培美曲塞联合顺铂与长春瑞滨联合顺铂治疗晚期乳腺癌对比观察

目的:比较培美曲塞联合顺铂与长春瑞滨联合顺铂(NP)治疗蒽环类和紫杉类耐药晚期乳腺癌临床疗效和毒副反应。方法:58例对蒽环类和紫杉类耐药晚期乳腺癌患者随机分为两组,分别给予培美曲塞联合顺铂30例与NP方案28例至少治疗两周期后进行评价。结果:培美曲塞联合顺铂组总有效率(RR)CR+PR=53.3%,疾病控制率(DCR)CR+PR+SD=83.3%,NP方案组总有效率(RR)CR+PR=50.0%,疾病控制率(DCR)CR+PR+SD=78.6%。两组疗效比较无显著性差异(P>0.05)。主要毒副反应为骨髓抑制和胃肠道反应。Ⅲ-Ⅳ度白细胞减少发生率:培美曲塞联合顺铂组8例(26.7%),NP方案组11例(39.3%),Ⅲ-Ⅳ度胃肠道反应率:培美曲塞联合顺铂组3例(10.0%),NP方案组6例(21.4%),培美曲塞联合顺铂Ⅲ-Ⅳ度毒副反应明显低于NP方案组,两组相比有显著性差异(P<0.05)。结论:培美曲塞联合顺铂与NP方案均是治疗蒽环类和紫杉类耐药晚期乳腺癌有效的方案。前者血液学及消化道反应毒性较轻,患者耐受性好,值得临床进一步推广。     

NP与MVP方案治疗晚期非小细胞肺癌的疗效比较

背景与目的:化疗是治疗晚期非小细胞肺癌(non-smallcelllungcancer,NSCLC)的主要方法,但目前临床治疗效果不能令人满意。本研究的目的为比较NP方案和MVP方案治疗NSCLC的近期疗效和不良反应,为临床治疗提供指导。方法:48例Ⅲ～Ⅳ期NSCLC采用NP方案,即长春瑞滨(vinorelbine,NVB)25mg/m2d1,8及顺铂(cisplatin,DDP)35mg/m2d1～3联合化疗;62例Ⅲ～Ⅳ期NSCLC采用MVP方案,即丝裂霉素(mitomycin,MMC)6mg/m2d1、长春地辛(vindesine,VDS)3mg/m2d1,8及DDP30mg/m2d1～3联合化疗。结果:NP组CR和PR共24例,有效率50%,中位缓解期5.5个月,中位生存期11个月;MVP组CR和PR32例,有效率51.6%,中位缓解期6.5个月,中位生存期14.5个月,两组疗效无显著性差异(P>0.05)。结论:NP方案与MVP方案治疗晚期NSCLC疗效相近,不良反应可耐受。建议NP方案采用深静脉给药或改进给药方法,能较好地解决NVB所致的静脉炎。     

沙培林配合化疗治疗晚期非小细胞肺癌的疗效观察

目的探讨沙培林配合化疗治疗晚期非小细胞肺癌(NSCLC)的疗效.方法将46例晚期NSCLC患者分为两组,治疗组26例,对照组20例.治疗组采用沙培林配合NP方案化疗,对照组单纯用NP方案化疗.结果治疗组总有效率(CR+PR)为50.0%(13/26),对照组(CR+PR)45.0%(9/20).治疗组达到有效所用时间平均为40 d,对照组84 d.治疗组白细胞下降和脱发等不良反应均比对照组明显减轻.结论沙培林和NP方案化疗治疗NSCLC疗效好,达到有效所用时间短,不良反应小.     

NP与MVP方案治疗晚期NSCLC的对照研究

目的通过随机对照研究,比较NP与MVP方案治疗晚期非小细胞肺癌(NSCLC)的疗效,并观察其毒副作用.方法共65例晚期NSCLC患者随机入组,治疗组30例应用NP方案(NVB+DDP),对照组35例应用MVP方案(MMC+VDS+DDP).每病例至少化疗2疗程.疗效及毒副作用评价均按WHO标准进行.结果治疗组CR3例,PR11例,总有效率46.6%,对照组CR1例,PR12例,总有效率37.1%.治疗组总有效率要高于对照组,但无统计学差异(P＞0.05).治疗组中位生存期8.5月,而对照组7.6月,两组无差异(P＞0.05).两组病例主要的毒副作用是骨髓抑制、消化道反应及静脉炎.结论NP方案可以在NSCLC治疗中作为一线方案逐步应用,并进一步研究.     

