肿瘤患者个体化检测化疗的疗效观察

目的探讨根据肿瘤患者个体化检测结果,选择预期敏感药物进行化疗的有效性。方法观察32例肿瘤患者,根据个体化检测结果进行化疗后的疗效、生活质量、不良反应及生存率。结果 32例患者中CR 15.6%(5/32),PR 46.8%(15/32),SD 25.0%(8/32),PD 12.5%(4/32),客观有效率为65.6%(21/32),疾病控制率为87.5%(28/32)。治疗结束后肿瘤标志物水平16例降至正常,9例呈下降趋势,但尚未降至正常,4例无明显变化,3例较治疗前水平升高。所有患者均未出现严重不良反应,治疗后KPS评分明显升高,与治疗前相比差异有统计学意义(P<0.05),治疗后患者饮食及体重增长率分别为71.9%(23/32)和59.4%(19/32)。2例患者因病情进展而死亡。结论根据个体化检测结果进行化疗可明显提高疗效,减轻不良反应。     

分子检测在个体化肿瘤化疗中的意义

 当前肿瘤治疗策略的确立主要是以循证医学证据为基础，虽比单纯依据经验的治疗迈进了一大步，但仍需经过多次调整,方能找到适合每一患者的最佳药物方案及剂量。而相同疾病的不同患者，由于个体遗传学特性的不同，对同一化疗方案的反应性不尽相同，导致疗效差异巨大。依据个体基因型确定药物类别和药物剂量的模式将开创个体化药物治疗的新纪元。     

静脉联合腹腔化疗治疗晚期胃肠肿瘤87例临床分析

目的：评价静脉联合腹腔化疗治疗对晚期胃肠肿瘤治疗效果和副作用。方法：对1996年至2000年11月间，我科对采用吡喃阿霉素静推、羟基喜树碱静滴、5-FU及顺铂腹腔灌注方法治疗87例晚期胃肠肿瘤进行分析，总结其的期治疗效果。结果：本组87例，总有效率52.9%(46/87)，中位生存期为15.7月，且毒副反应较轻。结论：静脉联合腹腔化疗是治疗晚期胃肠肿瘤的有效治疗手段，副反应轻，病人易于接受。     

晚期胃癌患者ERCC1 TUBB3 TYMS三基因联合检测指导的DCF方案个体化化疗的研究

  目的   根据ERCC1、TUBB3、TYMS基因mRNA表达水平选择Docetaxel、DDP、5-FU组成相应的化疗方案对晚期胃癌进行化疗的疗效、不良反应及生存期评价。   方法   前瞻性纳入于本院2009年5月至2012年5月初治的晚期胃癌的患者120例,随机分为二组:研究组（60例）:采用分支DNA-液相芯片技术定量检测胃癌组织ERCC1、TUBB3、TYMS基因mRNA表达水平,并根据检测结果,选择药物Docetaxel、DDP、5-FU组成相应敏感的化疗方案对其进行化疗;对照组（60例）:予以DCF方案化疗,观察两组疗效、不良反应,中位疾病进展时间（mTTP）及中位生存时间（mOS）。   结果   研究组、对照组化疗有效率分别为55 %、50 %,差异无统计学意义（P=0.357）。两组mTTP分别为10个月和7个月,差异无统计学意义（P=0.091）。两组mOS为13.7个月和11.6个月,差异有统计学意义（P=0.004）。两组间不良反应相似,但对照组不良反应Ⅲ°~Ⅳ°明显高于研究组,差异有统计学意义（P < 0.05）。   结论   晚期胃癌根据ERCC1、TUBB3、TYMS基因mRNA表达水平检测结果选择药物Docetaxel、DDP、5-FU组成相应敏感的化疗方案进行化疗,疗效非劣性、不良反应降低,且改善mOS。      

以异环磷酰胺为主的化疗方案治疗晚期肿瘤疗效分析

异环磷酰胺 (Ｉｆｏｓｆａｍｉｄｅ ,ＩＦＯ )为环磷酰胺的同分异构体 ,具有广谱抗肿瘤活性。我院 1995年 7月～ 1999年 7月应用以ＩＦＯ为主的化疗方案治疗晚期肿瘤 2 2例 ,结果报道如下。1　临床资料1.1　病例选择入选病例均符合以下标准 :①经病理组织学检查证实为恶性肿瘤 ;②年龄不超过 70岁 ;③Ｋａｒｎｏｆｓｋｙ评分在 6 0分以上 ;④有可测量的病灶 ;⑤血象及肝肾功能正常 ;⑥治疗前均作常规Ｘ线片、Ｂ超及ＣＴ检查。 2 2例患者年龄 2 5～ 70岁 ,中位年龄5 2岁 ,男性 14例 ,女性 8例 ,其中 10例为初治 ,12例为复治 ,病种分布见表 1…     

