EP方案联合力尔凡或甲地孕酮治疗非小细胞肺癌的疗效观察

目的：探讨在初治Ⅲb-Ⅳ期非小细胞肺癌（NSCLC）中三种治疗方案的优劣。即LM－EP方案[LIFEIN（力尔凡）、MA（Megestrol Aceatae,甲 地孕酮）、VP－16与PDD联合的生物化疗方案]、M－EP方案和EP方案。方法：A组（38例）接受LM－EP方案治疗，B组（38例）接受M－EP方案治疗；C组（36例）接受EP方案治疗。3组均以每4周为一周期，重复3个周期。客观疗效与不良反应按WHO标准进行评价，生活质量根据临床受益疗效评价。结果：A、B、C三组客观疗效（CR＋PR）无明显差异（P＞0．05），分别为31．8％、23．7％及22．2％，中位生存期A组较B、C两组长（P均＜0．01），分别为35周、29周和27周，临床受疗效A、B组高于C组（P均＜0．05）；机体免疫功能A组高于B、C两组（P均＜0．01）；白细胞减少及恶心呕吐反应C组较A、B两组均显著（P＜0．01，P＜0．05）；短暂性寒战，发热症状多见于A组（P＜0．01）；两组均未发现其它严重的不良反应。结论：LM－EP方案与M－EP方案和EP方案治疗晚期NSCLC的客观疗效（CR＋PR）无明显差异性，但前者不良反应小，中位生存期长，患者免疫功能及生活质量改善明显。     

草酸铂或顺铂联合氟脲嘧啶及醛氢叶酸治疗晚期胃癌的对比研究

目的：比较L-OHP＋CF＋5-FU方案与DDP＋CF＋5-FU方案对初次化疗的Ⅲ期胃癌患者的疗效、不良反应及生活质量的改善情况。方法：A组（34例）接受L-OHP＋CF＋5-FU方案治疗；B组（36例）接受DDP＋CF＋5-FU方案治疗。两组均以3周为1周期．重复3个周期。客观疗效与不良反应按WHO标准进行评价，生活质量根据临床受益疗效评价。结果：A、B两组客观疗效（CR＋PR）分别为52．9％及50．0％，P〉0．05；白细胞减少及恶心呕吐反应B组均较A组明显（P〈0．01）；外周神经炎A组比B组明显（P〈0．05），但较轻微，均在Ⅰ～Ⅱ度范围内。两组均未发现其他严重的不良反应。临床受益疗效A组高于B组（P〈0．05）。结论：L-OHP＋CF＋5-FU方案与DDP＋CF＋5-FU方案治疗晚期胃癌的客观疗效无明显差异性．但前者耐受性好，患者生活质量改善明显。     

复方苦参注射液联合NP方案治疗晚期非小细胞肺癌的临床研究

  目的 比较复方苦参注射液（岩舒）联合NP方案与NP方案对初治Ⅲb ~ Ⅳ期非小细胞肺癌（NSCLC）患者的疗效、毒性及生活质量的改善情况。方法 A组（34例）接受复方苦参注射液联合NP方案治疗；B组（36例）接受NP方案治疗。两组均以4周为1周期，重复3个周期。客观疗效与不良反应按WHO标准进行评价，生活质量根据临床受益疗效来评价。结果 A、B两组客观疗效（CR+PR）分别为26.5 %及22.2 %（P＞0.05）；中位生存期A组32周，B组27周（P＜0.01）；白细胞减少及恶心呕吐反应B组均较A组明显（P＜0.01）；两组均未发现其他严重的不良反应。临床受益疗效A组高于B组（P＜0.05）。结论 复方苦参注射液联合NP方案与单纯NP方案治疗晚期NSCLC的客观疗效差异无统计学意义，但A组患者不良反应小，中位生存期长，患者生活质量改善明显。     

