区域性热疗联合化疗治疗局部复发宫颈癌的疗效观察

目的 观察区域性热疗联合化疗治疗局部复发宫颈癌的疗效及不良反应.方法 自2008年3月至2010年7月64例局部复发宫颈癌按治疗模式的不同分成2组,单纯化疗组与热化疗组,化疗采用CPT-11 160mg/m2,d1;DDP 80mg/m2,d1,每3周重复,共2周期.热疗输出功率为1200W-1000W,以直肠进行测温,温度恒定在40.5℃-41.5℃,恒温治疗时间40min左右,2次/周,每次间隔72小时,8次/疗程.化疗同时行热疗,不行化疗时常规行热疗.结果 单纯化疗组有效率为36.6%,热化疗组有效率为61.7%(P<0.05);单纯化疗组III+IV度白细胞减少发生率明显高于热化疗组,(P<0.05);热化疗组未出现严重不良反应.结论 区域性热疗联合伊立替康+顺铂化疗局部复发宫颈癌,近期疗效确切、不良反应轻,且可减轻化疗不良反应,值得进一步推广应用,其远期疗效有待进一步观察.     

区域性热疗联合化疗治疗局部复发宫颈癌的疗效观察

目的：观察区域性热疗联合化疗治疗局部复发宫颈癌的疗效及不良反应。方法：自2008年3月至2010年7月64例局部复发宫颈癌按治疗模式的不同分成2组,单纯化疗组与热化疗组,化疗采用CPT-11160mg/m2,d1;DDP 80mg/m2,d1,每3周重复,共2周期。热疗输出功率为1200W-1000W,以直肠进行测温,温度恒定在40.5℃-41.5℃,恒温治疗时间40min左右,2次/周,每次间隔72小时,8次/疗程。化疗同时行热疗,不行化疗时常规行热疗。结果：单纯化疗组有效率为36.6%,热化疗组有效率为61.7%（P〈0.05）;单纯化疗组III＋IV度白细胞减少发生率明显高于热化疗组,（P〈0.05）;热化疗组未出现严重不良反应。结论：区域性热疗联合伊立替康＋顺铂化疗局部复发宫颈癌,近期疗效确切、不良反应轻,且可减轻化疗不良反应,值得进一步推广应用,其远期疗效有待进一步观察。     

Neoadjuvant chemotherapy followed by radiotherapy and concurrent hyperthermia in patients with advanced-stage cervical cancer: A retrospective study

Objective: To evaluate the efficacy of neoadjuvant chemotherapy, followed by radiotherapy and concurrent hyperthermia (triple therapy) in patients with advanced-stage cervical cancer.

Methods: We selected 43 patients from our hyperthermia database, who were treated from 1996 to 2010 with triple therapy for large primary tumours (>6?cm) or para-aortic lymph node metastases. All patients received platinum-based chemotherapy followed by full-dose radiotherapy, brachytherapy and five hyperthermia treatments. The response was evaluated by gynaecological examination and a CT-scan. Time-to-event variables were estimated using the Kaplan Meier method and the Cox regression method.

Results: The mean age of the patients was 50.4 years (range 29–80). The median tumour size was 5.6?cm at diagnosis (range 2.6–8.2), positive lymph nodes were present in 90.7%. A total of 67% of the patients completed all six planned courses of chemotherapy. After completion of neoadjuvant chemotherapy, 83.7% of patients achieved a complete or partial response. At the end of treatment, the complete response rate was 81.4% (95%CI 69.2–93.5). Grade 2, 3 and 4 acute vascular toxicity occurred in 17 patients. The incidence of grade 3–4 haematological toxicity did not exceed 10% and no neutropenic fever occurred. For grade 1–2 renal toxicity, a switch to carboplatin was made (n?=?6). No acute grade 3–4 renal toxicity was observed. No treatment-related deaths were recorded. The median follow-up time was 29.8 months (range 4.1–124.8). Overall survival rate at 12 months was 79% (95%CI 57.4–92.3).

