非小细胞肺癌放化疗不同联合模式疗效、预后因素及不良反应分析

目的 探讨放化疗不同联合模式治疗非小细胞肺癌(NSCLC)患者的疗效、不良反应,研究影响其预后的各种因素.方法 将151例经病理确诊的NSCLC患者按治疗模式不同分为3组,同步放化疗组(43例)、序贯放化疗组(49例)及单纯化疗组(59例),进行回顾性分析,评价疗效及不良反应,并分析预后因素.结果 同步放化组、序贯放化组及单纯化疗组有效率(CR+PR)分别为81.4%、73.5%、39.0%,中位生存时间分别为26、12和11个月,1年总生存率分别为80.2%、47.1%及45.6%,2年生存率分别为58.2%、38.5%及24.4%,3年生存率分别为32.7%、27.5%及0;3组不良反应主要为骨髓抑制反应,对于Ⅲ～Ⅳ级白细胞,同步放化组较单纯化疗组及序贯放化组下降明显(P＜0.05);而放射性食管炎及放射性肺损伤,同步放化疗组及序贯放化疗组之间差异无统计学意义;影响NSCLC预后的主要因素有年龄、PS评分、临床分期、治疗手段.结论 同期放化疗在提高中位生存时间及生存率方面优于序贯放化疗,尤其优于单纯化疗,且不良反应可以耐受.年龄、PS评分、临床分期、治疗手段对NSCLC患者生存率有影响.

Abstract：

Objective To explore the curative effects,prognostic factors,and adverse reactions of different treatment modalities of chemotherapy in patients with non-small cell lung cancer (NSCLC).Methods151 NSCLC patients were randomly assigned into 3 groups to undergo concurrent chemoradiotherapy ( n = 43 ) ,sequential chemo-radiotherapy ( n = 49 ) ,or pure chemotherapy (n = 59).The clinical data were analyzed.ResultsThe short-term effective rates of the concurrent and sequential chemo-radiotherapy groups were 81.4% and 73.5% respectively with no significantly difference between them,but both significantly higher than that of the pure chemotherapy group ( 39.0% ,both P ＜ 0.05 ).The mortality of the concurrent cherno-radiation group was 53.5% ,significantly lower than those of the sequential chemo-radiotherapy and pure chemotherapy groups (67.3% and 67.8% respectively,both P ＜0.05).The median survival time of the concurrent chemo-radiotherapy group was 26 months,significantly longer than those of the sequential chemo-radiotherapy and pure chemotherapy groups ( 12 and 11 months respectively,both P ＜ 0.05).The l-year survival rates of the 3 groups were 80.2% ,47.1%,and 45.6%.The 2-year survival rates were 58.2% ,38.5% ,and 24.4% ,and the 3-year survival rates were 32.7% ,27.5% ,and 0,respectively.The white blood cell decrease rates of the grades Ⅲ～Ⅳ of the concurrent chemo-radiotherapy group were significantly higher than those of the other 2 groups (both P ＜0.05 ).There were no significant differences in the rates of radiation esophagitis and radiation pneumonitis between the concurrent and sequential chemo-radiotherapy groups.Age,performance status score,clinical staging,and treatment modality were the 4 influencing factors in the prognosis of NSCLC ( all P ＜ 0.05 ).Conclusion Relatively safe with tolerable adverse reactions,concurrent chemo-radiotherapy is superior to sequential chemo-radiotherapy,particularly to pure chemotherapy,in increase of median survival time and survival rate in treatment of NSCLC.Age,PS,clinical staging and therapy method are independent indicators influencing the prognosis.     

恶性肿瘤骨转移放射治疗进展

骨转移是恶性肿瘤最常见的合并症之一,其引起的进行性骨痛、骨关节功能障碍、脊髓压迫、病理性骨折等,严重影响患者的生活质量。放射治疗是恶性肿瘤骨转移的重要治疗手段。对于单发的骨转移可用局部放疗的方法,而多发的骨转移可用局部放疗、放射性核素、双膦酸盐等联合治疗。     

大剂量阿胶治疗恶性肿瘤放疗所致血小板减少的临床观察

目的观察阿胶对恶性肿瘤放疗后所致外周血小板(PLT)减少的治疗效果。方法选取35例恶性肿瘤病人,其放疗后所致血液学毒性达到Ⅱ~Ⅳ度,PLT为<25×109/L~50×109/L,分为口服大剂量阿胶组和不予阿胶组进行临床观察。结果大剂量阿胶组外周血PLT在服药7天后有明显增多,21天后外周血小板恢复正常且稳定性好,较对照组有明显的治疗效果。结论大剂量阿胶在对放疗所致恶性肿瘤外周血PLT减少中有明显的治疗作用,能刺激PLT的再生与恢复。     