以顺氯氨铂为主的联合化疗方案治疗晚期肿瘤的疗效观察

本文报道我院自１９８９年９月～１９９２年１２月应用以顺氯氨铂为主的联合化疗方案治疗晚期恶性肿瘤３１例的结果。本组患者病期均较晚，故采用ＤＤＰ２Ｏｍｇ或４０ｍｇ，连用５天或３天，每次低剂量方案。３１例中，部分缓解１１例，有效率３５．５％（１１／３１）。稳定１６例，进展４例。毒性反应轻，有轻度恶心呕吐，对造血机能影响小，对肝肾等没有重大损害。结果表明低剂量ＤＤＰ为主联合化疗方案是有效而毒副反应小的方案。     

羟基喜树碱联合化疗治疗晚期消化道肿瘤的疗效观察

目的 观察羟基喜树碱(HCPT)联合化疗方案治疗消化道肿瘤的疗效与毒性。方法 64例晚期住院患，不同病种采用不同的化疗方案和给药途径，每28天为1个周期，3个周期为一个疗程后评价疗效。结果 总有效率为54．7％，其中大肠癌尤为明显，有效率为67．7％。主要不良反应为白细胞减少和胃肠道反应。Ⅲ、Ⅳ度不良反应包括白细胞减少10例(17．1％)，腹泻4例(6．3％)，恶心呕吐6例(9．4％)。结论 HCPT联合化疗治疗晚期消化道肿瘤患安全有效，不良反应可以耐受。     

个性化营养诊疗在晚期肿瘤患者中的应用研究

目的 探讨基于肿瘤营养诊疗系统的个性化营养诊疗在晚期肿瘤化疗患者中的应用价值。方法 选取2019年1月至6月于北京市朝阳区桓兴肿瘤医院新入院的晚期肿瘤化疗患者作为研究对象,所有患者新入院时采用营养风险筛查量表2002进行营养风险筛查,对于存在营养风险的102例患者（NRS 2002≥3分）采用信封法将患者随机分为对照组（n=51）和观察组（n=51）。对照组患者由营养支持小组进行全程营养管理,观察组患者采用肿瘤营养诊疗系统进行个性化营养诊疗。比较两组患者两个周期化疗前后营养状况变化及化疗不良反应发生情况。结果 两个周期化疗后,两组患者体重、肌肉量、四肢骨骼肌指数均保持稳定,与化疗前相比均未有显著性差异（P>0.05）。对照组患者相比于化疗前,血红蛋白［（99.17±12.54）g/L vs （115.26±13.14）g/L］、白蛋白［（34.2±2.33）g/L vs （37.8±2.16）g/L］和前白蛋白［（19.48±3.02）mg/dl vs （26.14±3.21）mg/dl］水平显著提升,差异均有统计学意义（P<0.05）;观察组患者相比于化疗前,血红蛋白［（110.08±15.74）g/L vs （122.91±23.08）g/L］、白蛋白［（37.20±3.18）g/L vs （42.01±5.73）g/L］和前白蛋白［（24.13±2.56）mg/dl vs （29.14±3.74）mg/dl］水平显著提升,差异均有统计学意义（P<0.05）。此外,两组患者出现骨髓抑制（5.9% vs 3.9%）、白细胞减少（5.9% vs 7.8%）,以及消化道反应（15.7 vs 19.6%）的情况均没有显著性差异（P>0.05）。结论 基于肿瘤营养诊疗系统的个性化营养诊疗与营养支持小组有助于维持晚期肿瘤患者在两个周期化疗过程中的营养状况,增加化疗耐受性。     

Survival of patients with advanced ovarian cancer treated with intermittent chemotherapy following cytoreductive surgery and adjuvant chemotherapy

