CT引导下经皮穿刺植入125I粒子治疗老年中心型肺癌近期疗效分析

目的:探讨CT引导下经皮穿刺组织间植入125I粒子治疗老年中心型肺癌的近期疗效。方法:30例老年中心型肺癌(鳞状细胞癌),随机分成A、B两组,A组为125I粒子治疗组(15例),采用经皮穿刺组织间125I粒子植入术,125I粒子放射性活度为0.8mCi/颗,据TPS计划系统确定粒子放射性总活度和布源。B组为对照组(15例),采用经支气管动脉化疗药物灌注术,灌注的化疗药物为环磷酰胺、多柔比星及顺铂。结果:A组总有效率86.67%,B组总有效率53.33%,二者比较差异有统计学意义,P<0.05。A组病例治疗后新发生椎体(T12)转移1例;B组病例治疗后新发生纵隔淋巴结转移1例,脑转移1例。结论:经皮穿刺组织间植入125I放射微粒子治疗老年中心型肺癌(鳞状细胞癌)近期疗效显著,优于单纯经支气管动脉化疗药物灌注术。     

CT引导下经皮穿刺植入^125I粒子治疗老年中心型肺癌近期疗效分析

目的：探讨CT引导下经皮穿刺组织问植入^125I粒子治疗老年中心型肺癌的近期疗效。方法：30例老年中心型肺癌（鳞状细胞癌），随机分成A、B两组，A组为^125I粒子治疗组（15例），采用经皮穿刺组织间^125I粒子植入术，^125I粒子放射性活度为0．8mCi／颗，据TPS计划系统确定粒子放射性总活度和布源。B组为对照组（15例），采用经支气管动脉化疗药物灌注术，灌注的化疗药物为环磷酰胺、多柔比星及顺铂。结果：A组总有效率86．67％，B组总有效率53．33％，二者比较差异有统计学意义，P〈0．05。A组病例治疗后新发生椎体（T12）转移1例；B组病例治疗后新发生纵隔淋巴结转移1例，脑转移1例。结论：经皮穿刺组织间植入^125I放射微粒子治疗老年中心型肺癌（鳞状细胞癌）近期疗效显著，优于单纯经支气管动脉化疗药物灌注术。     

经支气管动脉化疗药物灌注术联合^125I粒子植入治疗老年中心型肺癌近期疗效分析

为探讨经支气管动脉化疗药物灌注术联合CT引导下经皮穿刺组织间植入^125I粒子治疗老年中心型肺癌的近期疗效。将30例老年中心型肺癌（鳞状细胞癌）随机分为A、B组,A组（15例）为联合组,在行支气管动脉灌注化疗1周后CT引导下经皮穿刺组织间植入^125I粒子。单颗粒子活度为0.8mCi,根据TPS计划系统确定125I粒子总活度并布源,每例患者植入粒子在25～40粒。B组（15例）为对照组,单纯采用支气管动脉灌注化疗,两组患者所用化疗药物为CTX、ADM及DDP。结果示A组总有效率（CR＋PR）为86.67%,B组为53.33%,两者比较差异有统计学意义,P=0.0472。初步研究结果显示,经支气管动脉化疗药物灌注术联合经皮穿刺组织间植入^125I放射微粒子治疗老年中心型肺癌（鳞状细胞癌）近期疗效显著,优于单纯经支气管动脉化疗药物灌注术。     

经支气管动脉化疗药物灌注术联合125Ⅰ粒子植入治疗老年中心型肺癌近期疗效分析

为探讨经支气管动脉化疗药物灌注术联合CT引导下经皮穿刺组织间植入125Ⅰ 粒子治疗老年中心型肺癌的近期疗效.将30例老年中心型肺癌(鳞状细胞癌)随机分为A、B组,A组(15例)为联合组,在行支气管动脉灌注化疗1周后CT引导下经皮穿刺组织间植入125Ⅰ粒子.单颗粒子活度为0.8 mCi,根据TPS计划系统确定125Ⅰ粒子总活度并布源,每例患者植入粒子在25～40粒.B组(15例)为对照组,单纯采用支气管动脉灌注化疗,两组患者所用化疗药物为CTX、ADM及DDP.结果示A组总有效率(CR+PR)为86.67%,B组为53.33%,两者比较差异有统计学意义,P=0.047 2.初步研究结果显示,经支气管动脉化疗药物灌注术联合经皮穿刺组织间植入125Ⅰ放射微粒子治疗老年中心型肺癌(鳞状细胞癌)近期疗效显著,优于单纯经支气管动脉化疗药物灌注术.     