培美曲塞、吉西他滨联合奈达铂化疗方案治疗晚期非小细胞肺癌的临床疗效及安全性

目的 探讨培美曲塞、吉西他滨联合奈达铂化疗方案治疗晚期非小细胞肺癌的临床疗效及安全性.方法回顾性分析接受化疗的晚期非小细胞肺癌患者138例,其中接受培美曲塞联合奈达铂化疗方案患者69例(培美曲塞组),接受吉西他滨联合奈达铂化疗方案患者69例(吉西他滨组),对比分析2组患者近期疗效以及不良反应发生情况.结果培美曲塞组患者治疗总有效率为33.33%,吉西他滨组患者治疗总有效率为30.43%,2组差异不具统计学意义(P>0.05).2组患者化疗相关不良反应主要为胃肠反应以及血象改变,培美曲塞组患者脱发、恶心呕吐、血小板下降以及白细胞减少不良反应发生率显著低于吉西他滨组患者(P<0.05);2组间血红蛋白减少、肝肾毒性以及静脉炎不良反应发生率差异不具统计学意义(P>0.05).治疗后2组患者临床症状评分均有所改善,但2组间差异不具统计学意义(P>0.05).结论培美曲塞、吉西他滨联合奈达铂化疗方案治疗晚期非小细胞肺癌均可获得较好临床效果,但培美曲塞联合奈达铂化疗方案不良反应较轻,以Ⅰ~Ⅱ度为主,是较为理想的晚期非小细胞肺癌的化疗方案.     

新辅助化疗治疗Ⅲ期非小细胞肺癌的临床评价

目的　评价新辅助化疗 (术前诱导化疗 )在治疗ⅢA 期非小细胞肺癌 (NSCLC)中的应用价值。方法　将 10 2例Ⅲ A 期NSCLC患者随机分为 2个组 :新辅助化疗组 5 1例 ,诱导化疗后行手术治疗 ,其中 3 0例术前接受支气管动脉灌注 (BAI)化疗 ,2 1例术前接受全身化疗。单一手术组 5 1例 ,确诊后直接行手术治疗。结果　新辅助化疗组总有效率 (CR PR )为 49.0 % (2 5 / 5 1) ,化疗不良反应患者可耐受。新辅助化疗组手术切除率和完全性切除率为 92 .2 %和 5 4.9% ,明显高于单一手术组 (72 .5 %和 3 5 .3 % ,P<0 .0 5 )。新辅助化疗组患者 (3 4例 )平均中位生存期为 2 5个月 ,2年生存率为 5 5 .9% (19/ 3 4)。单一手术组患者 (3 2例 )平均中位生存期为 13个月 ,2年生存率为 2 8.1% (9/ 3 2 )。 2组比较有显著性差异 (P <0 .0 5 )。结论　对ⅢA 期NSCLC患者进行新辅助化疗可提高手术切除率 ,延长患者中位生存期 ,提高患者 2年生存率。     

Ⅲ期非小细胞肺癌术后辅助化疗疗效分析

目的评价Ⅲ期非小细胞肺癌(NSCLC)切除术后辅助化疗疗效,并对影响术后辅助化疗的因素进行初步分析。方法回顾性分析本院268例切除术后的Ⅲ期NSCLC,有94例于术后3~4周开始接受化疗(辅助化疗组),其中予以CAP方案化疗42例;EP方案化疗34例;NP方案化疗18例。在化疗组中化疗3~4周期56例;化疗4~6周期38例。另174例患者术后未行化疗(单纯手术组)。结果辅助化疗组和单纯手术组的5年生存率分别为27.6%和16.6%(P<0.05),差别有统计学意义。在辅助化疗组中行CAP、EP、NP方案化疗组的5年生存率分别为26.1%、26.4%和27.7%(P>0.05),而在化疗组中化疗3~4周期和化疗5~6周期患者的5年生存率分别为26.7%和28.8%(P>0.05)。结论对切除术后Ⅲ期NSCLC患者进行3~4周期,以顺铂为基础的化疗方案的辅助化疗,可以提高长期生存率。     

