肿瘤综合治疗中的循证医学和个体化治疗

现代医学模式已经由单纯的生物医学模式转变为"生物-心理-社会"医学模式,由经验医学转变为以证据为基础的循证医学(EBM),这一指导临床医学实践的新模式,在肿瘤的综合治疗中起到了重要的指导作用;同时"个体化治疗"也是肿瘤综合治疗中不可忽视的原则之一,在肿瘤的治疗中占有越来越重要的地位.在实际的临床工作中,"循证医学"和"个体化治疗"这两个概念并非相互对立,而是相辅相成、密不可分的,现代肿瘤专科医师,必须掌握这些概念并在实际工作中努力贯彻、综合运用,才能制定合理的肿瘤综合治疗方案,最大限度维护患者的利益、得到最佳的治疗效果.     

循证医学与肿瘤治疗

简要介绍循证医学的概念及目的,针对目前肿瘤治疗领域存在的问题,探讨在肿瘤治疗中应用循证医学的可行性。通过提出临床要解决的问题,采用先进手段进行高效检索选择最佳相关研究。判断信息的真实性和有用性、引用最佳最新成果解决问题四个步骤,可提高肿瘤临床治疗水平。     

第二届全国乳腺癌循证医学与个体化治疗理念学术研讨会暨山东省乳腺癌规范化个体化治疗学习班会议通知

为追踪乳腺肿瘤防治研究的前沿动态,回顾诠释乳腺肿瘤循证医学研究现状与热点问题,倡导个体化治疗理念,更好的提高乳腺肿瘤诊治、科研水平,由山东省肿瘤医院和《中华肿瘤防治杂志》社联合主办的“第二届全国乳腺癌循证医学与个体化治疗理念学术研讨会暨山东省乳腺癌规范化个体化治疗学习班”定于2011-09—02—2011—09—04在泉城济南召开。     

第二届全国乳腺癌循证医学与个体化治疗理念学术研讨会暨山东省乳腺癌规范化个体化治疗学习班会议通知

为追踪乳腺肿瘤防治研究的前沿动态,回顾诠释乳腺肿瘤循证医学研究现状与热点问题,倡导个体化治疗理念,更好的提高乳腺肿瘤诊治、科研水平,由山东省肿瘤医院和《中华肿瘤防治杂志》社联合主办的第二届全国乳腺癌循证医学与个体化治疗理念学术研讨会暨山东省乳腺癌规范化个体化治疗学习班定于2011-09-01-2011-09-04在泉城济南召开。会议将邀请乳腺肿瘤学界、期刊编辑界著名专家做专题报告,介绍最新进展;与会代表就相关问题进行大会交流及讨论。此次会议授予与会者国家级医学继续教育学分10分和省级医学继续教育学分5分。     

小细胞肺癌内科个体化治疗的临床研究

目的 探讨针对小细胞肺癌患者个体化治疗的临床疗效.方法 将小细胞肺癌患者100例随机分为对照组和观察组,每组各50例.对照组采用传统一线化疗方案进行治疗;观察组患者通过PCR检测患者体内各基因表型,针对性选择每个患者潜在的敏感化疗药物进行治疗.统计各组患者客观缓解率、疾病控制率、无进展生存时间、总生存时间和安全性分析.结果 与对照组相比,观察组患者总生存时间明显延长,其复发率较低.与对照组相比,观察组患者KPS评分明显较高.结论 通过检测与肿瘤药物相关的基因,可以指导临床针对性用药,从而避免无效化疗,减少患者痛苦,同时显著提高临床疗效.     

