response rate was 24% after chemotherapy and 41% after combined chemoradiotherapy (complete response, 7.5%). The overall median survival was 9 months and the 2-year survival was 14%. Survival was identical with or without maintenance chemotherapy. The 2-year survival of patients with complete response was 75% compared with 9% for patients with partial or minor response. These results suggest that only the few patients (ten) who achieve complete response have a strong probability of survival. It is therefore essential to search for other therapeutic modalities that result in an increase of the complete response rate.     

Clinical effects of chemoimmunotherapy for patients with peritoneal carcinomatosis

The present study was undertaken to determine whether chemoimmunotherapy using activated killer cells is better than chemotherapy alone for cancer patients with peritoneal carcinomatosis. Thirty-one cancer patients received adoptive immunotherapy by activated killer cells and chemotherapy by anticancer drugs selected by a chemosensitivity test (chemoimmunotherapy group), and another 31 cancer patients received chemotherapy (chemotherapy group). The regimen of chemotherapy was determined by the results of a chemosensitivity test in both groups. The clinical effects including response rate and survival were assessed. Five patients (16.1%) achieved complete response (CR), and 17 patients (54.8%) partial response (PR) in the chemoimmunotherapy group (response rate: 22/31 patients = 71.0%), whereas 4 patients (12.9%) achieved CR, and 5 patients (16.1%) PR in the chemotherapy group (response rate: 9/31 patients = 29.0%). The response rate was higher in chemoimmunotherapy group than in chemotherapy group (p<0.05). However, no difference was observed in survival between the two groups. Therefore, it is necessary to develop methods to induce more potent killer cells for adoptive immunotherapy.     

68例小细胞肺癌非手术综合治疗临床观察

我院自１９８５年９月至１９９３年１２月共收治ＳＣＬＣ８１例，本文仅对可评价疗效的非手术治疗的６８例进行分析。其中局限型４５例，广泛型２３例。１２例作单纯化疗，４８例先化疗后放疗，６例先放疗后化疗，仅２例作单纯放疗。结果显示，化疗联合放疗的综合治疗可明显提高完全缓解率，总有效率达８７％，１年生存率在局限型化疗和综合治疗中分别为５７．１％和８６．１％（Ｐ＜０．０５），广泛型为４０％和５５．６％（Ｐ＞０．０５）。     

复发卵巢上皮性癌的治疗与预后分析

目的 探讨复发卵巢上皮性癌的治疗措施及预后影响因素.方法 收集293例接受系统治疗的初治卵巢上皮性癌患者的临床资料,对在随访过程中复发的199例患者进行回顾性分析.结果 199例复发患者均接受了化疗,其中173例接受了单纯化疗,16例接受了手术治疗+化疗,10例接受了化疗+放疗.158例患者再次接受了以铂类为基础的化疗,而41例患者接受了不含铂类的化疗.全部患者总的有效率为43.7%(87/199),其中单纯化疗的有效率为39.9%(69/173),手术治疗+化疗的有效率为75.0%(12/16),化疗+放疗的有效率为60.0%(6/10).接受单纯化疗的173例患者中,无进展时间(PFI)≤6个月、7～12个月、13～24个月和＞24个月组的化疗有效率分别为5.1%、47.2%、82.1%和96.0%.接受再次肿瘤细胞减灭术治疗的16例患者中位总生存时间为41个月.单因素分析结果 显示,组织分化和PFI与复发卵巢上皮性癌的预后有关.Cox回归多因素分析结果 显示,PFI是复发卵巢上皮性癌预后的独立影响因素(OR=0.589,P=0.021).结论 PFI与化疗有效率有关,随着PFI的延长,化疗的有效率逐渐提高.紫杉醇+铂类方案对铂类敏感型患者的有效率要高于其他铂类联合方案.PFI是复发卵巢上皮性癌患者预后的独立影响因素.     