Background. The purpose of this study was to report the duration of the progression-free interval (PFI) in advanced ovarian cancer patients who were treated with intermittent maintenance chemotherapy. Methods. Between 1991 and 1998, 25 patients with stage III or IV ovarian cancer were enrolled in a trial of intermittent maintenance chemotherapy. All patients underwent cytoreduction surgery, and received adjuvant chemotherapy, after which they were treated with intermittent maintenance chemotherapy every 3 to 4 months for 2 years. Results. The median PFI in the 25 women in the intermittent chemotherapy group was 25 months, while in the 32 patients in the control group it was 18 months (P = 0.0124). The median survival of women treated with the intermittent chemotherapy was 34 months, and for the control group patients, it was 35 months (P = 0.0672). Multivariate analysis in the intermittent chemotherapy group revealed that the only factor that correlated significantly with PFI was the status after adjuvant chemotherapy (P = 0.0137). In patients with no evidence of disease after the adjuvant chemotherapy, the median survival was 39 months in the intermittent chemotherapy group, and 35 months in the control group (P = 0.0156). The median PFI was 28 months in the intermittent chemotherapy group, and 18 months in the control group (P = 0.0012). Conclusion. It would be warranted to perform intermittent maintenance chemotherapy for patients with advanced ovarian cancer, if a clinically disease-free status could be achieved after completion of the standard treatment procedure. Received: September 3, 2001 / Accepted: December 19, 2001     

岩舒注射液配合化疗治疗晚期胃癌的临床疗效观察

目的观察岩舒注射液配合化疗（5-Fu/CF/DDP方案）对晚期胃癌的临床疗效。方法 96例患者随机分为治疗组和对照组,治疗组给予岩舒注射液配合5-Fu/CF/DDP方案化疗,对照组单纯给予5-Fu/CF/DDP方案化疗。结果治疗组有效率为43.8%,对照组为41.7%,两组比较差异无显著性（P〉0.05）;但治疗组稳定率为81.3%,对照组为70.8%,两组比较差异有显著性（P〈0.05）。并且治疗组生活质量改善、症状改善、体重增加均优于对照组（P〈0.05）。同时治疗组CD3、CD4、CD4/CD8水平的提高亦明显高于对照组（P〈0.05）。治疗组的主要毒副反应明显减轻,尤其在消化道反应和骨髓抑制方面,两组比较差异均有显著性（P〈0.05）。结论岩舒注射液联合5-Fu/CF/DDP方案化疗具有提高免疫功能和一定的减毒增效作用,可进一步改善症状、延缓疾病进展、提高生存质量。     

NOB1 expression predicts early response to cisplatin-based chemotherapy in patients with advanced non-small cell lung cancer

Background: The aim of this study was to investigate the predictive value of Nin one binding (NOB1) expression for response to cisplatin-based chemotherapy in patients with advanced non-small-cell lung cancer (NSCLC).

Methods: A total of 105 consecutive patients with advanced NSCLC were retrospectively investigated between January 2012 and June 2014. We used transbronchial biopsy to collect cancer tissue samples. Immunohistochemistry were used in the detection of NOB1 protein expression. We assessed the chemotherapy early response by response evaluation criteria in solid tumours (RECIST) Version 1.1 at the end of the second cycle of chemotherapy.

Results: In the 105 transbronchial biopsy NSCLC specimens, 22 (21.0%) stained NOB1 ??, 35 (33.3%) stained +, 31 (29.5%) stained ++ and 17 (16.2%) stained +++. The early response rate to chemotherapy was 59.0% in overall NSCLC. Early response to chemotherapy has no relationship with patients' age, gender, smoke status, performance status and chemotherapy regimens (P>0.05), but related with TMN stage, histopathological grade, as well as NOB1 expression (P?P?=?0.008) for early response to chemotherapy.

Conclusion: Our results suggest that enhanced expression of NOB1 related with poor early response to cisplatin-based chemotherapy in patients with advanced non-small cell lung cancer.     

放化疗综合治疗局部中晚期鼻咽癌的疗效观察

目的 探讨诱导化疗+辅助化疗配合放疗综合治疗局部中晚期鼻咽癌的临床疗效和患者的耐受性.方法 于2003年2月至2005年7月,应用 PF方案诱导化疗1周期后3～7d开始行鼻咽癌常规根治性放疗,放疗结束后1w再予以PF方案化疗3个周期,化疗方案:DDP 30mg/m2,静脉滴入,d1～d3 ;5-FU 500mg/m2,静脉滴入,d1～d5,21d为1个周期,观察综合治疗的疗效和患者的耐受性.结果 治疗后3、6个月鼻咽原发病灶完全缓解率分别为95.6%和95.6%,颈部淋巴结完全缓解率分别为93.3%和97.8%.3年总生存率为80%,无进展生存率为73.3%.主要毒副反应为Ⅰ～Ⅱ度消化道反应.Ⅰ～Ⅱ度骨髓抑制发生率较高,主要是白细胞下降,口腔黏膜反应为Ⅰ～Ⅱ级,患者均能耐受.结论 诱导化疗+辅助化疗配合放疗综合治疗局部中晚期鼻咽癌的疗效较满意,毒副反应可以耐受,治疗依从性较好.     