唑来膦酸治疗恶性肿瘤骨转移不良反应护理体会

恶性肿瘤骨转移是临床常见的晚期癌症并发症之一,指的是机体任一器官因为原发性的恶性肿瘤向骨发生转移并且继续生长的肿瘤,其多会产生溶骨性破坏,导致疼痛和功能障碍。临床表现以局部疼痛症状逐渐加重为主．晚期甚至引起病理性骨折、高钙血症以及神经和脊髓压迫等情况,严重影响患者生活质量。唑来膦酸是目前已发现的骨转移临床治疗中抗骨吸收作用最强的一种药物,     

经导管动脉灌注PD-1单抗治疗恶性肿瘤所致免疫相关不良反应

【摘要】 目的 探讨恶性肿瘤患者经导管动脉灌注程序性死亡蛋白-1（programmed death-1, PD-1）单抗治疗的免疫相关不良反应（immune-related adverse events, irAE）。方法 收集接受经导管动脉灌注PD-1单抗治疗的79例患者的临床资料,包括性别、年龄、灌注次数、PD-1单抗经导管动脉灌注治疗免疫相关不良事件等信息,采用SPSS26.0统计软件分析不同灌注次数患者irAE的发生率、首次灌注时不同等级irAE的发生率,采用logistic回归分析免疫irAE的影响因素。结果 经导管动脉灌注PD-1单抗治疗晚期恶性肿瘤患者中,任何级别和2级及以上irAE发生率分别为82.27%和27.8%,其中发生3级不良反应患者仅2例;疲劳的不良反应发生率居首位,与是否首次灌注、是否联合化疗及是否单部位灌注有关;irAE发生率前5位分别为:疲劳、恶心、关节痛、瘙痒及皮疹。不良反应可自行缓解,无死亡病例及严重irAE的发生。结论 经导管动脉灌注PD-1单抗治疗晚期恶性肿瘤不良反应发生率较高,但以1～2级为主,耐受性好,可重复多疗程治疗,不良反应可自行缓解,且未引起治疗中断,是晚期恶性肿瘤患者可选择的新的治疗方式之一。     

青海地区采用放射治疗结合高压氧治疗7例晚期颌面部恶性肿瘤效果分析

目的:探讨中度高原地区晚期颌面部恶性肿瘤的放射治疗。方法:就我院2007年—2011年收治的7例失去手术时机、进行放射治疗和高压氧治疗的典型病例进行回顾性研究。结果:所有7例患者在高压氧改善了机体的供氧状态的基础上,促进了放射治疗的效果。结论:高海拔地区在晚期颌面部恶性肿瘤放射治疗的同时,辅助高压氧改善细胞的低氧内环境,有助于提高放射治疗的效果。     

恶性肿瘤适形放疗方法与临床观察

目的 评价恶性肿瘤适形照射的疗效及临床使用价值。方法 对96例适形放疗后随访半年以上的病例进行分析,以影像学所示肿瘤大小变化作为评价疗效的指标。结果 96例治疗后6月影像学检查显示:肿瘤消失3O例(31.3％),缩小56例(58.3％),无变化6例(6.3％),增大3例(3.1％)。其中肺癌的有效率92.7％,肝癌88.2％,转移瘤85％,其他肿瘤88.8％。总有效率89.6％。结论 恶性肿瘤适形放射治疗,疗程短,副作用小,疗效肯定。为对射线抗拒或无外科手术适应症的患者提供了一个新的治疗途径。但如何与常规外照射、外科手术、化疗等合理结合,以提高肿瘤治愈率,尚需进一步研究。     

恶性肿瘤的基因治疗联合放射治疗的研究进展

近些年在恶性肿瘤的基因治疗与常规治疗联合应用进行的一系列实验研究中,人们已发现基因治疗可加强肿瘤的放射敏感性,且两者可有协同作用.综述了基因治疗联合放射治疗用于恶性肿瘤治疗的研究进展及其分子机制.     

携抗癌药骨水泥对肿瘤模型的治疗效应

目的确定丝裂霉素、长春新碱和5-F尿嘧啶掺入骨水泥后经皮介入治疗小鼠移植瘤的抗肿瘤效应。方法60只昆明种小鼠,体重17~18 g。S180肉瘤细胞1×106在每只小鼠皮下注射,7 d后随机分4组,每组15只;3组为治疗组,每一组各以上述一种抗癌药骨水泥0.5 ml瘤块内注入;另1组为对照组,仅注入单纯骨水泥0.5 ml。每组10只荷瘤小鼠记录肿瘤大小变化,余5只作病理检查。结果3组治疗组中,肿瘤体积在1~10 d内逐日缩小或不增大;而对照组中肿瘤体积持续增大。病理检查见治疗组水泥块周边肿瘤组织片状坏死。结论3种抗癌药骨水泥经皮介入治疗S180肿瘤具有显著抗肿瘤效应。     

