临床药师参与胃癌新辅助化疗患者营养治疗的研究

目的：探讨临床药师参与胃癌患者营养治疗和药学服务的作用。方法拟行新辅助化疗的胃癌患者60例,随机分为干预组和常规治疗组,常规治疗组行常规化疗,干预组在常规化疗的基础上,临床药师对其营养状况进行全程干预,两组化疗方案均为XELOX方案（卡培他滨＋奥沙利铂）,每组各30例,观察治疗结束后两组营养指标、不良反应发生率和治疗完成率。结果干预组患者化疗结束后各项营养指标均优于常规治疗组（均P＜0.05）。严重骨髓抑制发生率低于常规治疗组（P＜0．05）。干预组全部按计划完成治疗,常规治疗组6例患者暂停或终止化疗（P＜0．05）。结论临床药师参与胃癌化疗患者营养治疗可以改善患者营养状况,降低药物不良反应发生率,提高抗肿瘤治疗顺应性和耐受性。     

进展期胃癌新辅助化疗的临床疗效观察

目的 评价进展期胃癌新辅助化疗的疗效及对预后的影响.方法 回顾性分析45例确诊进展期胃癌患者通过新辅助化疗后再行手术治疗的疗效及预后,并与60例同期收治的未经新辅助化疗的胃癌手术患者进行对照.结果 新辅助化疗组临床有效率RR(CR+ PR)为68.9％ (31/45),其中CR 6.7％(3例),PR62.2％ (28例),SD 28.9％(13例),PD 2.2％(1例),术后1例在病理水平达到完全缓解(pCR),缓解率为2.2％ (1/45).不良反应主要为Ⅰ及Ⅱ度白细胞减少、恶心、脱发、呕吐及黏膜炎,其中Ⅲ及Ⅳ级的白细胞减少及胃肠道反应6例(13.3％),无严重感染和死亡病例.新辅助化疗组手术根治性切除率为84.4％,对照组的手术根治性切除率为66.7％,两者差异有统计学意义(P＜0.05).与对照组比较,新辅助化疗组的术后生存期明显延长(P＜0.05),且两组术后并发症无明显差异.结论 手术切除较为困难或根治率低的局部晚期胃癌患者,术前配合新辅助化疗,可显著提高胃癌切除率,并且最终可明显提高胃癌患者的术后生存期.     

胃癌的辅助治疗

辅助化疗可改善日本胃癌患者的生存期;围手术期化疗给欧洲患者带来生存获益;辅助放化疗因其有效性和可行性成为美国胃癌根治术后患者的标准治疗方法;腹腔化疗亦在减少复发转移、延长生存期等方面起到了一定的作用,多在亚洲使用.     

可切除胃癌术后辅助化疗现状

世界范围内,胃癌发病率和死亡率占所有癌症的第2位.在中国胃癌占发病和死亡的第1位.5年生存率低.手术是惟一可根治的方法.术后辅助化疗在提高生存率方面的作用尚有争议.本文综述胃癌根治术后辅助化疗方面的现状.     

The case for routine use of adjuvant therapy in pancreatic cancer

Pancreatic cancer is a devastating disease with a poor prognosis for most patients. Surgical resection remains the cornerstone of treatment, providing the only realistic hope of long-term survival. Even with optimal surgical management, 5-year survival averages 15% to 20% for resectable disease. Progress is being made, however. Currently, the benefits of postoperative therapy for resected pancreatic ductal adenocarcinoma appear clear, and recommendations for such therapy appear to us to be well justified. Additional benefit to patients awaits the development of new agents, molecular targeted drugs, and novel approaches such as immunotherapy.     

1992～2005年辽宁庄河胃癌高发区1 003例胃癌病理形态学特征年代变化趋势

目的：从胃癌形态学方面，探讨辽宁省庄河地区胃癌高发区胃癌病理形态学特征及其年代变化趋势，探讨这种变化与胃癌发病影响因素之间的关系，为胃癌防治提供线索和依据。方法：选取1992-2005年在辽宁庄河市中心医院接受手术切除的胃癌标本共计1003例。标本均经4％甲醛固定，病理常规系统检查。结果：1003例胃癌患者平均发病年龄58．9岁（17～84岁）；不同年代胃癌高发年龄均为60～69岁，其次为50～59岁，男性胃癌患者明显多于女性患者（P〈0．001），男女患者之比为3．0：1。1003例胃癌患者中，共检出早期胃癌159例（15．9％），年均构成比为15．3％，中期胃癌195例（19．4％），晚期胃癌649例（64．7％）。各年间早期胃癌大体分型以Ⅲ型为主；进展期胃癌以BorrmannⅢ型为主。在淋巴结转移方面，早期胃癌各年间无淋巴结转移者多于有淋巴结转移者；进展期胃癌各年间有淋巴结转移者多于无淋巴结转移者。在组织学分型方面，乳头状管状腺癌、中分化管状腺癌、低分化管状腺癌和印戎细胞癌呈逐年下降趋势；黏液腺癌、未分化癌呈逐年升高趋势；若以Lauren分类为标准，在各年代间均以弥漫型胃癌占优势，并呈逐年上升趋势，肠型胃癌呈下降趋势，二者比值呈下降趋势。结论：随着年代的变迁，庄河地区胃癌临床流行病学特征有明显变化。     

