长春瑞滨联合足叶乙甙、顺铂治疗复发性难治性非霍奇金淋巴瘤

目的:研究长春瑞滨、足叶乙甙、顺铂(NEP方案)联合治疗难治性中高度恶性非霍奇金淋巴瘤的临床疗效及主要不良反应.方法:32例难治性中高度恶性非霍奇金淋巴瘤病人用NEP方案治疗,长春瑞滨25mg/m2静脉滴注,第1、8天;足叶乙甙80mg/m2,静脉滴注,第1天～5天;顺铂30mg/m2,静脉滴注,第1天～3天;21天～28天为1周期,连用2周期评定疗效. 结果:缓解率为78.1%(25/32);完全缓解率(CR)为25.0%(8/32),部分缓解率为53.1%(17/32).主要不良反应为骨髓抑制,白细胞减少的发生率为87.5%,Ⅲ～Ⅳ度的为40.6%,血红蛋白及血小板减少的发生率分别为34.4%和47.0%.脱发的发生率为50.0%,其它不良反应少见.结论:NEP方案可作为复发性、难治性中高度恶性淋巴瘤的解救治疗.     

IEP方案治疗37例复发性、难治性非霍奇金淋巴瘤

[目的]研究复发性，难治性中高度恶性非零奇金淋巴瘤的解救治疗。[方法]37例复发性，难治性中高度恶性非霍奇金淋巴瘤病人用IEP方案治疗；异环磷酰胺（IFO）2g静脉点滴，第1-4天（同时使用美斯纳）；足叶乙甙（Vp-16)100mg，静脉点滴，第1-4天；顺铂30mg/m^2，静脉点滴，第1-3天；21-28天为1周期，连用2周期评定疗效。[结果]总缓解率为81.1%(30/37)。完全缓解率（CR）为35.1%(13/37)，部分缓解率为45.9%(17/37)。主要不良反应为骨髓抑制和脱发，白细胞减少发生率为83.8%，其中Ⅲ-Ⅳ度发生率占43.2%。血红蛋白及血小板减少发生率分别为37.8%和43.2%。脱发发生率为91.2%，其它不良反应湛和见。[结论]IEP方案可作为复发性，难治性中高度恶性淋巴瘤的解救治疗。     

EPOCH方案治疗复发耐药NHL临床疗效

目的：评价EPOCH方案作为挽救方案的疗效及耐受性。方法：2004年6月至2006年12月应用EP-OCH方案治疗我院收治的复发耐药中高度恶性非霍奇金淋巴瘤（NHL）31例，每例至少接受过2个化疗方案的治疗，采用VP-1650mg／m^2/d、ADM或THP10mg／m^2／d、VCR0．4mg／m^2／d持续静脉滴注第1—4天。CTX750mg／m^2／d静推第6天，强的松60rag／m^2／d口服第1—5天，21天为1个疗程。结果：评价疗效者31例，评价不良反应疗程数为67，总有效率54．9％，其中完全缓解6例（19．4％），部分缓解11例（35．5％）。不良反应为骨髓抑制，其他系统不良反应少见。结论：EPOCH作为复发耐药中高度恶性NHL的挽救化疗方案经济有效，毒性可耐受。通过持续静脉滴注的给药途径可能减低肿瘤细胞的耐药率和化学毒性。     

VIM方案治疗复发与难治性非霍奇金淋巴瘤

目的 观察VIM方案(足叶乙甙、异环磷酰胺、米托蒽醌）治疗复发与难治性非霍奇金淋巴瘤（non-Hodgkin lymphoma,NHL)的疗效与毒性。方法 40例中高度恶性NHL，8例难治性，32例2次以上复发。治疗方案：足叶乙甙（VP－16）65mg/m^2、异环磷酰胺（IFO）1.0g/m^2静滴，d1-3；米托蒽醌（MIT）8mg/m^2静注，d1。结果 总缓解率55％（7例CR，15例PR）。缓解期2－29月，中位缓解期25月。毒性反应主要是骨髓抑制，大多数为I、Ⅱ度。结论 VIM方案治疗复发与难治性NHL较安全有效。     