~(125)I粒子植入联合支气管动脉灌注化疗栓塞治疗肺鳞癌的临床应用

目的探讨125I粒子植入联合支气管动脉灌注化疗栓塞治疗肺鳞癌的临床价值。方法选取2010年1月至2012年4月间收治的30例肺鳞癌患者,先行支气管动脉灌注化疗栓塞术,2⁴d之后行125I粒子植入术,术前采用计算机治疗计划系统(TPS)模拟布源,计算术中所需125I粒子的总活度及粒子数量。在CT引导下,将125I粒子植入瘤体区。术后1、2、4个月时行CT扫描,参照世界卫生组织(WHO)实体肿瘤疗效评价标准进行评价。结果125I粒子植入联合支气管动脉灌注化疗栓塞治疗后1、2、4个月的有效率分别为63.3%、93.3%和96.7%。全组30例患者均全部完成治疗,所有患者未出现严重并发症,化疗不良反应轻。结论125I粒子植入联合支气管动脉灌注化疗栓塞术作为治疗肺鳞癌患者的一种重要方法,临床疗效较为确切,治愈率较高,比较安全,值得推广应用。     

125I放射性粒子植入联合三维适形放疗治疗局部非小细胞肺癌的疗效

目的:探讨125I 放射性粒子(125I 粒子) 植入联合三维适形放疗治疗非小细胞肺癌的放射剂量、安全性和近期疗效.方法:对经病理学确诊的16例非小细胞肺癌病人(均为周围型,腺癌9 例,鳞癌7例) 予外照射(8MV的X线常规放疗) 治疗,60-66Gy/(30-33) 次.1-2个月左右复查胸部CT,观察肿瘤退缩情况,并开始应用125I 粒子.术前经三维立体定向125I 粒子植入放射治疗计划系统(TPS) 制定治疗计划,根据TPS 结果计算所需125I 粒子数和布源方法.在CT 引导下经皮穿刺组织间植入125I 粒子,内照射剂量为90-120Gy.术后应用TPS 进行剂量验证.结果:125I 粒子植入术后每3 个月左右复查胸部CT,肺部肿瘤完全消退者4例,部分退缩者12例.16例病人接受植入术中发生少量气胸者2 例;4 例出现咳血痰,给予止咳和止血药物后1-2d 症状消失.结论:125I 粒子植入联合外照射治疗非小细胞肺癌是一种有效的方法,且肺放射性损伤程度低,值得进一步研究.     

^125I放射性粒子植入联合三维适形放疗治疗局部非小细胞肺癌的疗效

目的：探讨^125I放射性粒子（^125I粒子）植入联合三维适形放疗治疗非小细胞肺癌的放射剂量、安全性和近期疗效。方法：对经病理学确诊的16例非小细胞肺癌病人（均为周围型,腺癌9例,鳞癌7例）予外照射（8MV的X线常规放疗）治疗,60-66Gy/（30-33）次。1-2个月左右复查胸部CT,观察肿瘤退缩情况,并开始应用^125I粒子。术前经三维立体定向^125I粒子植入放射治疗计划系统（TPS）制定治疗计划,根据TPS结果计算所需^125I粒子数和布源方法。在CT引导下经皮穿刺组织间植入^125I粒子,内照射剂量为90-120Gy。术后应用TPS进行剂量验证。结果：^125I粒子植入术后每3个月左右复查胸部CT,肺部肿瘤完全消退者4例,部分退缩者12例。16例病人接受植入术中发生少量气胸者2例;4例出现咳血痰,给予止咳和止血药物后1-2d症状消失。结论：^125I粒子植入联合外照射治疗非小细胞肺癌是一种有效的方法,且肺放射性损伤程度低,值得进一步研究。     

CT引导下125I 粒子植入联合化疗治疗复发性卵巢癌

目的:探讨CT引导下125I 粒子植入联合化疗治疗复发性卵巢癌患者的临床疗效及安全性。方法:回顾性分析采用125I粒子植入联合化疗治疗的21例复发性卵巢癌患者资料。共29处可评价病灶,其中25处适合125I 粒子植入治疗。应用治疗计划系统制定125I 粒子植入计划,在CT引导下植入粒子。粒子植入术后3 d 内行紫杉醇脂质体静脉化疗,次日经肿瘤供血动脉灌注卡铂,每3 周重复1 次,随访观察治疗效果及并发症。结果:2 个疗程化疗结束后125I 粒子植入治疗的25处病灶中完全缓解（CR）为16%（4/25）、部分缓解（PR）为56%（14/25）、疾病稳定（SD）为12%（3/25）、疾病进展（PD）为16%（4/25）,总有效率（CR+PR）为72%（18/25）,疼痛缓解率为82.4%（14/17）,KPS 评分较治疗前升高（P=0.019）。 中位无进展生存时间（PFS）为6.8 个月,中位生存时间（OS）为14.2 个月,1 年生存率为42.9%（9/21）,主要为血液学及消化道不良反应,所有患者未发生严重的放射性损伤并发症。结论:125I粒子植入治疗联合化疗能够提高复发性卵巢癌患者的临床缓解率,改善临床症状,并且耐受性良好。      