老年性乳腺癌的特点及个体治疗

目的探讨老年性乳腺癌的临床,病理,生物学特点及个体化治疗。方法回顾分析2008~2010年我院收治的50例70岁以上老年乳腺癌患者的临床、病理及合并症的资料。结果 50例患者均患有不同的合并症,病理类型以浸润性导管癌居多,占62%（31/50）,神经内分泌癌次之,占16%（8/50）,黏液癌占14%（7/50）。50例全部接受手术治疗,改良根治术29例,单纯乳房切除术8例,广切术13例;术后辅助化疗3例,占6%（3/50）,辅助内分泌治疗41例占82%（41/50）。随访2年,复发转移6例（12%）,死亡5例（10%）,其中3例死于其他疾病。结论老年性乳腺癌侵袭性低,预后好。治疗应根据老年人的全身状况、预期寿命,予以个体化治疗等综合治疗。     

循证医学模式对脑膜瘤患者术后并发症发生及生活质量的干预效果

目的 探讨循证模式干预对脑膜瘤患者术后并发症发生及生活质量的效果.方法 将80例脑膜瘤手术治疗患者分为对照组和观察组.对照组患者实施常规治疗,观察组患者在对照组基础上采用循证医学模式进行治疗.统计2组患者并发症发生率,采用MOS SF-36量表对2组患者生活质量进行评价.结果 观察组患者术后共有4例出现并发症,发生率为10.00%;对照组并发症发生率为22.50%(9例).观察组并发症发生率明显低于对照组.观察组患者生理功能、生理职能、躯体疼痛、总体健康、活力、社会功能、情感职能、情感健康、躯体生理健康总评、心理生理健康总评得分分别为(16.27±1.18)分、(3.62±0.20)分、(1.34±0.14)分、(11.20±1.15)分、(17.62±1.35)分、(5.34±0.27)分、(5.74±0.15)分、(18.74±1.25)分、(65.41±3.87)分和(25.91±2.20)分,均明显高于对照组,且差异有统计学意义.结论 采用循证模式进行临床干预可以有效降低脑膜瘤患者的术后并发症发生率,提高患者生活质量.     

吉西他滨配合中药个体化治疗老年晚期非小细胞肺癌

目的 观察吉西他滨配合中药个体化治疗老年晚期非小细胞肺癌（NSCLC）的疗效及不良反应。方法对26例NSCLC患者采用国产吉西他滨1000mg／m^2,d1,d8,静脉滴注,3周方案;化疗间期（即d2～d7和d9～d20）对患者四诊合参,辨证施治。每2周期按照RECIST标准（1．0版）进行疗效评价,按NCI—CTC（3．0版）评价毒性并随访生存情况。结果26例均可评价疗效,其中CR1例,PPO例,SD11例,PD4例,总有效率（CR＋PR）为38．5％,中住生存期为12．3个月,一年生存率为42．3％（11／26）,化疗后患者临床收益反应为80．8％（21／26）。不良反应以白细胞和血小板下降常见,但均可耐受。结论吉西他滨配合中药个体化治疗老年晚期NSCLC疗效较好,可明显改善生活质量,延长生存时间,不良反应较轻,患者易于耐受。     

Pharmacological Profiles of Acute Myeloid Leukemia Treatments in Patient Samples by Automated Flow Cytometry: A Bridge to Individualized Medicine

BackgroundWe have evaluated the ex vivo pharmacology of single drugs and drug combinations in malignant cells of bone marrow samples from 125 patients with acute myeloid leukemia using a novel automated flow cytometry–based platform (ExviTech). We have improved previous ex vivo drug testing with 4 innovations: identifying individual leukemic cells, using intact whole blood during the incubation, using an automated platform that escalates reliably data, and performing analyses pharmacodynamic population models.Patients and MethodsSamples were sent from 24 hospitals to a central laboratory and incubated for 48 hours in whole blood, after which drug activity was measured in terms of depletion of leukemic cells.ResultsThe sensitivity of single drugs is assessed for standard efficacy (E_MAX) and potency (EC₅₀) variables, ranked as percentiles within the population. The sensitivity of drug-combination treatments is assessed for the synergism achieved in each patient sample. We found a large variability among patient samples in the dose-response curves to a single drug or combination treatment.ConclusionWe hypothesize that the use of the individual patient ex vivo pharmacological profiles may help to guide a personalized treatment selection.     