羟基喜树碱联合顺铂治疗晚期食管癌的临床观察

目的：观察羟基喜树碱(HCPT)联合顺铂(PDD)组成的HP方案治疗晚期食管癌的近期疗效及不良反应。方法：应用HCPT(6mg／m^2d1～d3)加PDD(25mg/m^2d1～d3)治疗晚期食管癌31例。结果：CR2例,PR12例,NC15例,PD2例,总有效率45．2％;中位TTP2．5月。主要毒副反应为白细胞减少、恶心呕吐、腹泻,其中Ⅲ-Ⅳ度白细胞减少29．0％,Ⅱ-Ⅲ度恶心呕吐54．8％,Ⅱ-Ⅲ度腹泻12．9％。结论：HCPT联合PDD治疗晚期食管癌有较好的疗效,且毒性可以耐受,值得进一步研究。     

Irradiation with protons for the individualized treatment of patients with locally advanced rectal cancer: A planning study with clinical implications

Background and purpose

Ongoing clinical trials aim to improve local control and overall survival rates by intensification of therapy regimen for patients with locally advanced rectal cancer. It is well known that whenever treatment is intensified, risk of therapy-related toxicity rises. An irradiation with protons could possibly present an approach to solve this dilemma by lowering the exposure to the organs-at-risk (OAR) without compromising tumor response.

Material and methods

Twenty five consecutive patients were treated from 04/2009 to 5/2010. For all patients, four different treatment plans including protons, RapidArc, IMRT and 3D-conformal-technique were retrospectively calculated and analyzed according to dosimetric aspects.

Results

Detailed DVH-analyses revealed that protons clearly reduced the dose to the OAR and entire normal tissue when compared to other techniques. Furthermore, the conformity index was significantly better and target volumes were covered consistent with the ICRU guidelines.

Conclusions

Planning results suggest that treatment with protons can improve the therapeutic tolerance for the irradiation of rectal cancer, particularly for patients scheduled for an irradiation with an intensified chemotherapy regimen and identified to be at high risk for acute therapy-related toxicity. However, clinical experiences and long-term observation are needed to assess tumor response and related toxicity rates.     

静脉和腹腔化疗联合热疗治疗晚期胃癌伴腹水的疗效观察

目的观察多西他赛+氟尿嘧啶(5-Fu)静脉滴注全身化疗和腹腔内灌注顺铂局部化疗及热疗治疗晚期胃癌伴腹水的疗效及不良反应。方法 56例晚期胃癌合并癌性腹水患者采用联合静脉滴注多西他赛+持续静脉滴注5-Fu全身化疗和腹腔内灌注顺铂局部化疗并予局部热疗方案治疗;治疗2⁶个周期,每2个周期后评价疗效、临床受益及不良反应。结果 56例均可评价疗效,其中完全缓解(CR)12例(21.4%),部分缓解(PR)23例(41.1%),总有效率(RR)为62.5%,肿瘤进展时间(TTP)为8.7个月,中位生存期(OS)为13.4个月。腹水CR 15例(26.7%),PR 28例(50.0%),RR为76.7%。主要不良反应为骨髓抑制、消化道反应和口腔黏膜炎,其中Ⅲ6个周期,每2个周期后评价疗效、临床受益及不良反应。结果 56例均可评价疗效,其中完全缓解(CR)12例(21.4%),部分缓解(PR)23例(41.1%),总有效率(RR)为62.5%,肿瘤进展时间(TTP)为8.7个月,中位生存期(OS)为13.4个月。腹水CR 15例(26.7%),PR 28例(50.0%),RR为76.7%。主要不良反应为骨髓抑制、消化道反应和口腔黏膜炎,其中Ⅲ^Ⅳ度白细胞及血小板下降率为19.6%,ⅢⅣ度白细胞及血小板下降率为19.6%,Ⅲ^Ⅳ度血小板下降率为7.1%,ⅠⅣ度血小板下降率为7.1%,Ⅰ^Ⅱ度恶心呕吐、腹泻腹痛的发生率为58.9%,ⅢⅡ度恶心呕吐、腹泻腹痛的发生率为58.9%,Ⅲ^Ⅳ度为5.4%。无治疗相关性死亡。结论静脉化疗(多西他赛+5-Fu)和腹腔化疗(顺铂)的改良DCF方案及热疗是治疗晚期胃癌伴腹水的有效手段,不良反应可以耐受,值得临床进一步研究。     