Progress in neoadjuvant therapy for gastric cancer

Gastric cancer is one of the most common malignant tumor types in the world and the majority of patients have already reached the advanced stage at the time of initial diagnosis, owing to the subtle symptoms of gastric cancer in the early stage and the low rate of screening in the population. Surgical resection is one of the main treatments for advanced gastric cancer; however, the efficacy of surgery is limited by factors such as low radical resection rate and high distant metastasis rate. A large number of clinical trials have indicated that neoadjuvant therapy (NAT), which consists of neoadjuvant chemotherapy, neoadjuvant chemoradiotherapy and NAT combined with targeted therapy, may improve the therapeutic effect and prognosis of patients to different degrees. However, the benefit of NAT remains controversial due to the heterogeneity of clinical trials and gastric cancer itself. The present review summarizes the main research progress and key breakthrough of NAT for advanced gastric cancer and discusses its prospects.     

潜在可切除胃癌新辅助化疗的临床疗效观察

目的探讨潜在可切除胃癌新辅助化疗的临床疗效。方法收集本科收治的进展期及局部晚期潜在可切除胃癌患者31例,予以改良DCF方案（mDCF）化疗2～4个周期,观察其临床疗效及不良反应。结果全组获CR1例,PR15例,SD10例,PD5例,临床有效率为51．61％,疾病控制率为83．86％。手术切除率为64．52％（20／31）,其中R0切除率为45．16％（14／31）,R1切除率为12．90％（4／31）,R2切除率为6．45％（2／31）。姑息性手术7例（22．58％）。2例术后出现并发症,并发症发生率为10％（2／20）。主要不良反应为骨髓抑制、恶心呕吐及轻度肝功能损害,经对症处理后均可缓解及恢复。结论改良DCF方案应用于潜在可切除胃癌的新辅助化疗的临床疗效较好,该疗法可使肿瘤降期,增加手术切除的机会,化疗相关不良反应可耐受,安全性较高。     

胃癌患者术中腹腔热灌注化疗的临床研究

目的：探讨胃癌根治术中一次性腹腔温热灌注化疗的临床疗效。方法：将术中行一次性腹腔温热灌注化疗的50例胃癌患者（治疗组）与未行此方法治疗的100例患者（对照组）的腹腔游离癌细胞检出率及预后等情况进行对比。结果：治疗组的温热灌注液游离癌细胞检出率为7．4％；对照组冲洗液的癌细胞检出率为30．8％。治疗组与对照组术后两年内腹腔复发率分别为14．6％和38．7％（P〈0．01）。治疗组术后1、2、3年生存率分别为100％、79％和60％；对照组则为95．1％、50．2％和35．2％，两组2、3年生存率比较，差异有显著性（P〈0．01）。结论：一次性腹腔温热灌注化疗简便、高效、安全，具有杀灭腹腔游离癌细胞的作用，可降低患者术后腹腔复发率和提高生存率。     

甘肃省武威市胃癌发病率对比分析

目的:探讨甘肃省武威市胃癌发病特征及其流行趋势。方法:通过建立恶性肿瘤登记报告获取胃癌发病资料。结果:武威市胃癌发病率1991 ~ 1995 年为 61 62/10 万,1996~ 2000 年为 55 .96/10 万,后期低于前期。年龄组发病率前后两期均随年龄的增高而上升,65 岁以前各组前期高于后期,65岁及以后各组后期明显高于前期。结论:武威市胃癌发病呈下降趋势。     

Cyclophosphamide,methotrexate, and fluorouracil; oral cyclophosphamide; levamisole; or no adjuvant therapy for patients with high‐risk,premenopausal breast cancer

BACKGROUND:

The Danish Breast Cancer Cooperative Group (DBCG) 77B trial examined the relative efficacy of levamisole, single‐agent oral cyclophosphamide, and the classic combination of cyclophosphamide, methotrexate, and 5‐fluorouracil (CMF) against no adjuvant systemic therapy in high‐risk breast cancer patients. The authors report the results from that trial after a potential follow‐up of 25 years.

METHODS:

Between 1977 and 1983, 1146 premenopausal patients who had tumors >5 cm or positive axillary lymph nodes were assigned randomly to 1 of 4 options: no systemic therapy, levamisole 5 mg weekly for 48 weeks (the levamisole arm), oral cyclophosphamide 130 mg/m² on Days 1 through 14 every 4 weeks for 12 cycles (the C arm), or oral cyclophosphamide 80 mg/m² on Days 1 through 14 plus methotrexate 30 mg/m² and fluorouracil 500 mg/m² intravenously on Days 1 and 8 every 4 weeks for 12 cycles (the CMF arm).