Awareness,Understanding, and Adoption of Precision Medicine to Deliver Personalized Treatment for Patients With Cancer: A Multinational Survey Comparison of Physicians and Patients

Background.

Two separate multinational surveys of oncologists and patients with cancer were conducted to assess the awareness and use of biomarkers in clinical practice. These data explore the self-reported and physician-assessed levels of patient cancer literacy and factors affecting physicians’ choice to use biomarkers in treatment decisions.

Patients and Methods.

Interviews were conducted via telephone with patients and online with physicians. Physicians had 3–35 years of experience; were treating more than 15 patients/month; and specialized in breast, lung, or colorectal cancer. Patients had received treatment for breast, lung, or colorectal cancer within the previous 5 years.

Results.

Interviews with 895 physicians and 811 patients were completed. Most patients and physicians reported that patients understood that a tumor could be tested to determine what treatment would be most effective (78% and 73%, respectively) and that patients would be willing to participate in a personalized treatment plan. Whereas 85% of patients felt that they understood their treatment when it was explained to them, only 23% of doctors felt that their patients were always fully informed. Most physicians (90%) reported using biomarkers; among the 10% not performing biomarker analysis, the most cited obstacles were local availability, speed of obtaining results, and cost.

Conclusion.

These data demonstrate wide global use of biomarker testing but with regional variations reflecting cultural and local practice. Self-reported and physician-assessed cancer literacy, although generally high, highlighted important regional variations and the need to provide patients with additional information.

Implications for Practice:

Two surveys were conducted to evaluate the global use of biomarkers in clinical practice and the largely unreported patient experience of precision medicine. These findings are especially relevant because they address both self-reported and physician-assessed levels of patients’ “cancer literacy.” This unique opportunity allowed for identification of areas where patients and physicians are communicating effectively, and also where there is a teachable gap in patient education. Furthermore, surveying physicians about the advantages and roadblocks they experience with biomarker testing provided valuable information on ways to improve the delivery of precision medicine to provide personalized care and ultimately enhance patient care.     

Evidence-based estimation and radiotherapy utilisation rate in Andalusia

Introduction The objective of this study was to estimate the theoretical needs-based on evidence-of radiotherapy treatments (RDT) in Andalusia, compare these needs with actual use of RDT in 2006 and analyse their evolution from 2003. Materials and methods Correlation between quantitative variables was analysed with Pearson’s correlation coefficient. This dealt with differences between administered/estimated treatments and treatments carried out in years with the Student’s tdistribution, and the χ² test among qualitative variables. Results In Andalusia, the evidence-based rate of cancer irradiation is 55%. Eighty-five percent of theoretical treatments were administered in 2006. From this group, 107% were in gynaecological tumours, 100% in breast cancer cases, 71% in head and neck cancer and 48% in lung cancers; differences in the last two conditions were significant (p<0.01). As for regional distribution, differences were reported with reference to irradiation rates (p<0.0002) and resource distribution. In the last three years, an increment of 17% was observed in treatments conducted in public hospitals. The rate increased from 61% (with regard to optimal values) to 85% in 2006; in a parallel way, an increment was seen in therapy units (from 22 to 26) and radiation oncologists (from 57 to 69). Conclusions Despite the increment of irradiation rates seen in the last years, there is still a serious underutilisation of RDT for some cancer types (lung, head and neck cancer), as well as a great variability in the use of RDT between hospitals.     

中西医结合治疗放射性脑脊髓病的临床观察

目的探讨中西医结合治疗放射性脑脊髓病的治疗价值。方法将诊断为放射性脑脊髓病36例随机分成西医组和中西医结合组进行疗效比较。结果中西医结合组起效快,疗效持久,避免了激素反弹及其不良反应;西医组起效快,疗效短,激素用药时间长,激素减量期间病情易反弹,不良反应大。结论中西医结合组对放射性脑脊髓病的疗效显著,对提高患者生存质量起到了积极作用。