Mitomycin-C and capecitabine as third-line chemotherapy in patients with advanced colorectal cancer: a phase II study

Purpose The aim of this study was to investigate the therapeutic value and safety of third-line treatment with mitomycin-C (MMC) and capecitabine (Xeloda) in patients with advanced colorectal cancer pretreated with combination regimens including 5-fluorouracil (5-FU), folinic acid (FA) and irinotecan (CPT-11) or 5-FU, FA and oxaliplatin (L-OHP).Patients and methods A total of 21 patients (M/F 16/5, median age 60.0 years) with advanced colorectal cancer, all of whom had developed progressive disease while receiving or within 6 months of discontinuing two sequential chemotherapy lines with 5-FU, FA and CPT-11 or 5-FU, FA and L-OHP, were accrued to this study. At the time of their relapse or progression, cytotoxic chemotherapy, consisting of intravenous MMC 7 mg/m² on therapeutic day 1 plus oral capecitabine 1000 mg/m² twice daily on days 1–14, was initiated. After rest for 7 days, capecitabine 1000 mg/m² twice daily was administered on days 22–35 followed by 7 days rest. Treatment courses were repeated every 6 weeks unless there was evidence of progressive disease, unacceptable toxicity or patient refusal of treatment.Results All the patients were assessable for toxicity and 19 for response. The median number cycles of chemotherapy was two (range one to four). Only 1 patient (4.8%) had a partial response, 4 patients (19.0%) had stable disease, and 14 patients (66.7%) progressed. The median follow-up period was 7.3 months and median time to progression was 2.6 months. The median overall survival was 6.8 months. No toxic deaths occurred. Toxicities of third-line treatment were mild and manageable. As NCI/NIH common toxicity criteria, grade 3/4 anemia, neutropenia and thrombocytopenia occurred in two, one and one patients, respectively.Conclusion Our findings suggest that the combination of MMC and capecitabine in patients with advanced colorectal cancer pretreated with combination regimens including 5-FU, FA and CPT-11 or 5-FU, FA and L-OHP is safe. However, this regimen had a poor response rate and no definitive contribution to increasing patients overall survival time. Further evaluation of other salvage regimens seems to be warranted.     

以草酸铂为主的联合化疗方案治疗晚期胃癌

目的 :目的 :观察草酸铂 (L OHP)联合氟尿嘧啶 (5 FU)、甲酰四氢叶酸钙 (CF)和足叶乙甙 (VP 16 )治疗晚期胃癌的疗效。方法 :采用随机分组方法将 5 3例晚期胃癌患者分为两组 ,治疗组 2 7例 ,用L OHP 130mg/m2 ,加于葡萄糖注射液中静滴 3小时 ,第 1天 ;CF 10 0mg/m2 ,静滴第 1～ 5天 ;5 FU 30 0mg/m2 ,于CF后静滴 ,维持 6小时 ,第 1～ 5天 ;VP 1610 0mg ,静滴 ,第 1～ 3天 ;对照组 2 6例用DDP 80mg/m2 ,静滴第 1天 ,CF、5 FU和VP 16用法同治疗组。每 3～ 4周为一个周期。二个周期评价疗效。结果 :治疗组CR 3例 ,PR 15例 ,总有效率 6 6 7% ;对照组CR 1例 ,PR 9例 ,总有效率为 38 5 %。两组总有效率间差异有显著性 (P <0 0 5 )。治疗组周围感觉神经毒性发生率较对照组高 ,恶心、呕吐的发生率较对照组低 ,两组间差异均有显著性 (P <0 0 5 )。结论 :L OHP联合CF、5 Fu和VP 16方案治疗晚期胃癌疗效较好 ,不良反应轻 ,能耐受 ,值得进一步在临床推广使用