Conclusion: The triple therapy seems feasible and effective in the treatment of advanced-stage, high-risk cervical cancer. However, chemotherapy-induced vascular toxicity occurred frequently, which may warrant the use of prophylactic anticoagulants. We recommend a phase II trial for prospective confirmation for comparison with standard chemoradiation and the use of anticoagulants.     

热疗联合放化疗治疗宫颈癌的临床应用及对机体免疫力的影响

目的:对热疗联合放化疗治疗宫颈癌临床应用及对机体免疫力影响进行研究。方法:2012年6月至2014年6月来我院住院治疗的中晚期宫颈癌患者91例,分为对照组（放化疗）44例和观察组（放化疗+热疗）47例。对两组的临床疗效、不良反应及对机体免疫力的情况进行比较。结果:观察组近期疾病控制率高于对照组,放化疗反应减轻,观察组在减轻放射性直肠炎及提高患者免疫力方面有显著优势,差异有统计学意义（P<0.01）。结论:热疗联合放化疗治疗宫颈癌能减轻放射副反应,提高机体免疫力,并且有望提高患者远期生存率,减轻放化疗远期副反应,明显提高患者的生活质量,值得临床应用推广。     

微波深部热疗加同步放化疗治疗中晚期宫颈癌的临床效果

目的:评价微波深部热疗在中晚期巨块型宫颈癌治疗中的疗效及安全性。方法:将经放化疗和放化热疗治疗的100例Ⅱb-Ⅲb期、肿瘤直径大于4cm的巨块型宫颈癌患者各50例,分为对照组和实验组。对照组放化疗:外照射均采用6MV-X加速器调强放射治疗+192铱高剂量率后装腔内照射,同步顺铂40mg/m2,静点,每周1次,与外照射同步结束。实验组:放化疗与对照组相同,另加局部体外热疗,温度为(40±1)℃,60分/次,2次/周,共10次。治疗结束后1个月复查相关检查,进行疗效评价。结果:实验组达到CR者92%(46/50),对照组达到CR者仅78%(39/50),肿瘤缩小率实验组明显高于对照组,差异有统计学意义(χ2=4.201, P＜0.039)。结论:深部热疗联合同步放化疗是治疗中晚期宫颈癌、特别是巨块型宫颈癌的一种安全有效的方法,具有临床推广价值。     

Comparison of outcomes for patients with unresectable, locally advanced non-small-cell lung cancer treated with induction chemotherapy followed by concurrent chemoradiation vs. concurrent chemoradiation alone

PURPOSE: To retrospectively compare outcomes for patients with unresectable locally advanced non-small-cell lung cancer (NSCLC) treated at our institution with concurrent chemoradiation with or without induction chemotherapy. METHODS AND MATERIALS: We retrospectively analyzed 265 consecutive patients who received definitive treatment with three-dimensional conformal radiation and concurrent chemotherapy. Of these, 127 patients received induction chemotherapy before concurrent chemoradiation. RESULTS: The two groups of patients (with induction vs. without induction chemotherapy) were similar in age, performance status, weight loss, histology, grade, and stage. Patients who received induction chemotherapy had better overall survival (median, 1.9 vs. 1.4 years; 5-year rate, 25% vs. 12%; p < 0.001) and distant metastasis-free survival (5-year rate, 42% vs. 23%; p = 0.021). Locoregional control was not significantly different between the two groups. Multivariate analysis showed that induction chemotherapy was the most significant factor affecting overall survival, with a hazard ratio of 0.55 (95% confidence interval 0.40-0.75; p < 0.001). A planned subgroup analysis showed that induction chemotherapy was associated with a significant overall survival benefit for patients with adenocarcinoma or large-cell carcinoma (5-year rate, 24% vs. 8%; p = 0.003) but not for those with squamous cell carcinoma. A multivariate analysis of patients with adenocarcinoma or large-cell carcinoma confirmed that induction chemotherapy was the most significant factor associated with better overall survival, with a hazard ratio of 0.47 (95% confidence interval, 0.28-0.78; p = 0.003). CONCLUSION: Our retrospective analysis suggests that in combination with concurrent chemoradiation, induction chemotherapy may provide a small but significant survival benefit for patients with unresectable locally advanced adenocarcinoma or large-cell carcinoma of the lung.     