An analysis of induction and adjuvant chemotherapy in the multidisciplinary treatment of squamous-cell carcinoma of the head and neck

This study examines the role of combination chemotherapy with surgery and/or radiotherapy in the initial treatment of patients with advanced stage III and IV squamous-cell carcinoma of the head and neck (SCCHN). Two courses of initial (induction) cisplatin, bleomycin, and methotrexate with oral calcium leucovorin (PBM) were used with the principal intent of increasing the effectiveness of subsequent surgery and/or radiotherapy. Following induction chemotherapy and local treatment, disease-free patients who had responded to initial chemotherapy were entered into a randomized trial of adjuvant PBM. The response rates to induction PBM chemotherapy were a complete response (CR) rate of 26% and a partial response (PR) rate of 52%, for an overall response rate of 78%. A response to induction PBM was highly correlated with failure-free survival (P less than .0001). A Cox multistep regression analysis of potential prognostic factors was performed. After adjusting for the significant prognostic factors of performance status, initial tumor size, and primary tumor site, a response to induction chemotherapy remained independently associated with improved survival (P = .0002). The randomized trial of adjuvant chemotherapy demonstrated that such treatment significantly improved failure-free survival by decreasing local-regional failures. The benefit of adjuvant chemotherapy was particularly evident in patients who had a PR to induction chemotherapy (P = .01). The toxicity of this multidisciplinary approach was predictable and acceptable. Surgery and radiotherapy were not compromised by induction or adjuvant chemotherapy. Definitive evidence that chemotherapy can favorably influence survival awaits confirmation of these results by a randomized trial using a control arm of patients treated with conventional surgery and/or radiotherapy alone.     

Importance of primary site in assessing chemotherapy response and 7-year survival data in advanced squamous-cell carcinomas of the head and neck treated with initial combination chemotherapy without cisplatin

Two hundred eight patients with advanced head and neck squamous-cell carcinomas were treated between 1975 and 1982 with schedule A chemotherapy containing vincristine, bleomycin, methotrexate, 5-fluorouracil, and hydrocortisone administered over 24 hours followed by a folinic acid rescue. Chemotherapy was administered as initial treatment on days 1 and 14 before "curative" local therapy. Toxicity was minimal and patient compliance was 100%. Chemotherapy response was assessed on day 28 in 200 patients: 132 (66%) had an objective response and 68 (34%) were judged to be nonresponders. The complete remission (CR) rate following local therapy was significantly greater in chemotherapy responders (78%) than nonresponders (49%) (P less than .001). Overall median survival figures were 32 months for all patients, 37 months for all chemotherapy responders, and 69 months for all patients achieving CR. Analysis by tumor site showed that oral cavity or nasopharyngeal tumors responded well to initial chemotherapy (P less than .05 and P less than .01) compared with all other sites. This high response rate was not necessarily associated with increased survival, since the median survival of chemotherapy responders for oral cavity lesions was only 22 months, although in nasopharyngeal tumors, median survival figures were 64 months. Furthermore, the longest median survival duration of 69 months was observed in patients with laryngeal tumors, although these had a lower response rate (61%) to initial chemotherapy. Therefore, response to initial chemotherapy is not automatically a favorable prognostic sign. Survival figures appear markedly influenced by tumor site.     

Effect of Neoadjuvant Chemotherapy on Improvement of Surgical Resectibility and Survival of Patients with Stage ⅢA Non Small Cell Lung Cancer

Objective To assess the effect of neoadjuvant chemotherapy on surgical resectibility and surival in patients with stage III A non small cell lung cancer (NSCLC). Methods 42 patients with stage III A NSCLC were randomized to receive either two cycles chemotherapy followed by surgery (neoadjuvant chemotherapy group) or surgery alone (surgery alone group). All patients received four cycles chemotherapy after surgery. Results The overall response to chemotherapy was 42.9% (38.1% partial response and 4.8% complete response). Toxicity of chemotherapy was minor and consisted mainly of gastroenterological side effects and myelosuppression. Patients treated with neoadjuvant chemotherapy had estimated surgical resection rate of 95.2% (n=20) and a complete resection rate in 52.4% (n=11) compared to 66.7% (n=14) and 28.6% (n=6) respectively, for patients with surgery alone (P<0.05). None of the patients died from the operation. The median survival was 24.6 months in the neoadjuvant chemotherapy group as compared to only 10.8 months in the surgery alone group (P<0.05). The 2-year survival rate was 57.1% in the chemotherapy group as compared to 28.6% in the surgery alone group (P<0.05). Conclusion Neoadjuvant chemotherapy improves the surgical resectibility and increases the median survival and 2-year survival rate of patients with stage III A NSCLC. This study was supported by the Jiangsu Provincial Scientific and Technology Committee (BS200376).     