支气管动脉灌注化疗药物联合放疗治疗小细胞肺癌的临床分析

目的　观察支气管动脉灌注化疗药物联合放疗对治疗小细胞肺癌的近期疗效及全身副作用。方法　 2 0 0 0年 5月～ 2 0 0 1年 5月 5 0例小细胞肺癌进入该研究。治疗组 2 5例 ,中央型 16例 ,周围型 9例 ,采用支气管动脉灌注丝裂霉素 +托马克 +顺铂 ,联合放疗。对照组 2 5例 ,中央型 14例 ,周围型 11例 ,采用丝裂霉素 +托马克 +顺铂单纯全身化疗。结果　治疗组有效率 92 %明显高于对照组的有效率 80 % ,但统计学上无显著性差异。治疗组中央型和周围型有效率分别为 94%和 89% ,全身副反应方面 ,如胃肠道反应、骨髓抑制 ,治疗组和对照组发生率分别为 16%、2 0 %和 72 %、64 % ,有显著差异性。结论　支气管动脉灌注化疗联合放疗治疗小细胞肺癌疗效较高 ,全身毒副反应少。     

免疫因子癌灶注射联合动脉灌注化疗双介入治疗晚期肺癌(附17例报告)

目的　评价免疫因子癌灶注射联合支气管动脉灌注化疗双介入治疗晚期肺癌的临床价值。材料与方法　对17例失去手术机会的晚期肺癌采用双介入疗法，即经纤维支气管镜或经皮直接穿刺癌灶局部注射免疫因子联合支气管动脉灌注化疗（BAI）治疗，并与16例同期单作BAI治疗肺癌病例作疗效对照研究。结果　双介入组完全缓解（CR）2例，部分缓解（PR）13例，近期显效率（CR＋PR）为83．23％，明显优于单纯BAI的CR＋PR56．25％（P<0．05），而且有6例经治疗后，影像学检查提示有II期手术机会。结论本“双介入疗法”对中晚期肺癌有较好疗效，特别是对中央型者有较大临床价值。     

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.     

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     

奥沙利铂联合羟基喜树碱治疗晚期胃癌临床分析

背景与目的体外及体内的临床研究显示,奥沙利铂(L-OHP)对多种肿瘤有显著抑制作用并与绝大多数抗癌药物具有相加或协同细胞毒作用.本文旨在观察L-OHP联合羟基喜树碱(HCPT)治疗晚期胃癌的近期疗效和患者耐受性,并与传统的化疗方案进行对比.方法采用非随机的分组方法将43例晚期胃癌患者分为L-OHP+HCPT方案组(治疗组)与Vp-16+CF+5-FU(ELF)方案组(对照组),其中男性28例,女性15例,中位年龄59岁,KPS评分≥60,观察两组的近期疗效和患者耐受性.结果治疗组24例有效率58.3%(14/24),对照组19例有效率42.1%(8/19).治疗组有效率高于对照组,两组差异有显著性(P<0.05).两组不良反应主要是骨髓抑制、恶心、呕吐、口腔炎、周围神经炎、静脉炎、脱发等,均在Ⅰ、Ⅱ度范围内.结论L-OHP联合HCPT方案治疗晚期胃癌疗效较好,不良反应可以耐受.     

Varicella-Zoster Virus Prophylaxis with Low-Dose Acyclovir in Patients with Multiple Myeloma Treated with Bortezomib

BackgroundVaricella-zoster virus (VZV) reactivation is a common complication in patients with multiple myeloma (MM) treated with bortezomib, with an incidence rate of 10%-60%. The aim of our study was to analyze the effect of acyclovir prophylaxis in this patient population.Patients and MethodsWe studied 98 consecutive patients with relapsed MM treated with bortezomib. Bortezomib 1.3 mg/m² was given on days 1, 4, 8, and 11 of a 21-day cycle. At first, patients did not receive any VZV prophylaxis, but because of the high incidence of VZV reactivation, VZV prophylaxis with acyclovir was implemented subsequently.ResultsA total of 11 patients treated with bortezomib did not have any VZV prophylaxis, and 4 of these 11 patients (36%) developed VZV reactivation in the form of herpes zoster. No VZV reactivations were observed in the 32 patients who received acyclovir 400 mg 3 times daily or the 55 patients who received acyclovir in a dose reduced to 400 mg once daily during bortezomib treatment.ConclusionVaricellazoster virus reactivation is a common and serious adverse effect of bortezomib treatment. Acyclovir 400 mg once daily is sufficient to protect from VZV reactivation in patients with MM treated with bortezomib.