3D打印模板插植后装放疗联合深部热疗对盆腔复发性宫颈癌的疗效分析

目的:探讨3D打印模板插植后装放疗(brachytherapy,BT)联合深部热疗(hyperthermia,HT)对盆腔复发性宫颈癌的近期疗效.方法:选取2017年1月至2021年3月河北省沧州中西医结合医院收治的复发性宫颈癌患者73例临床病理资料,其中单独行3D打印模板插植后装放疗39例为对照组、联合深部热疗34例...     

同期放化疗的宫颈癌患者预后的多因素分析

目的：总结我科收治的宫颈癌患者同步放化疗的治疗结果,并分析影响预后的因素。方法：2006年1月1日-2010年12月31日收治的170例Ib1-IVa 宫颈癌患者进入回顾性研究。化疗选用含顺铂的三个方案之一,放疗采用外照射加192Ir高剂量率腔内后装照射,A点总剂量78-90Gy,B点外照射剂量46-56Gy。将患者的临床分期、盆腔及主动脉旁淋巴结情况、肿瘤大小（＞or≤4cm）、肿瘤消退情况、肿瘤标志物作为分析因素,用COX回归对上述分析因素与无进展生存期（progression-free survival,PFS）和总生存期（overall sur-vival,OS）的关系进行单因素和多因素分析。结果：单因素和多因素分析显示影响PFS的因素有：临床分期（P＜0．01）,肿瘤大小（P＜0．01）,肿瘤消退情况（P＝0．01）和肿瘤标志物（P＝0．01）。影响OS的因素为：临床分期（P＝0．01）,肿瘤大小（P＝0．01）与肿瘤消退情况（P＜0．01）。5年生存率Ib1-Ⅱa 期患者为：91．5％,Ⅱb 期患者为：70．8％,Ⅲ期患者为：42．7％,IVa 期患者为：20．5％。结论：同步放化疗治疗不能手术切除的宫颈癌患者,影响预后的主要因素是临床分期、肿瘤大小和肿瘤消退情况。     

Neo-adjuvant platinum-based chemotherapy followed by chemoradiation and radical surgery in locally advanced cervical cancer (Lacc) patients: A phase II study

Purpose

The aim of this Phase II, non-randomized study was to assess activity and safety of neoadjuvant chemotherapy (NACT) before chemoradiation (CT/RT) followed by radical surgery (RS) in locally advanced cervical cancer (LACC) patients.

Reversal of cervical dysplasia with hyperthermia

Purpose: Patients with recurrent cervical carcinoma within a previously irradiated area respond poorly to chemotherapy. We have treated these patients with simultaneous cisplatin and hyperthermia (CDDP?+?HT) and investigated response, toxicity, palliative effect and survival.

Materials and methods: Between 1992 and 2005 47 patients received CDDP?+?HT. Response was evaluated by gynaecologic examination and CT-scan. The Common Toxicity Criteria (CTC) were used for evaluation of toxicity and palliative effect. The Kaplan-Meier method was used to estimate survival, and Cox regression analysis to evaluate the influence of prognostic factors.

Results: The objective response rate was 55%, palliation was achieved in 74% and operability in 19% of patients. Two patients are currently disease free at 9 years and 18?+?months following treatment and 2 remained disease free until death by other causes. The median survival was 8 months and was influenced by duration of disease free interval and tumour diameter. Grade 3–4 haematological toxicity was observed in 36% of patients and renal toxicity was maximum grade 2.

Conclusion: CDDP?+?HT results in a high response rate and acceptable toxicity in patients with recurrent cervical cancer.     