美罗华联合CHOP方案治疗侵袭性B细胞淋巴瘤45例临床疗效观察

目的：观察美罗华（利妥昔单抗，Rituximab）联合CHOP（RCHOP）方案治疗侵袭性B细胞非霍奇金淋巴瘤的临床疗效、不良反应。方法：45例CD20阳性的B细胞非霍奇金淋巴瘤患者，随机分为RCHOP组（22例）和CHOP对照组（23例），分别采用美罗华联合CHOP和单用CHOP方案治疗．CHOP方案：环磷酰胺750mg／m^2．静脉注射，d1；吡喃阿霉素40mg／m^2或表阿霉素60mg／m^2，静脉注射，d1；长春新碱1．4mg／m^2，静脉注射，d1；强的松100mg．口服，d1～d5，每21天为1个周期、重复治疗。RCHOP方案：美罗华375mg／m^2，静脉滴注，每1个周期第1天（d1）；第3天开始CHOP方案，每21天为1个周期，重复治疗。全部45例患者完成4个周期化疗后进行疗效评价．随访观察生存情况。结果：RCHOP组完全缓解率（CR）为68．2％，总有效率为81．8％；CHOP组分别为34．8％、78．3％，两组CR率有显著性差异（P〈0．05）。RCHOP组1年总生存率（OS）为90．9％，2年OS为81．8％．3年OS为773％；CHOP组分别为91.3％、69．5％、47．8％；两组患者的3年OS有显著性差异（P〈0．05），两组患者不良反应主要为轻中度骨髓抑制和胃肠道反应，不良反应发生率相近（P〉0．05），均可耐受。RCHOP组6例（27．2％）出现美罗华输注相关的不良反应．经对症处理后好转。结论：美罗华联合CHOP（RCHOP）方案治疗侵袭性B细胞非霍奇金淋巴瘤疗效显著，患者耐受良好．应推荐作为首选方案．     

ABVD-21方案治疗霍奇金淋巴瘤37例

目的观察ABVD-21方案治疗霍奇金淋巴瘤（HL）的临床疗效和不良反应。方法多柔比星（ADM）25mg／m^2，静脉滴注，第1、8天；博莱霉素（BLM）10mg／m^2，肌肉注射，第1、8天；长春新碱（VCR）1．4mg／m^2，静脉滴注，第1、8天；氮烯咪胺（DTIC）375mg／m^2，静脉滴注，第1、8天；每21d重复，每例至少完成4个周期的化疗。结果全组37例患者均可评价疗效，CR33例（89．17％），PR2例（5．41％），SD1例（2．70％），PD1例（2．70％），总有效率（CR＋PR）94．59％，3年无失败生存（FFS）81．08％，3年无复发生存（RFS）91．89％，3年总生存率（OS）94．59％，Ⅲ～Ⅳ度粒细胞减少仅8．10％。结论ABVD-21方案治疗HL有效率高，毒副作用可耐受，值得进一步应用。     

EPOCH方案治疗复发难治侵袭性非霍奇金淋巴瘤32例

【摘要】目的观察EPOCH方案治疗复发难治侵袭性非霍奇金淋巴瘤（NHL）的疗效及安全性。方法选择经病理确诊的复发难治侵袭性NHL患者32例,应用EPOCH方案化疗,观察其近期疗效和不良反应。具体用药为依托泊苷（VP16）每天50mg／m^2,多柔比星（ADM）或吡柔比星（THP）每天10mg／m^2,长春新碱（VCR）每天0．4mg／m^2持续静脉滴注,第1天至第4天,环磷酰胺（CTX）每天750mg／m^2静脉滴注第5天,泼尼松每天60mg／m^2口服第1天至第5天,21d为1个疗程。结果32例患者总有效率62．5％,完全缓解（CR）率21．9％,部分缓解（PR）率40.6％,主要不良反应为骨髓抑制。结论EPOCH方案可作为复发难治侵袭性NHL的治疗方案,缓解率高,安全性好,其长期疗效有待进一步观察。     

异环磷酰胺为主的联合方案治疗26例复发性非霍奇金淋巴瘤

目的 研究复发性中高度非霍奇金淋巴瘤（NHL）的解救治疗。方法26例患者均采用DICE方案化疗，异环磷酰胺（IFO）1．0g／m。静滴，第1～4天；美司钠（Mesna）用量为IFO的60％于IFO0、4、8h静脉冲入；地塞米松（Dexamethasone）10mg静滴，第1～4天；顺铂（DDP）25mg／m^2静滴，第1～4天；足叶乙甙（Vp-16）100mg／m^2静滴，第1～4天。4周为1疗程，连用2疗程评价疗效。结果CR23．1％（6／26），PR46．1％（12／26），RR69．2％（18／26），毒副反应主要是骨髓抑制、恶心、呕吐、脱发等。给予对症处理后均能缓解，无治疗相关病死率。结论DICE方案可作为复发性中高度NHL的解救治疗。     

