Trimetrexate in advanced hormone-refractory prostate cancer

Summary The antitumor activity and toxicity of trimetrexate (TMTX) was evaluated in measurable, hormone-refractory, advanced prostate cancer patients. Patients were required to have an ECOG performance status < 3, bidimensionally measurable disease, serum creatinine 1.5 mg/dL, normal bone marrow function, and adequate hepatic function. Prior non-hormonal systemic therapy, active infection, third space effusions were exclusion criteria. TMTX 12 mg/m² daily for five days (8 mg/m² for patients with any prior radiation therapy or age 75 years) was administered every 3 weeks. There were no responses in the 18 eligible patients. Median time to treatment failure and median survival were 6 and 20 weeks, respectively. Myelosuppression was the most frequent toxicity observed and was mild to severe in all but 4 patients. Two patients whom experienced life-threatening reversible leukopenia and grade 4 thrombocytopenia developed in 2 further patients. Non-hematologic toxicity was also reversible and was mild to severe. TMTX at this dose and schedule is inactive in advanced, hormone-refractory prostate cancer.     

Evaluation of deoxycoformycin in patients with advanced renal cell carcinoma

This study was conducted by the Eastern Cooperative Oncology Group (Paul P. Carbone, M.D., Chairman, CA 21115) and supported by Public Health Service Grants from the NCI, National Institutes of Health, and the Department of Health and Human Services.     

Phase II trial of ifosfamide in epidermoid carcinoma of the esophagus: unexpectant severe toxicity

Thirty-two patients with advanced epidermoid carcinoma of the esophagus were treated with ifosfamide (1.50 gm/m² daily × 5 days) with uroprotective mesna in a phase II study. Eighteen patients were previously untreated. Of 28 evaluable patients, two (7%) had partial remissions lasting 2+ and 6+ months. Toxicity was predominantly myelosuppression with a median WBC nadir of 1.8 cells/ul. Seven patients required hospitalization for nadir sepsis. Ifosfamide has minimal activity in esophageal cancer and causes severe myelosuppression.     

Trimetrexate in advanced renal cell carcinoma

Thirty-four chemotherapy-naive, ambulatory patients with advanced renal cell cancer were treated with the non-classical antifol trimetrexate at the intravenous dose of 12 mg/m2 daily x 5 every three weeks (8 mg/m2 qd x 5 for greater than 30% bone marrow previously irradiated). One patient experienced a partial response lasting 24 weeks for a response rate of 3% (exact 95% CI, 0.1 to 15.3%). Toxicity was manageable and primarily myelosuppression, gastrointestinal, and mucosal. Trimetrexate has little activity in advanced renal cell carcinoma at this dose and schedule.     

高龄食管癌的外科治疗

目的探讨高龄食管癌患者的外科治疗经验。方法回顾性分析本科72例70岁以上接受食管癌外科治疗患者的临床资料。结果切除率97.2%,围术期死亡1例,死亡率1.39%。结论高龄患者通过严格掌握手术适应证,术前加强对并发症的处理,尽量选择创伤小、时间短的术式,加强术后监护处理,是可以承受开胸手术,取得与普通年龄食管癌手术相似的结果。     

Phase II trial of trimetrexate in untreated advanced gastric carcinoma

Summary Twenty-three evaluable patients with advanced gastric adenocarcinoma were treated with trimetrexate at doses of 8–12 mg/m² intravenously daily for five days, with cycles repeated every 21 days. One complete response was seen for an overall response rate of 4% (95% confidence interval 0–22%). Hematologie toxicities of grade 3 were seen in 10/23 patients, and overall any grade 3 or greater toxicity was seen in 14/ 23 patients. Trimetrexate has minimal activity against gastric adenocarcinoma in this study, and no further investigation of this agent at this dose and schedule is recommended in this disease.     

高龄食管贲门癌患者围术期治疗体会(附31例分析)

目的 :提高高龄食管贲门癌患者外科手术成功率 ,降低围术期死亡率。方法 :回顾性分析 31例 70岁以上高龄食管贲门癌患者手术治疗的成功经验。结果 :31例患者全部治愈出院 ,术后并发症为 19%。结论 :对高龄食管贲门癌患者的手术治疗应持积极态度。术前手术适应证的选择、合理的围术期处理是预防术后并发症、降低死亡率的关键     

羟基喜树碱联合顺铂和平阳霉素治疗Ⅳ期食管癌临床分析

目的评价羟基喜树碱联合顺铂和平阳霉素治疗Ⅳ期食管癌的疗效和毒性。方法经病理证实的46例Ⅳ期食管癌病人,采用羟基喜树碱 顺铂 平阳霉素方案:羟基喜树碱10m g连续7天;顺铂30m g/m2,第1~3天应用;平阳霉素16m g,第1.8天应用,21天为1周期。结果完全缓解(CR)2例,部分缓解(PR)20例,稳定(SD)18例,进展(PD)6例,总有效率47.8%。初治25例中,CR PR 15例,有效率为60.0%。复治21例中CR PR 6例,有效率达28.6%。两组差异有显著性(P<0.05)。毒副反应为骨髓抑制和胃肠道反应。结论羟基喜树碱联合顺铂和平阳霉素对Ⅳ期食管癌疗效较好,毒副反应可以耐受。     