Randomized controlled trial of neoadjuvant chemotherapy with cisplatin and vinorelbine in patients with stage IIIA non-small cell lung cancer in China

Aim:   The aim of this study was to evaluate the efficacy of cisplatin plus vinorelbine as a regimen of neoadjuvant chemotherapy on the improvement of surgical resectability and survival in Chinese patients with stage IIIA non-small cell lung cancer (NSCLC).
Methods:   Fifty-six patients with stage IIIA NSCLC were randomly assigned to undergo either surgery preceded by two cycles of chemotherapy with cisplatin plus vinorelbine (the neoadjuvant chemotherapy arm) or immediate surgery (the primary surgery arm). The patients who had a complete resection received two to four cycles of chemotherapy, and those with incomplete resection received radiotherapy followed by two cycles of chemotherapy after surgery.
Results:   The overall response rate to neoadjuvant chemotherapy was 53.6%, with a complete response of 7.1%. A pathological complete response was seen in two patients (8%). The complete resection rates were 78.6% in the neoadjuvant chemotherapy arm and 60.7% in the primary surgery arm. The median overall survival and median disease-free survival was 30 months and 24 months, respectively, in the neoadjuvant chemotherapy arm as compared to 16 months and 11 months in the primary surgery arm ( P  = 0.04 and P  = 0.048). The 3-year and 5-year survival rate was 49.7% and 31.9%, respectively, for the neoadjuvant chemotherapy arm and 29.2% and 3.6% for the primary surgery arm.
Conclusion:   Neoadjuvant chemotherapy with cisplatin plus vinorelbine regimen is effective and tolerable and can improve the overall survival and disease-free survival time in Chinese patients with stage IIIA NSCLC.     

THE CLINICAL COURSE AND TREATMENT RESULTS OF LUNG METASTASES FROM BREAST CANCER

Ａｐｐｒｏｘｉｍａｔｅｌｙ３０％ｏｆｐａｔｉｅｎｔｓｗｉｔｈｂｒｅａｓｔｃａｎｃｅｒｈａｖｅｒｅｃｕｒｅｎｃｅｏｆｄｉｓｅａｓｅａｎｄｍｅｔａｓｔａｓｅｓｗｉｔｈｉｎ５ｙｅａｒｓａｆｔｅｒｏｐｅｒａｔｉｏｎｏｎｐｒｉｍａｒｙｔｕｍｏｒ，ｗｉｔｈａｒｅ...     

托瑞米芬联合长春瑞滨和顺铂二线治疗中晚期非小细胞肺癌的疗效

目的:前瞻性研究托瑞米芬(toremifene, TOR)联合NP方案(顺铂加长春瑞滨)二线治疗含铂联合化疗方案一线治疗失败的中晚期非小细胞肺癌(non-small cell lung cancer, NSCLC)患者的疗效和安全性.方法:2004年1月-2006年2月,44例接受含铂联合化疗方案一线治疗失败的ⅡB～Ⅳ期NSCLC患者接受了TOR联合NP方案的二线治疗.化疗2个周期后评价疗效和不良反应,并分析生存情况.结果:44例患者的中位化疗周期数为1.8个(范围:1～3个),其中可评价疗效者为37例(既往曾经接受NP方案化疗者21名,接受其他含铂联合化疗方案者16例).37例患者接受二线治疗后,4例获得部分缓解,19例为疾病稳定,14例为疾病进展,无完全缓解者,总有效(完全缓解+部分缓解)率为10.8%(4/37),疾病控制(完全缓解+部分缓解+疾病稳定)率为62.2%(23/37).其中,肺鳞癌患者的有效率和疾病控制率分别为27.3%(3/11)和72.7%(8/11),高于肺腺癌患者的0%(0/18)和44.4%(8/18)(P<0.05).44例患者的中位生存期为8.2个月,中位疾病稳定时间为4.0个月(1.0～10.2个月),总的1年生存率为24.4%.其中,肺鳞癌患者的中位生存期和1年生存率分别为9.2个月和33.3%,肺腺癌患者的中位生存期和1年生存率分别为7.1个月和27.7%,两者比较差异均无统计学意义(P>0.05).男性与女性患者的生存差异也无统计学意义.化疗中,1例患者因肝功能损害(高胆红素血症)中止治疗.化疗不良反应主要包括胃肠反应、骨髓抑制和肝功能损害等,无严重不良反应发生.结论:TOR联合NP方案二线治疗NSCLC患者的疗效与目前的一线含铂联合化疗方案相似,尤其对于肺鳞癌患者而言,且不良反应未见明显增加.     