NP与EP方案治疗非小细胞肺癌疗效观察

 目的 观察比较NP与EP方案治疗非小细胞肺癌（NSCLC）的近期疗效和毒副作用。方法 75例NSCLC患者随机分为NP组和EP组，化疗2周期后比较近期疗效和毒副作用。结果 NP组CR1例，PR15例，EP组CR 0例，PR 10例，总有效率NP组42.1 ％，EP组27.0 ％，初治有效率NP组48.1 ％，EP组31.0 ％，腺癌有效率NP组44.4 ％，EP组18.6 ％，P值均＜0.05。主要毒副作用为白细胞下降，Ⅲ ~ Ⅳ度发生率NP组18.4 ％，EP组10.8 ％，Ⅲ ~ Ⅳ度消化道反应二组相似。结论 NP方案治疗NSCLC 近期疗效较EP方案明显好，毒副作用二组相似。     

NP方案和CAP方案治疗晚期非小细胞肺癌疗效对比分析

目的：对比性观察分析长春瑞滨＋顺铂(NVB＋DDP)方案与环磷酰胺＋阿霉素＋顺铂(CAP)方案治疗非小细胞肺癌的临床疗效。方法：48例Ⅲ—IV期NSCLC肺癌采用NVB25mg／m＾2dl，5iv；DDP35mg／m^2dl—3天联合方案及56例Ⅲ—IV期NSCLC采用CAP方案。即CTx600mg／m^2dl天，ADM35mg／m^2dl天，DDP30mg／m^2dl-3天。结果：NP组：CR＋PR＝24例，有效率50％，中位缓解期5．5个月，中位生存期11个月。CAP组：CR＋PR＝20例，有效率35．7％，中位缓解期4个月、中位生存期8个月。主要毒副反应：NP组为骨髓抑制及静脉炎，cAP组为消化道反应、脱发、心电图改变。结论：NP组联合化疗治疗晚期NSCLC疗效较高，副作用可以耐受，值得临床推广应用。     

GP方案与NP方案治疗晚期非小细胞肺癌的对比研究

目的观察吉西他滨(GEM)联合顺铂(DDP)与长春瑞滨(NVB)联合DDP治疗晚期非小细胞肺癌(non-small-celllungcanc-er,NSCLC)的疗效及毒副反应。方法GP方案组41例,GEM1000mg/m2第1,8天静脉滴注,DDP40mg第1~3天静脉滴注,水化;NP方案组52例,NVB25mg/m2第1,8天静脉滴注,DDP40mg第1~3天静脉滴注,水化;均21d为1个周期,治疗4个周期后按WHO疗效及毒副反应标准评价。结果GP方案41例,PR17例,SD20例,PD4例,有效率(RR)41.5%;主要毒副反应为骨髓抑制,其中Ⅲ~Ⅳ度白细胞降低为26.8%,此外约50%的患者表现为疲乏和食欲不振,化疗结束后即能恢复。NP方案组52例,PR21例,SD25例,PD6例,RR40.4%,与GP方案组比较差异无统计学意义,P>0.5。NP方案的主要毒副反应为骨髓抑制,Ⅲ~Ⅳ度白细胞下降为26.9%,与GP方案组下降26.8%比较差异无统计学意义,P>0.5。NP方案组局部静脉炎的发生率为19.2%,与GP方案组比较有显著统计学意义,P<0.05。结论GP方案和NP方案对晚期NSCLC均有一定的客观肿瘤缓解率,毒副反应低,值得临床应用。     

Importance of biologic status to the postoperative prognosis of patients with stage III nonsmall cell lung cancer

The prognosis of patients with stage III nonsmall cell lung cancer was studied, with special attention to their biologic status prior to lung resection. The biologic status was estimated from the neutrophil/lymphocyte ratio in the peripheral blood, serum albumin level, and erythrocyte sedimentation rate. Among 46 patients who underwent potentially curative operations, 31 cases of biologic status A or B (more than two parameters normal) revealed 37.6% of a 5-year survival rate, whereas there was no 5-year survivor in 15 cases of biologic status C or D (more than two parameters abnormal). Of the 5-year survival rate in T3N0 disease of biologic status A or B, the 60% surviving (of 10 cases) was in marked contrast to the same stage disease of biologic status C or D where only 1 patient (of 10 cases) was still surviving at more than 30 months. In 30 patients with T3N0, T3N1, and T2N2 diseases of biologic status A or B, where long-term survivors were derived, the 5-year survival rate in 30 patients of biologic status A or B was 36.6% in contrast to no long-term survivor in the same stage diseases of biologic status C or D (n = 25). We conclude that surgical results in stage III nonsmall cell lung cancer will be beneficial in patients of biologic status A or B, but nonbeneficial in patients with the same stage of biologic status C or D.     

