动脉灌注化疗并同期放疗的综合治疗中晚期胰腺癌

目的观察动脉灌注化疗并同期放疗的综合治疗中晚期胰腺癌的作用。方法９２年１月至９６年１月收治５２例中晚期胰腺癌,２３例行动脉灌注化疗并同期放疗（综合组）,２９例行单纯放疗（单放组）。单放组每周照５次,每次１８０－２００ｃＧＹ,总量５０００－６０００ｃＧＹ／５－６．７周,综合组动脉灌注化疗,每次５－Ｆｕ１．０、ＭＭＣ１０ｍｇ、ＤＤＰ６０ｍｇ,每４周一次,平均２．３次／人,同期放疗方案同单放组。结果腹痛、黄疸的症状缓解率两组之间无明显差异,但综合组黄疸改善时间较长（１３个月对５个月Ｐ＜０．０５）;肿瘤缩小率达５０％以上综合组６９．６％（１６／２３）,单放组３７．９％（１１／２９）;两组１、２、３年生存率分别为７８．５％、３７．１％、２６．７％和５２．３％、２２．９％、１０．５％,综合组明显好于单放组。结论不能手术切除的中晚期胰腺癌通过动脉灌注化疗并同期放射治疗的综合治疗较单放组能获得较高的生存率。     

放疗,放化疗结合治疗中晚期食管癌

为了观察在放疗的同期追加化疗能否提高对中晚期食管癌的疗效,将１５６ 例中晚期食管癌随机分成Ａ、Ｂ２ 组,每组７８ 例。Ａ组：每周放疗６ 次,每次２ Ｇｙ;Ｂ组：放疗方式同Ａ 组,另于周末（ 放疗休息日）化疗,ＰＤＤ２０ ｍｇ 、５Ｆｕ ０．５ ｇ／ｍ ２ ,静脉滴注共５ 次。各组照射总肿瘤量为６４ ～７０ Ｇｙ 。随访结果：１、２、３ ａ 生存率,Ａ组分别为６９ ．２ ％（５４／７８） 、２３．１ ％ （１８／７８）和１２ ．８ ％ （１０／７８） ;Ｂ 组分别为７９ ．５％ （６２／７８）、４８ ．７％ （３８／７８）和２０．５ ％（１６／７８）。Ｂ 组２ ａ 生存率明显高于Ａ 组（Ｐ＜ ０．０１）,１、３ ａ 生存率２ 组无显著性差异（Ｐ＞ ０．０５）。结果显示,采用每周６ 次、每次２ Ｇｙ 放疗＋ 周末化疗方式治疗中晚期食管癌,近期疗效优于单纯放疗组,无明显毒副作用。     

放疗与放化综合治疗晚期食管癌220例对比分析

采用单纯放疗和放疗加化疗ＤＦＰ方案（ＤＤＰ、５－Ｆｕ、潘生丁）治疗晚期不宜手术的食管癌２２０例，单放组和综合组各１１０例，放疗剂量均为６０～７０Ｇｙ／６～７周，而化疗于放疗前两周完成。治疗结果：综合组完全缓解率８３．６％（９２／１１０）、单放组７７．２％（８５／１１０）；１、２年生存率综合组为７３．６％（８１／１１０）、４６．３％（５１／１１０），单放组为４７．２％（５２／１１０）、２０％（２２／１１０）（Ｐ＜０．０１）。     

选择性动脉灌注化疗加放疗联合治疗晚期食管癌的临床研究

１９９０年６月至１９９２年６月选择晚期初诊食管癌６０例，随机分为两组：选择性动脉插管灌注化疗加放疗组和单纯放疗组，前组选用阿霉素６０ｍｇ，５－氟脲嘧啶１ｇ，顺铂４０ｍｇ灌注化疗２疗程后即行放疗。放疗量为ＤＴ５０Ｇｙ／５周。后组放疗量ＤＴ６０－７０Ｇｙ／６～７周。近期疗效判断前组明显优于后组，１年生存率分别为６３．３％和３６．７％，有显著差异。两组副作用无显著差别。     

放射治疗食管癌后配合DF方案化疗

目的 探讨放射治疗后配合ＤＦ方案化疗对食管瘤的治疗价值。方法 将１９２例食管癌患者随机分为２个组行前瞻性临床研究。一组９６全行放射治疗后配合ＤＦ方案化疗（综合组）,另一组９６例行单纯放射治疗（单放组）。放射治疗采用６ＭＶＸ射线常规照射,Ｄｒ６０～７０Ｇｙ;化疗在放射治疗后１个月内按计划每３周行１个周期。２个组均随访３年。结果 综合组与单放组１,２,３年生存率分别为６１．５％,４４．８％,３４．４％     

放疗与放化综合治疗晚期食管癌220例对比分析

采用单纯放疗和放疗加化疗ＤＦＰ方案（ＤＤＰ、５－Ｆｕ、潘生丁）治疗晚期不宜手术的食管癌２２０例，单放组和综合组各１１０例，放疗剂量均为６０－７０Ｇｙ／６－７周，而化疗于放疗前两周完成，治疗结果：综合组完全缓解率８３．６％（９２／１１０＿、单放组７７．２％）８５／１１０）；１、２年生存率综合组为７３．６％（８１／１１０）、４６．３％（５１／１１０），单放组为４７．２％（５２／１１０）、２０％（２２／     