乳腺癌肺转移的临床病程及治疗研究

目的探讨乳腺癌肺转移的临床病程特点与内科治疗结果。方法共收治１２２例乳腺癌肺转移患者。全部患者均行化疗或内分泌治疗,疗效评价按ＷＨＯ标准,生存率按寿命表法计算。结果原发癌初次治疗后出现肺转移的中位时间为２２个月,继发转移部位以肺内、肝、骨多见。治疗总有效率为４８％,其中ＣＲ率１５％。含ＤＤＰ方案的ＣＲ率（２１％）高于非ＤＤＰ方案（７％,Ｐ＜０．０５）,接受前者治疗的患者中位生存期比后者长;含蒽环类药方案的ＰＲ率（４８％）高于非蒽环类方案（２０％,Ｐ＜０．００１）,但两组患者的中位生存期相近;而化疗与化疗加内分泌治疗的ＣＲ与ＰＲ率差异无显著意义（Ｐ＞０．０５）。本组患者１,３,５和１０年生存率分别为７７％、２２％、１１％和１０％。影响生存期的因素包括近期疗效、原发肿瘤大小、无病间隙期、肺转移数目、是否合并其他部位转移等。结论本研究确定了乳腺癌肺转移的临床病程特征及预后因素。联合化疗特别是含ＤＤＰ的方案可能延长患者的生存期。     

贝伐单抗联合一线化疗治疗晚期结直肠癌的临床观察

目的:探讨贝伐单抗联合一线化疗对晚期结直肠癌生存期和安全性的影响.方法:选择38例晚期结直肠癌患者随机数字表法分成研究组(n=20)和对照组(n=18),研究组采用贝伐单抗联合FOLFIRI或FOLFOX4方案,对照组给予单纯FOLFIRI或FOLFOX4方案.评估比较疗效和不良反应,并随访生存时间.结果:研究组和对照组有效率分别为90.0％(18/20)和50.0％(9/18),x2=7.47,P＜0.01.研究组中位生存期和中位无进展生存时间(PFS)为16.8和9.3个月,明显长于对照组的11.2和6.3个月,t值分别为4.68、4.83,P值均＜0.05.研究组6和12个月生存率分别为85.0％和65.0％,对照组为66.7％和27.8％,差异有统计学意义,x2值分别为5.93、8.41,P值均＜0.01.两组患者化疗期间不良反应发生比较,差异无统计学意义,P＞0.05.结论:贝伐单抗联合FOLFIRI或者FOLFOX4方案对晚期结肠癌患者不失为一种较理想的选择,能够提高疗效,明显提高患者的生存时间,且不良反应轻微.     

CHOP与CHOP-L方案治疗45例血管免疫母细胞性T细胞淋巴瘤的疗效及其预后分析

目的:评价应用CHOP与CHOP-L方案治疗血管免疫母细胞性T细胞淋巴瘤（AITL）的疗效及其预后影响因素。方法:对2005年1月-2012年1月经中国医科大学附属盛京医院病理及免疫组化结果确诊的45例AITL患者的临床资料及随访信息进行回顾性分析,分析CHOP与CHOP-L方案的治疗效果及其预后影响因素。结果:18例应用CHOP方案治疗,总有效率（OR）为50%,其中完全缓解率（CR）5例（27.8%）,部分缓解率（PR）4例（22.2%）;1、2、3年的总生存率（OS）分别为66.7%、44.4%及33.3%,无病生存率（DFS）分别为33.3%、22.2%、22.2%。27例应用CHOP-L方案化疗,OR为74%,其中CR 9例（33.3%）,PR 11例（40.7%）;1、2、3年的OS分别为81.4%、62.9%及37%,DFS分别为40.7%、33.3%、25.9%。应用CHOP-L方案化疗、Ann Arbor分期I-II期、结外侵犯0~1个、Ki-67≤50%、无巨大包块、无皮疹的患者疗效较好,且差异有统计学意义（P<0.05）。Ann Arbor分期I-II期、ECOG评分0~1分、Ki-67≤50%、无巨大包块（＞10cm）、结外侵犯0~1个及应用CHOP-L方案化疗的患者均较对照组有较高的3年OS与DFS,且差异有统计学意义（P<0.05）;女性患者及无B症状患者生存期优于男性及合并B症状患者（P<0.05）,但DFS差异无统计学意义（P>0.05）。多因素分析显示ECOG评分是影响本组患者生存的独立预后因素（P<0.05）。结论:AITL以老年、晚期患者多见,预后较差,左旋门冬酰胺酶（L-ASP）联合CHOP方案化疗提高了其治疗的有效率、3年生存率及DFS,且安全性好,不良反应可耐受。Ann Arbor分期、结外侵犯、Ki-67≤50%、巨大包块、皮疹及化疗方案是影响近期疗效的重要因素。患者的Ann Arbor分期、ECOG评分、Ki-67、巨大包块、结外侵犯的程度及化疗方案的选择是影响预后的重要因素。     