A Phase III Study on Intermittent Versus Weekly Cisplatin and Etoposide in the Treatment of Advanced Non-Small Cell Bronchogenic Carcinoma

Summary

A group of 55 patients with advanced non-small cell bronchogenic carcinoma entered a random study on combined cisplatin (CDDP) and etoposide (VP16), either intermittendy (I = CDDP 60 mg/m² day 1 and VP16 120 mg/m2 day 1-3 every 3-4 weeks) or weekly (W = CDDP 20 mg/m² and VP16 120 mg/m²). Five out of 31 (16%) évaluable patients in group I and 6/27 (22%) in group W obtained partial remission (no statistical difference). Toxicity was mild and survival was similar for both groups. The authors conclude that the weekly combination of CDDP plus VP16 is neither less toxic nor more effective than the intermittent one.     

肺癌干细胞与肺癌转移相关机制的研究进展

肺癌干细胞是来源于肺癌具有自我更新及多向分化潜能的一部分细胞群,被认为是肺癌发生发展的根源,其在肺癌转移过程中扮演重要角色,可能的作用机制主要包括上皮间质转化、肿瘤微环境、肿瘤血管生成、肿瘤耐药性、信号转导通路等几个方面.本文将对肺癌干细胞与肺癌转移相关机制做进一步探索,以期为防治肺癌转移提供新策略.     

Amylase-producing lung cancer

A bronchioloalveolar carcinoma of lung associated with hyperamylasemia occurring in a 40-year-old woman is described. Another 13 cases of such a tumor from the English literature are reviewed. A majority of the lung tumors associated with hyperamylasemia were adenocarcinomas. When the amylase isoenzymes were determined, the amylase appeared to be salivary-gland type (S-type). Electron microscopic studies had revealed membrane-bound electron-dense granules within the tumor cells.     

Myasthenic syndrome (Eaton-Lambert syndrome) associated with pulmonary adenocarcinoma

A case of a 57-year-old man who presented with the clinical features of Eaton-Lambert syndrome preceding the diagnosis of lung adenocarcinoma at autopsy by 7 years, is reported. Although myasthenic syndrome is intimately associated with pulmonary small cell carcinoma, which connotes a grave prognosis, a small percentage of the tumor can be squamous cell carcinoma or adenocarcinoma, which may be resectable. Therefore, a continued search for evidence of intrathoracic neoplasm must be pursued following manifestations of myasthenic syndrome.     

老年人肺癌320例分析

目的 :研究老年人肺癌的临床特点、误诊原因及治疗方法。方法 :回顾性分析 1980～ 1999年收治的≥ 60岁肺癌 32 0例临床资料。结果 :老年人肺癌占同期肺癌的 38.0 % ,男女之比为 3∶1。临床表现以咳嗽 ( 82 .8% )、咯血 ( 4 1.0 % )、胸痛 ( 2 6.9% )、胸闷 ( 36.6% )常见 ,全身症状 75.5%和肺外表现4 3 4 %亦多见。误诊原因主要是肺外症状多、伴随基础病多、辅助检查无特异性。老年人肺癌总的 5年生存率 15.6% ,综合治疗、单纯手术、放疗、化疗及其他治疗 5年生存率分别为 30 .0 %、2 0 .0 %、5.6%、0、0。结论 :老年人肺癌发病率高 ,女性发病率上升应重视 ,掌握其临床特点 ,结合合理的辅助检查可望减少误诊。治疗方法以手术为主的综合治疗为首选。     

Lung cancer in chromate workers: high-risk group for multiple lung cancer

We diagnosed eight (8.9%) lung cancer patients in 90 workers exposed to chromate compounds. The duration of exposure ranged from 8 to 31 years, with a mean value of 18 +/- 8 years. The histological classification was squamous-cell carcinoma in seven patients and adenocarcinoma in one patient. The site of origin of the primary tumors was located peripherally in two (25%) and centrally in six (75%). All but one of these patients underwent surgery. In three (37.5%) of these patients, lung cancer foci were detected during the postoperative follow-up by sputum cytology and bronchoscopy. Two of these three patients had multicentric cancer foci: double primary early squamous-cell carcinoma in one and early squamous-cell carcinoma + small-cell lung cancer in the other. In a high-risk group such as chromate workers, we should emphasize early detection of lung cancer by serial sputum cytology, chest x-rays, and bronchoscopy. Lung cancer patients with chromate exposure should be treated with due regard to the possibility of synchronous or metachronous cancer.     