RESULTS:

The 10‐year invasive disease‐free survival (IDFS) rate was 38.6% in the control arm compared with 55.5% in the C arm, 48.8% in the CMF arm, and 35.2% in the levamisole arm. Compared with the control arm, the hazard ratio for an IDFS event was 0.62 in the C arm (P = .001) and 0.70 in the CMF arm (P = .01). The hazard ratio for death was 0.70 in both the C arm (P = .02) and the CMF arm (P = .02) at 10 years, and the overall survival (OS) benefit was maintained during 25 years of follow‐up. No significant differences were observed in IDFS or OS between the C arm and the CMF arm or between the levamisole arm and the control arm.

CONCLUSIONS:

Compared with controls, both cyclophosphamide and CMF significantly improved disease‐free survival and OS, and the benefits persisted for at least 25 years in premenopausal patients who had high‐risk breast cancer. Cancer 2010. © 2010 American Cancer Society.     

Multimodality therapy for the curative treatment of cancer of the esophagus and gastroesophageal junction

This review examines the role of combined-modality therapy in the treatment of locally advanced esophageal cancer. While surgery remains a cornerstone of treatment, recent studies have demonstrated that pre- or perioperative chemotherapy is associated with improved survival. Primary chemoradiotherapy is the accepted standard of care for medically inoperable patients. Neoadjuvant chemoradiotherapy continues to be investigated and is associated with several advantages over neoadjuvant chemotherapy alone, including an improvement in the pathologic complete response rate and resectability; patients who achieve a pathologic complete response also appear to have improved survival. Adjuvant chemoradiotherapy may be considered for patients who undergo primary resection of lower esophageal/gastroesophageal junction adenocarcinoma. Future directions include the investigation of novel chemotherapy regimens, the addition of targeted therapies and the use of PET to provide an early assessment of response.     

开普拓在肠癌辅助治疗中的应用现状与前景

开普拓是一种半合成、可溶性的喜树碱衍生物。是特异性拓扑酶Ⅰ抑制剂,通过抑制肿瘤细胞DNA重联步骤,导致DNA单链断裂而产生抗肿瘤作用。开普拓和奥沙利铂同为新一代抗肿瘤药物,目前已成为治疗转移性大肠癌最有效的药物之一。     

可切除结直肠癌肝转移患者的术前和术后化疗

可切除结直肠癌肝转移患者术后约有75%的复发率.围手术期的氟尿嘧啶、亚叶酸、奥沙利铂(FOLFOX)化疗较单纯手术可以减少合格入组患者和手术患者的疾病进展风险.但术前化疗可导致肝血管改变和脂性肝炎从而增加手术风险.汇总分析显示与单纯手术相比,术后接受氟尿嘧啶和亚叶酸为基础的辅助化疗,有延长无疾病进展生存期的趋势.贝伐单抗无论术前还是术后使用可能均不会增加手术风险.如何合理地选择化疗时机及最佳持续时间等问题尚待解决.     

胃癌辅助化疗的研究进展

胃癌一直是肿瘤死亡的主要原因,手术根治性切除是治愈的唯一手段。胃癌辅助化疗是在根治性手术后减少局部和远处复发的方法。许多Ⅲ期临床研究试图证实辅助治疗的疗效,但至今仍没有确立标准的治疗方案。本文就辅助治疗在胃癌中的进展作一总结。     

胃癌伴有食管浸润患者临床病理学分析与非开胸术式的选择标准

目的：对伴有食管浸润的胃癌通过临床病理学因素的分析，探讨非开胸术式及开胸术式的选择标准。方法：对手术切除的87例食管浸润胃癌（其中非开胸术式42例，开胸术式35例）的病理组织学进行分析。结果：我们认为仅考虑预防断端复发的非开胸术式的适应证：1）分化型癌食管浸润距离〈20mm的病例；2）未分化型癌食管浸润长度〈10mm的病例；3）明显的食管浸润的未分化型癌及食管浸润≥21mm的分化型癌需行开胸术式；4）在非开胸术式中，纵隔内淋巴结复发仅2例，因此不需要通过开胸进行纵隔淋巴结廓清。结论：根据手术适应证选择部分食管浸润胃癌病例进行非开胸术式是容许的。     

胃癌伴有食管浸润患者临床病理学分析与非开胸术式的选择标准

目的:对伴有食管浸润的胃癌通过临床病理学因素的分析,探讨非开胸术式及开胸术式的选择标准。方法:对手术切除的87例食管浸润胃癌(其中非开胸术式42例,开胸术式35例)的病理组织学进行分析。结果:我们认为仅考虑预防断端复发的非开胸术式的适应证:1)分化型癌食管浸润距离<20mm的病例;2)未分化型癌食管浸润长度<10mm的病例;3)明显的食管浸润的未分化型癌及食管浸润≥21mm的分化型癌需行开胸术式;4)在非开胸术式中,纵隔内淋巴结复发仅2例,因此不需要通过开胸进行纵隔淋巴结廓清。结论:根据手术适应证选择部分食管浸润胃癌病例进行非开胸术式是容许的。