亚砷酸联合吉西他滨和顺铂治疗难治性或复发性非霍奇金淋巴瘤

目的：观察亚砷酸注射液（三氧化二砷,As2O3）联合吉西他滨和顺铂方案治疗难治性或复发性非霍奇金淋巴瘤（NHL）的有效率。方法：18例难治性或复发性NHL患者,男性12例,女性6例,中位年龄51岁。给予As2O3注射液10mg／d静脉滴注第1—14天,吉西他滨1000mg／m^2,第1和第8天,顺铂25mg／m^2第1—3天,21d为1个周期。结果：18例患者中完全缓解4例,部分缓解7例,有效率61．1％。肿瘤中位进展时间（TTP）6．5个月,1年生存率42．3％。不良反应主要为血液学毒性、肝肾功能损害。结论：亚砷酸注射液联合吉西他滨和顺铂方案是治疗复发或难治性非霍奇金淋巴瘤较为安全、有效的化疗方案。     

铂类为基础的三种化疗方案治疗晚期非小细胞肺癌的临床研究

目的：观察紫杉醇（paclitaxel，Taxel）、长春瑞滨（vinorelbine，NVB）、吉西他滨（gemcitabine，GEM）分别联合顺铂（cisplatin，DDP）方案对晚期非小细胞肺癌（non—small cell lung cancer，NSCLC）的疗效及毒副反应。方法：93例晚期非小细胞肺癌患者随机分为TP组（紫杉醇＋顺铂）32例、NP组（长春瑞滨＋顺铂）31例、GP组（吉西他滨＋顺铂）30例。给药方法：紫杉醇135mg／m^2，第1天；长春瑞滨25mg／m^2，吉西他滨1000mg／m^2，均在第1、8天使用；顺铂80mg／m^2，分2天使用。统计各组有效率（CR＋PR）、中位生存期（median duration of survival）、1年生存率（1year survival rate）。结果：TP组有效率（CR＋PR）为43．8％，中位生存期为8．6月，1年生存率为32．1％；NP组有效率为38．7％，中位生存期为8．4月，1年生存率为26．5％；GP组有效率为36．7％，中位生存期为9．4月，1年生存率为38．1％，三组间疗效无显著差异（P〉0．05）。主要不良反应为骨髓抑制、消化道反应，均可耐受。11P组骨髓抑制发生率相对较高，NP组静脉炎发生率高于TP、GP组，有显著性差异（P〈0．05）。结论：三种联合化疗方案对晚期NSCLC疗效确切，三种方案间无显著差异，均可作为一线化疗方案在临床应用。     

Bacteria and cancer--antagonisms and benefits

There is considerable historical and recent evidence concerning the antagonisms between acute bacterial infections or their toxins and cancer and allied diseases. These data provide renewed incentives to undertake clinical programmes with mixed bacterial vaccines in many countries at the present time.     

Religiosity and physical and emotional functioning among African American and White colorectal and lung cancer patients

The literature suggests that religiosity helps cope with illness. The present study examined the role of religiosity in functioning among African Americans and Whites with a cancer diagnosis. Patients were recruited from an existing study and mailed a religiosity survey. Participants (N = 269; 36% African American, 56% women) completed the mail survey, and interview data from the larger cohort was utilized in the analysis. Multivariate analyses indicated that in the overall sample religious behaviors were marginally and positively associated with mental health and negatively with depressive symptoms. Among women, religious behaviors were positively associated with mental health and negatively with depressive symptoms. Religiosity was not a predictor of study outcomes for men. Among African Americans, religious behaviors were positively associated with mental health and vitality. Among Whites, religious behaviors were negatively associated with depressive symptoms. These findings suggest a mixed role of religious involvement in cancer outcomes. The current findings may have applied potential in the areas of emotional functioning and depression.     