同步放化疗治疗复发性宫颈癌的疗效及安全性

目的探讨同步放化疗与单纯放疗治疗复发性宫颈癌的疗效及安全性。方法将260例复发性宫颈癌患者依据治疗方式不同分为同步放化疗组(150例)和单纯放疗组(110例),单纯放疗组予以放疗,同步放化疗组在单纯放疗组的治疗基础上予以同步化疗。比较两组患者临床疗效、血清肿瘤标志物[鳞状细胞癌相关抗原(SCC-Ag)、癌胚抗原(CEA)、糖类抗原72-4(CA72-4)]水平、不良反应及生存情况。结果同步放化疗组患者治疗有效率为90.00%(135/150),明显高于单纯放疗组的71.82%(79/110),差异有统计学意义(P﹤0.01)。治疗前,两组患者SCC-Ag、CEA及CA72-4水平比较,差异均无统计学意义(P﹥0.05);治疗后,两组患者SCC-Ag、CEA及CA72-4水平均降低(P﹤0.05),且同步放化疗组患者SCC-Ag、CEA及CA72-4水平均明显低于单纯放疗组(P﹤0.01)。两组患者3~4级不良反应总发生率比较,差异无统计学意义(P﹥0.05)。同步放化疗组患者3年生存率及5年生存率均明显高于单纯放疗组,差异均有统计学意义(P﹤0.01)。结论同步放化疗相较于单纯放疗治疗复发性宫颈癌具有更加显著的疗效,可降低血清肿瘤标志物水平,提高生存率,且不会明显增加不良反应。     

A phase I/II study of combined weekly systemic cisplatin and locoregional hyperthermia in patients with previously irradiated recurrent carcinoma of the uterine cervix.

We investigated the feasibility and the anti-tumour activity of weekly cisplatin and the simultaneous application of local hyperthermia in patients with a pelvic recurrence of cervical cancer in previously irradiated area. Dose levels of cisplatin 60 mg m(-2), 70 mg m(-2) and 80 mg m(-2) were studied. Treatment objective of hyperthermia was the achievement of a tumour temperature of > or = 42 degrees for 60 min, during cisplatin administration. The protocol advised six weekly cycles of combined treatment. Nineteen patients, median age 47 years (range 26-71), were treated. A total of 89 cycles of combined treatment were administered. Even at the highest dose level of cisplatin, 80 mg m(-2) weekly, no dose-limiting toxicity was observed. Leucocytopenia at scheduled retreatment resulted in 1 or 2 weeks postponement in five cases. Neurotoxicity and renal toxicity were mild or absent. Maximum tumour temperatures achieved ranged 39.7-43.6 degrees C, mean 41.6+/-0.7 degrees C. All 19 patients were evaluable for response. One patient achieved a complete response that lasted 20 months, and nine patients achieved a partial response for a median duration of 6 months (range 4-50+ months), for an overall response rate of 53%. One patient subsequently underwent salvage surgery and currently remains free of disease at 4 years. We found that this combined hyperthermia-dose-intensive cisplatin regimen was well-tolerated. The true impact of the combination of cisplatin and locoregional hyperthermia can only be answered in a randomized study. Nonetheless, based on existing data on the poor efficacy of cisplatin in pelvic recurrent cervical cancer, we believe that the combined modality approach of weekly hyperthermia plus dose-intensive cisplatin is an attractive regimen, particularly if subsequent salvage surgery is available.     

Pembrolizumab plus chemotherapy in Japanese patients with persistent,recurrent or metastatic cervical cancer: Results from KEYNOTE‐826