双介入联合膀胱灌注治疗浅表性膀胱癌的临床研究

[目的]探讨于术前术后双介入治疗联合膀胱内灌注化疗治疗浅表性膀胱癌及预防术后复发的临床效果。[方法]58例浅表性膀胱癌随机分为3组。A组18例，先尿道膀胱肿瘤电切术（TURBT）或膀胱部分切除术，术后膀胱腔内用丝裂霉素C灌注；B组20例，TURBT术或肿瘤部切术4～6周后．于双侧髂内动脉内灌注顺铂和羟基喜树碱针．同时间隔辅以膀胱腔内丝裂霉素C灌注化疗；C组20例，在术前约3～4天，先于患侧膀胱动脉内用喜树碱微球2～10颗栓塞再采用与B组相同的治疗。[结果]C组术中肿瘤创面出血较其他两组少（P〈0．01），手术时间较其他两组明显缩短（P〈0．05）；肿瘤1年内复发的比较无明显差异性（P〉0．05）；2年内复发的A组和C组比较有显著性差异（P〈0．05），B组和C组无显著性差异（P〉0．05）；3年内复发的3组之间比较有显著性差异（P〈0．05），其中C组最低。术后副作用比较没有显著性差异（P〉0．05）。[结论]双介入治疗联合膀胱内灌注化疗对治疗浅表性膀胱癌及预防术后复发疗效肯定，明显提高了肿瘤的切除率，明屁缩短了手术时间．延缓肿瘤复发且副作用没有明显增加。     

低剂量密集式紫杉醇方案配合全胃肠外营养治疗晚期胃癌

[目的]探讨低剂量密集式紫杉醇配合全胃肠外营养治疗晚期胃癌的疗效。[方法161例胃癌根治术后复发转移的晚期患者分为三组：A组（20例）应用最佳支持治疗策略；B组（20例）单纯采用低剂量密集式紫杉醇联合化疗方案；C组（21例）采用低剂量密集式紫杉醇联合化疗方案＋全胃肠外营养（TPN）。观察比较三组患者近期疗效、1年生存率、毒副反应及KPs评分变化。[结果]1年生存率C组42．9％（9／21），B组30％（6／20），A组10％（2／20），A、B、C三组比较，差异无显著性（P=-0．06）。可能与样本量小有关。有效缓解率（RR）C组57．1％（12／21），B组35％（7／20）．两组比较．差异无显著性（P=-0．15）。治疗后KPS评分均值三组均上升，差异具有显著性（P〈0．05）。[结论]低密式紫杉醇联合化疗方案能显著改善术后复发转移胃癌患者疗效及生活质量。全胃肠外营养对低密式紫杉醇联合化疗方案具有增敏作用。     

108例鼻咽癌颈部放射性皮炎治疗分析

[目的]观察金因肽（重组人表皮生长因子，rhEGF）联合氦氖激光外照射及二者单用治疗鼻咽癌颈部放射性皮炎的疗效。[方法]108例鼻咽癌放疗中出现2级及以上颈部皮炎患者被随机分为3个组治疗：单用金因肽组（A组）；单用氦氖激光外照射组（B组）；联合应用金因肽和氦氖激光组（C组）。评价放射性皮炎创面愈合时间，有效率及放疗中断时间。[结果]A、B组的创面愈合时间、有效率及放疗中断时间近似（P均〉0．05），C组的创面愈合时间、有效率及放疗中断时间优于A、B组（P均〈0．01）。[结论]联用金因肽及氦氖激光外照射对鼻咽癌颈部放射性皮炎的疗效优于单用金因肽或氦氖激光。     

艾迪注射液加NP方案治疗中晚期非小细胞肺癌临床疗效观察

目的观察艾迪注射液配合NP方案治疗非小细胞肺癌（NSCLC）的疗效。方法98例NSCLC随机分为两组，治疗组接受艾迪加NP方案，对照组单用NP方案。两组均以4周为1个周期，重复3个周期。结果治疗组比对照组的近期客观疗效有效率高，但差异无显著性（P〉0．05）；而临床症状及生存质量改善率差异有显著性（P〈0．05）。结论艾迪注射液有助于NSCLC患者临床症状的改善并提高生存质量。     

肝动脉化疗栓塞联合三维适形放疗治疗原发性肝癌

[目的]探讨肝动脉介入化疗栓塞术（TACE）联合三维适形放疗（3D42RT）治疗原发性肝癌的疗效。[方法]44例原发性肝癌患者用抽签法随机分为A组、B组，A组22例先予TACE治疗2～3次，3周后进行3D-CRT，放射剂量为2～3Gy／次，5次／周，总剂量为50Gy～60Gy；B组22例单纯行TACE治疗2～3次。[结果]A组有效率为86．3％，B组有效率为54．5％，A组有效率明显高于B组（P〈0．05），A组的1、2年生存率分别为72．7％和50．0％，B组的1、2年生存率分别为45．5％和18.3％，A组生存率亦明显高于B组（P〈0．05）。两组间毒副反应无明显差异（P〉0．05）。[结论]TACE联合3D-CRT能提高原发性肝癌的疗效，毒副反应可以耐受。     