VEGF及KDR在大肠腺瘤和腺癌中的表达及意义

目的：探讨VEGF和KDR在大肠腺瘤和大肠腺癌中的表达及临床病理特征的关系。方法：大肠腺瘤和大肠腺癌组织标本各100例,采用免疫组织化学染色法检测VEGF和KDR在标本中的表达情况。结果：VEGF和KDR在大肠腺癌组中的阳性表达明显高于大肠腺瘤组（P〈0.05）;在正常大肠黏膜均未见VEGF和KDR表达的阳性染色;VEGF阳性表达组中KDR的阳性表达率为70%,显著高于VEGF阴性表达组中KDR的阳性表达率16%,两组比较有统计学意义（P〈0.01）。结论：大肠腺癌组织中KDR的表达与肿瘤大小、转移情况、浸润深度密切相关;VEGF和KDR在大肠腺瘤中的表达与患者的年龄、性别及分型均无相关性,而与增生程度相关（P〈0.05）。在大肠腺癌患者中VEGF及KDR表达更高,二者具有协同效应。     

Renal irradiation and the pharmacology and toxicity of methotrexate and cisplatinum

We used a rat model to study the effects of renal irradiation on the pharmacology of methotrexate (MTX) and cisplatinum (cis-Pt). Unanesthetized rats were given bilateral kidney irradiation (20 Gy in 9 fractions). At 9 months after irradiation, 3% of the animals had died and survivors showed moderately impaired renal function. At 15 months, 30% of the animals had died and survivors showed severely impaired renal function. Some animals were given i.v. MTX 1 week to 15 months after irradiation. In irradiated rats, the area under the MTX plasma clearance curve equaled that of controls through 6 months, and was significantly above controls from 9 months on. Other animals were given i.p. cis-Pt 1 week to 9 months after irradiation. The acute toxicity of cis-Pt was the same in control and irradiated rats when cis-Pt was given immediately before or after irradiation. Beginning 3 months after irradiation there was a progressive increase in cis-Pt toxicity and a simultaneous decrease in urinary platinum excretion. Irradiated animals that survived cis-Pt treatment showed increased radiation nephritis; the greatest effect occurred when cis-Pt was given 3 months or more after irradiation. MTX and cis-Pt clearance decreased when renal dysfunction was first observed and changes in renal function preceded changes in drug clearance and toxicity.     

Fruit and vegetables and cancer risk

The possibility that fruit and vegetables may help to reduce the risk of cancer has been studied for over 30 years, but no protective effects have been firmly established. For cancers of the upper gastrointestinal tract, epidemiological studies have generally observed that people with a relatively high intake of fruit and vegetables have a moderately reduced risk, but these observations must be interpreted cautiously because of potential confounding by smoking and alcohol. For lung cancer, recent large prospective analyses with detailed adjustment for smoking have not shown a convincing association between fruit and vegetable intake and reduced risk. For other common cancers, including colorectal, breast and prostate cancer, epidemiological studies suggest little or no association between total fruit and vegetable consumption and risk. It is still possible that there are benefits to be identified: there could be benefits in populations with low average intakes of fruit and vegetables, such that those eating moderate amounts have a lower cancer risk than those eating very low amounts, and there could also be effects of particular nutrients in certain fruits and vegetables, as fruit and vegetables have very varied composition. Nutritional principles indicate that healthy diets should include at least moderate amounts of fruit and vegetables, but the available data suggest that general increases in fruit and vegetable intake would not have much effect on cancer rates, at least in well-nourished populations. Current advice in relation to diet and cancer should include the recommendation to consume adequate amounts of fruit and vegetables, but should put most emphasis on the well-established adverse effects of obesity and high alcohol intakes.     

New and emerging radiosensitizers and radioprotectors

The combination of chemotherapy and radiation has led to clinical breakthroughs in several disease sites, and current work continues to define optimum combinations of proven chemotherapy as well as more recently available, noncytotoxic agents. Administration of systemic therapies allows modulation of radiation response to improve tumor control (radiosensitization) or to prevent normal tissue toxicity (radioprotection). Substantial progress has been made in identifying the targets of standard chemotherapeutic radiation sensitizers and protectors as well as in the introduction of a new generation of molecularly targeted therapies in combination with radiation. We have reviewed the most recent, predominantly early phase clinical trials combining systemic agents with radiation. Although the proof of an improved schedule ultimately needs to come from well-run Phase III trials, the search among schedules could be shortened by the use of surrogate endpoints such as presence of active drug metabolites in the tumor. This has been accomplished only in a few cases and needs to become a more standard part of radiation sensitizer and protector trials.