Pembrolizumab plus chemotherapy with or without bevacizumab demonstrated prolonged progression‐free survival (PFS) and overall survival (OS) versus chemotherapy in patients with persistent, recurrent, or metastatic cervical cancer in the phase 3, randomized, double‐blind, placebo‐controlled KEYNOTE‐826 study. We report outcomes in patients enrolled in Japan. Patients received pembrolizumab 200 mg or placebo Q3W for up to 35 cycles plus chemotherapy (paclitaxel 175 mg/m² + cisplatin 50 mg/m² or carboplatin AUC 5) with or without bevacizumab 15 mg/kg. Dual primary endpoints were PFS per RECIST v1.1 by investigator assessment and OS in the global population; these were evaluated in patients with tumors with PD‐L1 combined positive score (CPS) ≥1, all‐comers, and PD‐L1 CPS ≥10. Fifty‐seven patients from Japan were randomized (pembrolizumab plus chemotherapy, n = 35; placebo plus chemotherapy, n = 22). Pembrolizumab plus chemotherapy improved PFS versus placebo plus chemotherapy in patients with PD‐L1 CPS ≥1 (n = 51; hazard ratio [HR; 95% CI], 0.36 [0.16–0.77]), all‐comers (n = 57; 0.45 [0.22–0.90]), and patients with PD‐L1 CPS ≥10 (n = 25; 0.36 [0.12–1.07]). HRs (95% CI) for OS were 0.38 (0.14–1.01), 0.41 (0.17–1.00), and 0.37 (0.10–1.30), respectively. Incidence of grade 3–5 AEs was 94% in the pembrolizumab group and 100% in the placebo group. Consistent with findings in the global KEYNOTE‐826 study, pembrolizumab plus chemotherapy with or without bevacizumab may prolong survival versus placebo plus chemotherapy with or without bevacizumab and had a manageable safety profile in Japanese patients with persistent, recurrent, or metastatic cervical cancer.     

热疗联合放化疗治疗局部晚期宫颈癌的远期疗效分析

目的:探讨热疗联合放化疗治疗晚期宫颈癌的远期疗效及晚期毒副反应。方法:收集2012年6月至2014年6月我院收治的局部晚期宫颈癌患者91例,分为两组:44例放化疗组和47例热放化疗组。对两组的5年总生存及晚期毒副反应进行比较。结果:热放化疗组5年总生存率略高于放化疗组（72.9%vs 65.4%）,但差异无统计学意义（P=0.455）。热放化疗组可降低晚期放射性直肠炎的发生率（P=0.042）。结论:热疗联合放化疗可降低晚期放射性肠炎,与放化疗相比有望提高远期生存率,需扩大样本量进一步研究。     

紫杉醇联合顺铂治疗复发性宫颈癌的临床观察

Objective： To observe the efficacy and toxicities of paclitaxel plus cisplatin in the treatment of recurrent cervical cancer. Methods： Twenty-three patients with a diagnosis of recurrent cervical cancer were eligible. Three-weekly chemotherapy regimen consisted of paclitaxel 135-150 mg/m^2 infusion for 3 h on day 1, cisplatin 25 mg/m^2 infusion on day 1 to 3. All patients received at least two cycles treatment. Results： The response rates was 47.8%, including CR 2 cases （8.7%）, PR 9 cases （39.1%）. The major toxicity included neutropenia, nausea vomiting, arthralgia, myalgia and alopecia. Conclusion： Paclitaxel combined with cisplatin is an effective therapy with acceptable adverse reactions for recurrent cervical cancer.     

顺铂或多西紫杉醇同期放化疗治疗局部晚期宫颈癌疗效分析

目的：比较顺铂或多西紫杉醇同期放化疗治疗局部晚期宫颈癌疗效。方法：38例IIb到IVa期患者随机分为每周顺铂同期放化疗组（22例）或多西紫杉醇同期放化疗组（16例）。顺铂30mg/m2或多西紫杉醇25mg/m2抗过敏预处理,每周放疗的第一天同步静脉滴注,连续6周;放疗方法：两组患者外照射放疗采用直线加速器盆腔大野DT 30Gy后中央挡铅改为盆腔四野加量照射至DT 50Gy,常规分割,180-200cGy/F,盆腔四野照射期间每周局部后装铱192照射一次,每次剂量6Gy,共6次,A点剂量达3600cGy。观察两组治疗效果和不良反应并进行比较。结果：两组患者总有效率82%vs 87%,临床获益率91%vs 94%,差异无统计学意义（P〉0.05）;两组随访1年无进展生存率（PFS）比较77%vs 81%,总生存率（OS）95%vs 100%,差异无统计学意义（P〉0.05）;但多西紫杉醇同期放化组较顺铂同期放化组治疗无论在血液系统不良反应和非血液系统不良反应方面都明显降低,统计学比较差异有显著性P〈0.05。结论：多西紫杉醇同期放化疗可取得不亚于顺铂同期放化治疗的疗效,且多西紫杉醇不良反应明显降低。     