Prevention and therapy of squamous cell carcinoma of the rodent esophagus using freeze-dried black raspberries

Aim： This study was conducted to determine if short-term treatment of Nnitrosomethylbenzylamine （NMBA）-induced tumors in the rat esophagus with dietary freeze-dried black raspberries （FBR） would result in tumor regression and enhanced survival of the animals. Methods： Four-week-old male Fisher-344 rats were administered an AIN-76A control diet and injected subcutaneously with 0.5 mg/kg NMBA once per week for 15 weeks. At 19 weeks, when rats had an average of 5-6 tumors （papillomas） per esophagus, they were given a control diet containing either 5%, 10%, or 20% FBR. After 7 weeks of berry treatment, all surviving rats were killed and tumor incidence, number and volume were determined. Results： Esophageal tumor incidences, numbers and volumes in NMBA-treated rats were not influenced by any of the berry treatments. There were progressive increases in the survival of NMBA-treated rats fed 5%-20% FBR diets; however, these increases were not significant. Conclusion： FBR at 5%, 10%, and 20% of the diet had no effect on the development of NMBA-induced tumors in the rat esophagus or on animal survival when administered for 7 weeks beginning at the papilloma stage of tumor development. Thus, FBR appear to have no therapeutic value in the treatment of esophageal tumors. In contrast, dietary FBR are highly effective in preventing the development of NMBA-induced esophageal tumors in rats when administered before and during NMBA treatment or shortly after NMBA treatment when the esophagi contain preneoplastic （dysplastic） lesions of varying degrees of severity.     

食管癌术后残余食管和胸腔胃运动功能对胃食管反流的影响

目的探讨食管癌术后残余食管和胸腔胃运动功能改变对胃食管反流的影响。方法定期对食管中段癌术后患者46例(A组)进行食管测压、显示子胃排空和24-h食管pH监测,结果与健康志愿者11例(B组)作比较。结果 A组手术后和术后12个月残余食管和胸腔胃运动功能均低于B组(P<0.01和P<0.05)。A组胸胃排空率与DeMeester评分之间以及长于5min反流评分与残余食管原发蠕动幅度、蠕动次数之间均无相关关系(P>0.05)。结论食管癌术后胸腔胃和残余食管运动功能的恢复不足以减轻胃食管反流以及改善食管酸清除功能。     

PTX与LFP方案治疗晚期食管癌的临床观察

目的观察紫杉醇（PTX）联合LFP方案治疗晚期食管癌的近期疗效及毒反应。方法46例晚期食管癌采用PTX＋LFP方案，PTX按周剂量给药，即PTX80mg／m^2，静脉滴注，1次／周，连续2周，LFP方案常规给药。21d为1个周期，至少完成两周期评价。结果全组46例均可评价疗效，28例初治有效率67．8％，18例复治有效率50．0％，总有效率60．8％，主要毒副作用为骨髓抑制。结论PLFP方案治疗晚期食管癌疗效较好，毒反应可以耐受，可作为治疗晚期食管癌的有效方案。     

First-line treatment in the management of advanced renal cell carcinoma: systematic review and network meta-analysis

Objectives: To conduct a systematic review and network meta-analysis (NMA) to assess effectiveness of first-line treatments for advanced renal cell carcinoma (RCC).

Methods: Database searches were conducted to identify randomized controlled trials (RCTs) reporting results for eligible treatments. A fixed-effect Bayesian NMA was conducted to assess the relative effectiveness of treatments, with progression-free survival (PFS) reported as hazard ratios (HRs) and 95% credible intervals (CrIs).

Results: Eleven unique RCTs were suitable for inclusion in the NMA. In the base case, in terms of PFS, sunitinib was superior compared with bevacizumab + IFN-α (HR = 0.79, 95% CrI: 0.64 – 0.96), everolimus (HR = 0.70, 95% CrI: 0.56 – 0.87), sorafenib (HR = 0.56, 95% CrI: 0.40 – 0.77) and temsirolimus + bevacizumab (HR = 0.74, 95% CrI: 0.56 – 0.96). Although, the point values for the mean and median HRs were < 1.0, there was no significant difference in PFS between sunitinib and axitinib, pazopanib or tivozanib. Although sensitivity analyses impacted the results of the NMA, no treatment was significantly more efficacious than sunitinib.