胰腺癌术前、术后化疗的疗效

[目的]探讨胰腺癌术前、术后系统化疗对预后的影响。[方法]临床收集101名胰腺癌患者分为三组，A组：对26例胰腺癌患者术前术后行系统化疗；B组：42例术后单纯化疗；C组：33例仅行手术切除或姑息手术。对各组生存率进行比较。[结果]术后1年A、B、C三组生存率比较有显著性差异（x^2=30．66，P=0．000），A组88．46％高于B组59．53％（x^=5．899,P=0．021）；B组高于C组27．27％（x^2=13．83，P〈0．01）。术后2、3年生存率A组与B组比较、B组与C组比较均有显著性差异（P〈0．05）。[结论]胰腺癌术前、术后行系统化疗。能明显提高术后1、2、3年的生存率。     

热疗联合长春瑞滨和顺铂方案治疗晚期非小细胞肺癌临床疗效观察

目的：观察热疗联合化疗治疗晚期非小细胞肺癌（NSCLC）的近期疗效及毒副反应。方法：采用随机配对的方法将不能手术的ⅢA、ⅢB和Ⅳ期NSCLC患者分为A、B两组，A组采用热疗加化疗，B组单纯化疗。结果：A组和B组有效率（CR＋PR）分别为62．07％和32．14％，P〈0．05；生活质量改善率分别为62．07％和32．14％，P〈0．05。结论：初步观察到热疗联合化疗治疗晚期NSCLC有良好的耐受性和较好的近期疗效。     

Experience with Impedance Phlebography Compared with Venography

Venography is a particularly reliable method for the diagnosis of deep venous thrombosis but is not suitable as a screening test. Impedance phlebography represents another attempt to discover a simple, non-invasive and reliable method of detecting deep venous thrombosis. It does not, however, meet these criteria.     

Compliance with guidelines and correlation with outcome in patients with advanced germ-cell tumours

PurposeTo evaluate prior compliance with guidelines in patients treated with salvage chemotherapy for advanced germ-cell tumours (GCT).Patients and methodsData concerning the initial management of patients requiring salvage chemotherapy for GCT at Institut Gustave Roussy between 2000 and 2010 were obtained and correlated with recommendations for treatment. Criteria of non-compliance were defined based on guidelines. Compliance with guidelines, predictive factors for non-compliance and the impact on outcome were analysed.ResultsAmong 82 patients treated in the salvage setting, guidelines to initial treatment were followed in only 41 cases (50%). The most common non-compliance criteria were non-adherence to the planned dose (16%), an inappropriate interval between first-line chemotherapy cycles (16%), the lack of post-chemotherapy surgery (16%) and a long interval to post-chemotherapy surgery (48%). Compliance with standard care was better in cancer centres than in other hospitals (private or public) (Odd Ratio (OR): 6.9, P = 0.001). A poor-risk status according to the International Germ Cell Cancer Collaborative Group (IGCCCG) was also predictive of compliance in univariate but not in multivariate analysis. No significant difference in outcome after salvage chemotherapy was observed. Patients relapsing after non-compliant first-line therapy tended to be more easily salvaged, which is consistent with the fact that their initial treatment was inadequate. Some of these relapses were therefore probably not due to true biologically refractory disease.ConclusionGuidelines for first-line treatment are adhered to in only half the patients requiring salvage chemotherapy. As the only predictive factor for non-compliance was the treating centre, centralisation of patients with GCT in well-trained hospitals should be recommended.     