顺铂或多西紫杉醇同期放化疗治疗局部晚期宫颈癌疗效分析

目的:比较顺铂或多西紫杉醇同期放化疗治疗局部晚期宫颈癌疗效。方法:38例IIb到IVa期患者随机分为每周顺铂同期放化疗组(22例)或多西紫杉醇同期放化疗组(16例)。顺铂30mg/m2或多西紫杉醇25mg/m2抗过敏预处理,每周放疗的第一天同步静脉滴注,连续6周;放疗方法:两组患者外照射放疗采用直线加速器盆腔大野DT 30Gy后中央挡铅改为盆腔四野加量照射至DT 50Gy,常规分割,180-200cGy/F,盆腔四野照射期间每周局部后装铱192照射一次,每次剂量6Gy,共6次,A点剂量达3600cGy。观察两组治疗效果和不良反应并进行比较。结果:两组患者总有效率82%vs 87%,临床获益率91%vs 94%,差异无统计学意义(P>0.05);两组随访1年无进展生存率(PFS)比较77%vs 81%,总生存率(OS)95%vs 100%,差异无统计学意义(P>0.05);但多西紫杉醇同期放化组较顺铂同期放化组治疗无论在血液系统不良反应和非血液系统不良反应方面都明显降低,统计学比较差异有显著性P<0.05。结论:多西紫杉醇同期放化疗可取得不亚于顺铂同期放化治疗的疗效,且多西紫杉醇不良反应明显降低。     

术前同期放化疗对局部晚期宫颈癌近期疗效的综合评价

目的 观察奈达铂、替加氟新辅助化疗联合腔内后装放疗,同期治疗局部晚期宫颈癌(LACC)临床疗效。方法 回顾性分析了81例LACC患者,分为三组,分别于术前接受奈达铂+替加氟新辅助化疗(NACT)、单纯腔内后装放射治疗(CLI)、新辅助化疗联合后装放疗(CCR),比较不同的治疗方法对手术疗效的影响。结果 CCR组对宫颈局部肿瘤的治疗有效率(CR+PR)为88.9%,明显高于NACT组(70.4%,χ²=7.85,P＜0.01)及CLI组(63.0%,χ²=10.71,P＜0.01)。CLI组(25.9%)白细胞下降较NACT(81.5%,χ²=16.76,P＜0.01)及CCR(88.9%,χ²=21.89,P＜0.01)组明显减轻。宫旁脉管癌栓发生与盆腔淋巴结转移及宫旁浸润发生率三组相比无统计学差异。结论 新辅助化疗联合腔内后装治疗,有望成为局部晚期宫颈癌最佳的术前治疗方案。     

The synchronization of chemotherapy to circadian rhythms and irradiation in pre-operative chemoradiation therapy with hyperthermia for local advanced rectal cancer. Abbreviations: 5-FU 5-fluorouracil LV Leucovorin APR abdomino-perineal resection

Purpose: The therapeutic and adverse effects of pre-operative chrono-chemoradiation with local hyperthermia for patients with rectal adenocarcinoma were evaluated.

Materials and methods: Pre-operative radiation therapy of a total dose of 40?Gy (n?=?10) or 50?Gy (n?=?19) on the whole pelvis and hyperthermia once a week during the radiation therapy for 1?h were performed for patients with T2–T4 rectal adenocarcinoma. Chemotherapy consisted of 5-FU (250?mg?m^?2?per?day) and LV (25?mg?m^?2?per?day) administered by continuous infusion in the night for 5 days a week in the second and fourth weeks of radiation.

Results: Grade 3+ toxicities were seen only in two patients (6.9%). A significant down staging was seen in 41.4% of all cases and 52.6% of cases with a radiation dose of 50?Gy. Of the patients who had received surgical resection of a tumour, three (11.1%) had no residue pathologically in the specimen and eight (29.6%) had microscopic lesions.

Conclusions: These results yielded a high response rate with minimal toxicities for advanced low-rectal adenocarcinoma. The administration of 5-FU during the sleeping time before irradiation might have an advantage not only as a chronotherapy but also as a radiation sensitizer.