Conclusion: Results from this analysis suggest that there is no treatment superior to the current benchmark treatment, sunitinib, in the management of advanced RCC in the first-line setting.     

食管癌和贲门癌切除器械吻合1360例

目的评价食管癌和贲门癌切除器械吻合的效果。方法笔者1998-08～2006-03应用圆型吻合器对1 360倒食管、贲门癌切除后进行机械吻合。其中男760例,女600例。年龄16～88岁。食管癌800例,贲门癌560例。食管胃颈部吻合12例,胸顶吻合98例,弓上吻合620例,弓下吻合630例。结果术后出现吻合口瘘7例(0．5%),发生术后吻合口狭窄22例(1．6%),术中吻合出现器械故障20例(1．5%)。结论消化道圆型吻合器在上消化道重建手术中是安全可靠的,器械吻合是减少术后吻合口瘘的有效技术。     

上段食管癌的非开胸切除

目的探讨上段食管癌的手术治疗术式和操作要点。方法回顾分析了我科1996年4月至2002年12月收治上段食管癌74例患者，肿瘤下缘均在主动脉弓上缘以上，采用非开胸切除，胃或结肠代食管颈部吻合。结果74例均顺利完成手术，32例上胸骨劈开，全喉全食管切除5例，结肠代食管6例，吻合口瘘5例．肺部感染2例，喉返神经损伤2例，胃排空障碍1例，呼吸衰竭死亡1例。结论本报告方法避免开胸、创伤小，操作方便且效果满意。     

肿瘤转移抑制基因表达与晚期食管癌对铂类药物化疗敏感性的关系

目的 探讨肿瘤转移抑制基因(nm23-H1)在晚期食管癌中表达与化疗敏感性的关系.方法 应用免疫组化分析方法,检测57例食管癌患者nm23-H1表达,以铂类为主化疗至少2个疗程后进行化疗效果评价.结果 nm23-H1阳性率为42.1%,与食管癌的临床组织分级有关,而与淋巴结转移、性别、年龄、位置及细胞分化无关; nm23-H1 ( )的患者,其化疗敏感性明显优于nm23-H1(-)患者.结论 晚期食管癌患者中,恶性度越高,nm23-H1表达越高.nm23-H1提示术后以铂类药物为主的化疗敏感性.     

晚期自发性食管破裂治疗方法探讨

目的探讨晚期自发性食管破裂的治疗方法。方法回顾性分析本院1997年1月至2008年12月22例晚期自发性食管破裂患者的治疗方法,8例患者选用食管内支架置入,13例作剖胸探查、食管裂口带蒂膈肌瓣修复,1例仅作胸腔引流及肠道营养支持。结果全组治愈18例,治愈率81.8%,死亡4例,死亡率18.2%。8例患者食管内支架置入,治愈率87.5%,其中1例并发支架下滑移位,经更换支架后30d治愈出院,另1例因支架造成严重的食管瘘及胸腔感染死亡,其余6例患者术后无明显并发症,平均住院29d治愈出院。13例剖胸手术患者,治愈率84.6%,术后2例出现严重食管瘘及胸腔感染,并因多脏器功能衰竭死亡,其余11例患者无严重并发症,平均住院38天治愈出院。1例仅作胸腔引流、肠道营养支持患者因胸腔感染出现多器官功能衰竭死亡。结论晚期自发食管破裂患者应该积极治疗,食管内支架置入或剖胸探查、食管裂口带蒂膈肌瓣修复,是可以选择的方法,但选择哪一种治疗方法更为合适,应该因病情、病变部位以及临床经验等具体情况而定。     

食管贲门癌器械吻合600例无吻合口瘘临床分析

目的：探讨消化道吻合器在食管癌和贲门癌手术中的临床应用效果。方法：连续应用消化道吻合器对600例食管、贲门癌切除后行机械吻合。其中食管癌320例,贲门癌280例。胸顶吻合8例,弓上吻合120例,弓下吻合432例。结果：术后无吻合口瘘发生．吻合口狭窄12例（2．00％）。结论：消化道吻合器在上消化道重建手术中是安全可靠,是避免和减少术后吻合口瘘的有效方法。     

NP与FP方案治疗晚期食管鳞癌的临床对比观察

目的：比较长春瑞滨（NVB）联合顺铂（DDP）与氟尿嘧啶（5-Fu）联合顺铂治疗晚期食管鳞癌的疗效和毒副作用。方法：62例晚期食管鳞癌患者随机分为NP组和FP组。分别采用NP（NVB＋DDP）和FP（5-Fu＋DDP）方案化疗。结果：NP组有效率53．3％,FP组有效率34．4％,两组间比较,差异有统计学意义（P〈0．05）;毒副作用除局部静脉炎NP组高于FP组外,其余相同。结论：NP方案治疗晚期食管鳞癌优于FP方案,值得临床上进一步观察和研究。