Multimodality therapy of favorable prognosis non-hodgkin's lymphoma

Twenty-seven previously untreated patients with favorable prognosis non-Hodgkin's lymphoma were treated with a combination of total body irradiation followed by cyclophosphamide - vincristine - prednisone (CVP). The dose of total body irradiation was planned. to be 150 rad followed by 6 cycles of chemotherapy. The complete response rate was 59 %; the complete plus partial response rate, 93 %. The 50 % disease-free survival was 8 months. The actuarial projected 5 year survival was 60 % and the disease-free survival at 5 years was 27 %. The program was well tolerated by the majority of patients. It is possible for some patients with favorable non-Hodgkin's lymphomas to achieve prolonged periods of disease-free survival when treated with combinations of irradiation plus chemotherapy.     

全身化疗同步或序贯脑放疗治疗非小细胞肺癌脑转移患者的疗效与毒副反应

目的 探讨全身化疗同步脑放疗或序贯脑放疗治疗非小细胞肺癌(NSCLC)脑转移患者的疗效和毒副反应.方法 采用前瞻对照方法,将60例NSCLC脑转移患者分为全身化疗同步脑放疗组(同步组)和全身化疗序贯脑放疗组(序贯组),每组各30例.结果 共59例患者完成治疗,总体客观缓解率(ORR)为22.0%,脑转移灶的ORR为35.6%,中位无进展生存期(PFS)为3个月,中位生存期(MST)为16个月,1年和2年总生存率分别为55.0%和24.4%.同步组和序贯组的总体ORR分别为20.0%和24.1%,脑转移灶的ORR分别为43.3%和27.6%,中位PFS分别为3和4个月,MST分别为16和13个月,差异均无统计学意义(均P>0.05).同步组和序贯组的1年生存率分别为58.5%和52.9%(P=0.365),2年生存率分别为37.2%和18.9%,同步组明显优于序贯组(P=0.011).同步组白细胞减少的发生率低于序贯组,差异有统计学意义(P=0.029);其他毒副反应的发生率差异无统计学意义(P>0.05).结论 全身化疗同步脑放疗治疗NSCLC脑转移可以取得较好疗效,且患者耐受性良好.

Abstract：

Objective To evaluate the efficacy, survival and toxicity in patients with brain metastases from non-small cell lung cancer ( NSCLC), treated with concurrent systemic chemotherapy and whole brain radiation therapy (WBRT) or sequential systemic chemotherapy/WBRT.Methods A total of 60 NSCLC patients with brain metastases were divided into two groups in this prospective clinical study:concurrent systemic chemotherapy and WBRT group (concurrent group ) and sequential systemic chemotherapy/WBRT group (sequential group).Results Of 59 assessable patients, the overall response rate was 22.0%, and the brain response rate was 35.6%;the median progression-free survival time was 3.0 months, and the overall 1- and 2-year survival rates were 55% and 24.4%, respectively, with a median survival time of 16.0 months.The overall response rate was 20.0% in the concurrent group and 24.1% in sequential group (P > 0.05 ).The brain response rates of 43.3% in concurrent group and 27.6% in sequential group were also not significantly different (P > 0.05 ).The median progression-free survival time for the patients in the concurrent group was 3.0 months versus 4.0 months in the sequential group, and the median survival time was 16.0 months versus 13.0 months ( all P >0.05 ).The 1- and 2-year survival rates were 58.5% and 37.2% versus 52.9% and 18.9%, respectively, with a significant difference in the 2-year survival rate between the two groups ( P = 0.011 ).In the sequential group, leukopenia was more frequent during chemotherapy than that in the concurrent group ( P = 0.029).Conclusion Concurrent systemic chemotherapy and WBRT is effective with tolerable adverse events in treating brain metastasis from NSCLC with an encouraging survival, and deserves further large sample and randomized multicenter clinical trials.     