Treatment with methylnaltrexone is associated with increased survival in patients with advanced cancer

BackgroundMethylnaltrexone (MNTX), a peripherally acting μ-opioid receptor (MOR) antagonist, is FDA-approved for treatment of opioid-induced constipation (OIC). Preclinical data suggest that MOR activation can play a role in cancer progression and can be a target for anticancer therapy.Patients and methodsPooled data from advanced end-stage cancer patients with OIC, despite laxatives, treated in two randomized (phase III and IV), placebo-controlled trials with MNTX were analyzed for overall survival (OS) in an unplanned post hoc analysis. MNTX or placebo was given subcutaneously during the double-blinded phase, which was followed by the open-label phase, allowing MNTX treatment irrespective of initial randomization.ResultsIn two randomized, controlled trials, 229 cancer patients were randomized to MNTX (117, 51%) or placebo (112, 49%). Distribution of patients' characteristics and major tumor types did not significantly differ between arms. Treatment with MNTX compared with placebo [76 days, 95% confidence interval (CI) 43–109 versus 56 days, 95% CI 43–69; P = 0.033] and response (laxation) to treatment compared with no response (118 days, 95% CI 59–177 versus 55 days, 95% CI 40–70; P < 0.001) had a longer median OS, despite 56 (50%) of 112 patients ultimately crossing over from placebo to MNTX. Multivariable analysis demonstrated that response to therapy [hazard ratio (HR) 0.47, 95% CI 0.29–0.76; P = 0.002) and albumin ≥3.5 (HR 0.46, 95% CI 0.30–0.69; P < 0.001) were independent prognostic factors for increased OS. Of interest, there was no difference in OS between MNTX and placebo in 134 patients with advanced illness other than cancer treated in these randomized studies (P = 0.88).ConclusionThis unplanned post hoc analysis of two randomized trials demonstrates that treatment with MNTX and, even more so, response to MNTX are associated with increased OS, which supports the preclinical hypothesis that MOR can play a role in cancer progression. Targeting MOR with MNTX warrants further investigation in cancer therapy.Clinical trials numberNCT00401362, NCT00672477.     

Sarcopenia is associated with survival in patients with urothelial carcinoma treated with systemic chemotherapy

International Journal of Clinical Oncology - Sarcopenia impacts perioperative outcomes and prognosis in various carcinomas. We aimed to investigate whether sarcopenia at the time of chemotherapy...     

超声心动图诊断26例心脏黏液瘤

应用经胸二维超声心动图（2DE）、彩色血流显像（CDFI）及频谱多普勒显像（Doppler）诊断26例心脏黏液瘤（27个瘤体）,对团块的位置、数目、大小、形状、瘤蒂附着点和活动度、心腔内及瓣膜口血流等进行探查及分析．认为心脏超声检查是心脏黏液瘤的首选检查方法,具有实时、经济、简便易行等优点。     

Costs associated with complications are lower with capecitabine than with 5‐fluorouracil in patients with colorectal cancer

BACKGROUND:

Capecitabine, an oral alternative to 5‐fluorouracil (5‐FU) in patients with colorectal cancer (CRC), has equal clinical efficacy and a favorable safety profile; however, its use may be limited because of unit cost concerns. In this study, the authors measured the cost of chemotherapy‐related complications during treatment with capecitabine‐ and 5‐FU–based regimens.

METHODS:

Patients with CRC who received at least 1 administration of capecitabine or 5‐FU during 2004 and 2005 were identified from the Thomson MarketScan research databases. Monthly frequency and cost for 23 complications were recorded. Logistic regression was used to predict complication probability. General linear models were used to predict monthly complication cost and total monthly expenditure.

RESULTS:

In total, 4973 patients with CRC met the inclusion criteria for this analysis. Although the most frequently observed complications were the same between capecitabine and 5‐FU (nausea and vomiting, infection, anemia, neutropenia, diarrhea), each was observed with greater frequency in 5‐FU–based regimens. The mean predicted monthly complication cost was significantly higher (by 136%) with 5‐FU monotherapy than with capecitabine monotherapy (difference, $601; 95% confidence interval [95% CI], $469‐$737). In addition, the mean predicted monthly complication cost for 5‐FU+oxaliplatin was higher than the cost with capecitabine plus oxaliplatin (difference, $1165; 95% CI, $892‐$1595). When acquisition, administration, and complication costs were taken into consideration, there were no significant differences in the total cost between capecitabine regimens and 5‐FU regimens.

CONCLUSIONS:

Capecitabine compared well with 5‐FU–based therapy in patients with CRC and was associated with lower complication rates and associated costs. Cancer 2009. © 2009 American Cancer Society.     

Living with secondary breast cancer: coping with an uncertain future with unmet needs

JOHNSTON S.R.D. (2010) European Journal of Cancer Care 19 , 561–563 Living with secondary breast cancer: coping with an uncertain future with unmet needs