清火排毒化肿胶囊急性毒性及长期毒性研究

目的 :探讨清火排毒化肿胶囊单次或多次给药后 ,动物出现的毒性反应及其性质和程度 ,寻找药物的安全范围 ,为临床用药提供科学依据。方法 :急性毒性试验为测定小鼠最大给药量方法。长期毒性试验为大鼠连续以清火排毒化肿胶囊 2 7g/kg、1 35 g/kg或 0 4 5 g/kg·体重 ,灌胃给药 12周 ,观察大鼠各项生理、病理指标变化 ,停药后继续观察 2周。结果 :清火排毒化肿胶囊对小鼠一日内灌胃的最大药量为 10 8g/kg·体重。长期毒性试验结果显示 ,1 35 g/kg组和2 7g/kg组与对照组比较 ,WBC分类和CR有统计学意义 (P <0 0 5或P <0 0 1) ;给药组与对照组比较 ,心、肺脏器权重系数差别有统计学意义 (P <0 0 5或P <0 0 1) ;病理组织学检查 ,高剂量组和对照组比较无统计学意义。恢复期末 ,给药组与对照组比较 ,各项观察指标均无统计学意义 (P >0 0 5 )。结论 :清火排毒化肿胶囊按拟定临床剂量及疗程服用是安全的。     

Study on hematological toxicity in irradiation and ICRF 159 combination treatment during experimentation on animals with particular consideration of long-term effects (author's transl)]

Experiments on animals are utilized for the control of hematological toxicity in sound NMRI mice during and after fractionated ICRF 159 therapy, fractionated whole-body irradiation and a combination of both. In the course of the 32-day therapeutic phase, and also during the total follow-up period lasting 196 days, continual determination of leukocytes and thrombocytes was performed. Leukocyte and thrombocyte depression is related to radiation effects during the phase of therapy and subsequently. In the later period of follow-up, however, hematological toxicity developed by ICRF 159 is higher than that produced by irradiation. Early and late effects of the preparation must be distinguished therefore. The thrombocytopenic effect is altogether less pronounced than the leukocytopenic effect. Here, too, the thrombocytopenic action of ICRF 159 appears in the course of the late phase only, but then more distinctly. The present results are discussed and compared to hitherto existing observations from animal experimentation and from clinical findings described in literature.     

Incidence of oxygen toxicity during the treatment of dysbarism.

Oxygen (O2) toxicity may result from exposure to partial pressures of O2 above 0.6ATA. Potential toxic exposure for divers occurs during the treatment of dysbarism. In the recompression chamber, PO2 may range from 0.9ATA to 3.3ATA depending upon the treatment table employed. This retrospective study examines the nature and incidence of O2 toxicity in 998 patients who underwent recompression treatment at our facility from 1983 through 2001. Only patients evaluated for diving related injury were considered for this study. Of 1189 charts reviewed, 998 patients received recompression and were entered into this study. The total number of treatment exposures was determined as was the total number of O2 toxicity events characterized as either pulmonary or CNS, and patients were divided into male/female analysis. Overall incidence as well as the incidence for both toxicity types was determined, and their occurrence in both male and female patients was ascertained. 2166 recompressions were undertaken, 449 female and 1717 male. The peak PO2 for these treatments ranged from 2.6ATA to 2.9ATA. 155 O2 toxicity events occurred in 152 patients, 49 females and 103 males. Three patients, 2 females and 1 male, had mixed events. Incidence of an O2 toxic event = 7.0 per 100 recompressions. Incidence of pulmonary toxicity overall = 5.0 per 100 recompressions, while CNS events = 2.0 per 100 recompressions with overall seizure rate = 0.6 per 100 recompressions. In females, pulmonary toxicity rate = 6.9 per 100 recompressions, CNS toxicity rate = 4.4 per 100 recompressions with seizures occurring at 1.3 per 100 recompressions. In males, pulmonary toxicity rate = 4.6 per 100 recompressions, CNS toxicity rate = 1.4 per 100 recompressions, and seizures at 0.4 per 100 recompressions.     

The long-term hazards of the treatment of thyroid cancer with radioiodine

Two-hundred and fifty-eight patients treated with high-activity 131I for thyroid cancer and on prolonged follow-up have been reviewed to determine long-term hazards and their relation to the radiation dose received. The expectation of life of those dying from causes other than cancer was slightly reduced in the female patients. A small, significant excess of deaths from cancer of the bladder and from leukaemia was found which, assuming that these were due to radiation, gave inferred risk-rates respectively of 0.4 and 4.9 deaths per 10(4) PYG (patient-year-grays) to the bladder wall and red marrow. Of 31 younger patients (eight male, 23 female), four of the marriages have been infertile. The fertile marriages produced a total of 44 live births. Considerable gonad irradiation (estimated 0.8-2.7 Gy) was compatible with apparently normal fertility. Despite the high level of irradiation of the salivary glands, no malignancies and only one adenoma was found. Impaired pulmonary function occurred in only one of the patients who had diffuse bilateral metastases. In this patient, tumour in the lung was persistent throughout, so that radiation was probably not alone responsible.