Neoadjuvant chemotherapy for local advanced breast cancer with stage IIIB

In this study, we have done a retrospective evaluation of the clinical benefits of neoadjuvant chemotherapy in 25 patients with stage IIIB, locally advanced breast cancer in terms of response rate and survival benefit. Most of these patients were treated with an anthracycline-based regimen such as CAF and EC, and some were also treated sequentially with docetaxel. An overall objective response was observed in 15 patients (60%), composed of 1 patient (4%) with a complete response (CR) and 14 (56%) with a partial response (PR). No progressive disease was observed. Following neoadjuvant chemotherapy, locoregional treatment (mastectomy without partial resection) was carried out in 24 patients, 1 of whom also received radiotherapy. The rate of local recurrence in neoadjuvant chemotherapy with anthracycline-based regimens was lower than those of adjuvant chemotherapy with anthracycline-based and non-anthracycline-based regimens (10.0% versus 33.3% and 28.5%, respectively). By contrast, the rate of distant metastasis with neoadjuvant chemotherapy was higher than that seen with anthracycline-based adjuvant chemotherapy regimens (35.0% versus 11.1%, respectively), while the rate of distant metastasis in non-anthracycline-based regimens was even higher at 66.6%. The 5-year survival in the responders treated with neoadjuvant chemotherapy was better than in the non-responders (90.9% versus 50.0%; NS, P=0.28, log-rank test). The survival at 5 years in the patients treated with neoadjuvant chemotherapy was inferior to that with adjuvant anthracycline-based chemotherapy regimens (69.7% versus 77.8%), although the survival in neoadjuvant chemotherapy was better than those of non-anthracycline-based adjuvant regimen (69.7% versus 66.7%). However, at 10 years the overall survival with anthracycline-based neoadjuvant chemotherapy regimens was superior to that seen with either anthracycline or non-anthracycline-based adjuvant chemotherapy regimens. These results suggest that primary (neoadjuvant) systemic therapy with anthracycline-based regimens for locally advanced, stage IIIB, breast cancer may have a potential survival benefit when given in combination with adjuvant chemotherapy, as it will provide the best means of decreasing both local recurrence and distant metastasis.     

韦氏环非霍奇金淋巴瘤综合治疗疗效及其预后因素分析

目的:探讨韦氏环非霍奇金淋巴瘤(NHL)综合治疗疗效及影响预后的因素.方法:回顾分析2001-07-2010-07收治的63例韦氏环NHL所有病例,用Kaplan-Meier计算其3、5年总生存率(OS)和无瘤生存率(DFS),Log-rank进行显著性检验,Cox模型进行单因素和多因素分析.结果:全组死亡20倒,3、5年OS分别为76.1％和64.4％.3、5年DFS分别为69.0％和61.6％.原发灶放射治疗剂量＜40、40～50 及＞50 Gy的5年OS分别为48.6％,73.7％和48.2％,x2=3.766,P=0.152.放疗前给予≥3个周期的化疗组及＜3个周期的化疗组5年OS分别为71.3％和58.5％·x2=0.797,P=0.372.多因素分析结果显示,近期疗效与国际预后指数(IPI)是独立预后因素.结论:对于韦氏环NHL患者宜采取综合治疗模式.近期疗效与IPI可作为韦氏环NHL临床预后的参考指标.     