Stereotactic Ablative Radiotherapy in the Treatment of Early-Stage Lung Cancer – A Done Deal?

Stereotactic ablative radiotherapy (SABR) is an important curative-intent treatment option for early-stage non-small cell lung cancer. It offers good cancer control without invasive surgery and has become the standard of care for medically inoperable patients. The literature on SABR for early-stage non-small cell lung cancer is substantial and continues to grow. However, there remain areas of controversy where data are limited – notably the use of SABR in medically operable patients. Other areas of some debate include the treatment of central/ultra-central and large (>5 cm) lesions, as well as treatment with co-existing interstitial lung disease. This review article provides an overview of the current literature together with a discussion of future directions.     

A Phase II Study with Teniposide (VM26) in Patients with Progressed or Relapsed Small Cell Lung Cancer (SCLC)

Summary

Sixteen patients with advanced small cell lung cancer who relapsed or progressed under first-line therapy, were treated with second-line chemotherapy consisting of: teniposide, 60 mg/m², i.v. days 1-5, every 3 weeks until further progression.

The response rate was: 3 minor responses, 6 stable disease, 5 progressive disease, 1 early death and 1 not evaluable. After the introduction of teniposide, median survival was 4.5 (range 1-11) months, compared to the median survival (2 months, range 1-11) observed in 40 contemporary patients of our series, who relapsed or progressed and subsequently received no treatment. The assessment of the difference was significant: chi-square = 4.05, P<0.05. In addition a particular comparison was performed with 15/40 patients who matched according to the major predictive parameters of disease. These patients experienced 2 months (range 1-7) of median survival which was significantly shorter than that of the teniposide treated group (chi-square = 4.48, P< 0.05). On these bases, teniposide appeared to be effective, but the small size of the study suggests caution in evaluating the results.     

Dietary alpha-, beta-, gamma- and delta-tocopherols in lung cancer risk

Studies of vitamin E and cancer have focused on the alpha-tocopherol form of the vitamin. However, other forms of vitamin E, in particular gamma-tocopherol may have unique mechanistic characteristics relevant to lung cancer prevention. In an ongoing study of 1,088 incident lung cancer cases and 1,414 healthy matched controls, we studied the associations between 4 tocopherols (alpha-, beta-, gamma-, and delta-tocopherol) in the diet and lung cancer risk. Using multiple logistic regression analysis, the adjusted odds ratios (OR) and 95% confidence intervals (CI) of lung cancer for increasing quartiles of dietary alpha-tocopherol intake were 1.0, 0.63 (0.50-0.79), 0.58 (0.44-0.76) and 0.39 (0.28-0.53), respectively (p-trend < 0.0001). For dietary intake of beta-tocopherol, the OR and 95% CI for all subjects were: 1.0, 0.79 (0.63-0.98), 0.59 (0.45-0.78) and 0.56 (0.42-0.74), respectively (p-trend < 0.0001). Similar results for dietary gamma-tocopherol intake were observed: 1.0, 0.84 (0.67-1.06), 0.76 (0.59-0.97) and 0.56 (0.42-0.75), respectively (p- trend = 0.0002). No significant association between delta-tocopherol intake and lung cancer risk was detected. When the 4 tocopherols were summed as total tocopherol intake, a monotonic risk reduction was also observed. When we entered the other tocopherols in our model, only the association with dietary alpha-tocopherol intake remained significant; i.e., increasing intake of dietary alpha-tocopherol accounted for 34-53% reductions in lung cancer risk. To the best of our knowledge, this is the first report of the independent associations of the 4 forms of dietary tocopherol (alpha-, beta-, gamma- and delta-tocohperol) on lung cancer risk. Given the limitations with case-control studies, these findings need to be confirmed in further investigations.