睾丸生殖细胞肿瘤综合治疗的长期疗效

目的 分析睾丸生殖细胞肿瘤(TGCTs)患者的临床特征、综合治疗疗效、生存率以及与预后有关的因素。方法 对107例行高位睾丸切除 精索静脉结扎术、术后均行化疗的TGCTs患者进行回顾性分析。近期疗效比较采用χ^2检验;生存率的计算采用Kaplan-Meiel生存曲线;生存率的比较采用Log rank检验。结果 107例患者中位年龄32岁。精原细胞瘤33例(30．8％),其中Ⅰ期14例,占42．4％;非精原细胞瘤74例(69．2％),其中I期21例,占28．4％。临床分期和病理类型是影响患者预后的主要因素。患者总的3,5,10年生存率分别为75．8％、73．5％和73．5％。精原细胞瘤患者3,5,10年生存率分别为100％、96．8％和96．8％;非精原细胞瘤患者3,5,10年生存率分别为63、5％、61．7％和61．7％。64例患者可评价疗效,单用化疗的患者中,17例(26,6％)达CR,另有8例(12．5％)化疗加放疗或解救手术后达CR。获CR与未获CR者5年生存率分别为91．7％和26．2％。结论 Ⅰ期TGCTs预后好。采用以化疗为主的综合治疗可明显提高转移性TGCTs患者的疗效和生存率。     

A novel arterial infusion chemotherapy for the treatment of patients with advanced pancreatic carcinoma after vascular supply distribution via superselective embolization

BACKGROUND: Patients with American Joint Committee on Cancer Stage IV advanced pancreatic carcinoma have been treated by systemic chemotherapy, intraarterial chemotherapy, radiation therapy, and multidisciplinary treatment using a combination of these. However, the outcome has not always been satisfactory. In the current study the authors describe the method and results of a new chemotherapy for advanced pancreatic carcinoma. METHODS: To restrict the blood flow into the pancreas (mainly to the great pancreatic artery and the caudal pancreatic artery), the peripancreatic blood vessels were embolized superselectively with microcoils. In 31 patients with advanced pancreatic carcinoma, the catheter tip for the arterial infusion chemotherapy was placed in the splenic artery just proximal to the branching of the great pancreatic artery when the treatment was given for primary tumors, and in the common hepatic artery when the treatment was given for a metastatic liver lesion. The other end of the catheter was connected to an implanted injection port embedded in the femoral region, and 5-fluorouracil and cisplatin were administered by continuous arterial infusion. RESULTS: Of the 31 patients with advanced pancreatic carcinoma, 23 (74%) underwent hemodynamic change and arterial infusion chemotherapy, with a response rate of 73.9% (complete response rate of 8.7% and a partial response rate of 65.2%) and a mean survival period of 18.26 +/- 10.06 months. The 1-year, 2-year, and 3-year survival rates were 90.9%, 42. 8%, and 18.3%, respectively, with a mean survival period of 19.0 months. Of these 23 patients, the 16 patients with liver metastases had a response rate of 68.8% and a mean survival period of 16.25 +/- 8.35 months, whereas the 7 patients without liver metastases had a response rate of 87.5% and a mean survival period of 22.86 +/- 12.69 months. CONCLUSIONS: In patients with Stage IV advanced pancreatic carcinoma, arterial infusion chemotherapy after hemodynamic change was found to be effective against both primary tumors and metastatic liver lesions. The authors believe that the treatment presented in the current study should be attempted, even in patients with advanced pancreatic carcinoma, as long as the blood vessels for vascular supply distribution exist.     

Cisplatin and vindesine for disseminated non-small cell lung cancer. Results of a prospective trial with 81 patients

Eighty-one patients with disseminated non-small cell lung cancer (stage IV) were treated with 2 monthly cycles of initial chemotherapy combining cisplatin with vindesine. The initial chemotherapy-responding patients (CR, PR, MR) were randomized to 2 cycles or 4 cycles of maintenance chemotherapy. After initial chemotherapy, the response rate was 33% (CR, PR, MR) with 18.5% objective responses. The overall 1-year survival rate was 15% with 37% for responders as opposed to 2% for non-responders. Maintenance chemotherapy did not improve the response rate obtained after initial cycles. The small number of patients does not allow us to reach a definite conclusion on the optimum duration of maintenance chemotherapy. In the absence of large placebo versus chemotherapy randomized trials, no definite conclusion can be made on the benefit of chemotherapy in disseminated non-small cell lung cancer. This study suggests, however, that chemotherapy is associated with a significantly longer survival in responding patients.