诱导化疗加放疗与单纯放疗不能手术的Ⅲ期非小细胞肺癌

目的评价诱导化疗加放射治疗不能手术的Ⅲ期非小细胞肺癌（ＮｏｎＳｍａｌＣｅｌＬｕｎｇＣａｎ－ｃｅｒ，ＮＳＣＬＣ）疗效。材料与方法１１１例不能手术的Ⅲ期ＮＳＣＬＣ病人被随机分为两组：５５例病人接受丝裂霉素８～１０ｍｇ／ｍ２，第１天；顺铂２０ｍｇ／ｍ２，第１～５天；长春花碱６ｍｇ／ｍ２，第６天（或长春酰胺３ｍｇ／ｍ２第１，８天）联合化疗（ＭＰＶ方案）；２～４疗程后给予放疗（化放组）。５６例病人接受单纯放疗（单放组）。两组放疗方式和剂量相同，常规分割放射，每次２Ｇｙ，每周５次。原发灶和淋巴结受累部位的总剂量为６０～６８Ｇｙ，淋巴引流区５０Ｇｙ。结果化放组总有效率为６３．６％，完全缓解（ＣＲ）１４．５％，中位生存期为１４个月；单放组总有效率为５５．４％，ＣＲ５．４％，中位生存期为１０个月。两组的总有效率无差别（Ｐ＞０．２５），但生存期有明显的差异（Ｐ＜０．０２５）。化疗的毒副反应主要是胃肠道反应和骨髓抑制。两组放疗副反应（急性和迟发性肺损伤）相似。结论诱导化疗加放射治疗不能手术的Ⅲ期ＮＳＣＬＣ，毒性可耐受，生存期优于单纯放疗。     

放疗与化疗同步治疗食管癌近期疗效观察

目的：探讨放疗与化疗同步联合治疗食管癌的近期疗效。方法：对５０例食管癌患者进行随机对照试验,２５例采用ＤＤＰ加５－Ｆｕ联合放疗同步治疗（实验组）,２５例单纯放疗（对照组）。两组均采用常规分割放疗,每次２．０Ｇｙ,总剂量６０～７０Ｇｙ。实验组放疗第１、２２天同时开始化疗,ＤＤＰ总量达２４０ｍｇ,５－Ｆｕ总量３．０ｇ。结果：实验组肿瘤完全消退所需放射剂量低于对照组（Ｐ〈０．０１）;放疗结束后病变完全消     

中晚期鼻咽癌同期放化疗的临床研究

目的：探讨同期化疗加放疗对中晚期鼻咽癌远期疗效的影响。方法：８８例３、４ａ期鼻咽癌（＇９２分期）随机分为化疗加放疗组（７和化组４４例）和单纯放疗组（单放组４４例）。单纯组采用＾６０Ｃｏ加１８０ｋｖＸ线常规分割，鼻咽部及颈切线用＾６０Ｃｏ－γ线，颈部垂直野用１８０ｋｖＸ射线。鼻咽部剂量６５～７８Ｇｙ，颈部根治量６０～７０Ｇｙ，残留病灶加１０Ｇｙ左右，放化组加用顺铂（ＤＤＰ）及氟尿嘧啶（５－ＦＵ）化疗     

顺铂加长春酰胺配合外照射治疗晚期鼻咽癌的临床研究

目的 观察放化综合治疗晚期鼻咽癌的疗效,方法 ６４例Ｎ２￣Ｎ３晚期鼻咽癌患者随机分为综合组（放疗＋化疗）和单纯放疗组,综合组放疗前后采用化疗方案;顺铂３０ｍｇ／日,连续５天,长春酰胺（Ｖｉｎｄｅｓｉｎｅ,西艾克,ＶＤＳ）３ｍｇ／ｍ＾２,第１天,第７天,两组放疗方法,剂量相同。结果综合组,单纯放疗组在放疗４０Ｇｙ和放疗结束后３个月,颈淋巴结消退率分别为４３．８％、８７．５％和２８．１％、７５．０％（     

介入动脉化疗加适形放射治疗胰腺癌21例临床分析

对 2 1例胰腺癌先行介入动脉化疗 ,2周后行适形放射治疗 ,每次 5～ 6Gy ,7～ 8次。获有效率 (CR PR)为71 4% ( 15 /2 1) ,1、2年生存率为 78 6% ( 11/14 )和 3 0 % ( 3 /10 )。初步研究结果提示 ,介入动脉化疗加适形放射治疗是一种对胰腺癌行之有效的方法 ,有必要对其作进一步研究。     

动脉化疗联合三维适形放疗治疗局部晚期胰腺癌的临床疗效

目的探讨动脉化疗联合三维适形放疗治疗局部晚期胰腺癌的疗效和安全性。方法 20例局部晚期胰腺癌采用吉西他滨（1 000 mg/m^2）区域性动脉灌注结合静脉化疗联合三维适形放疗治疗。放疗采用常规分割,1.8～2.0Gy/次,1次/天,5次/周,放疗剂量95%PTV45～50 Gy/25次。结果 20例患者全部完成治疗计划,原发灶完全缓解率为5.0%,部分缓解率为65.0%,总有效率为70.0%。临床获益率为80.0%。中位生存期为13个月,1、2年总生存率分别为56.2%、19.6%。1～2级白细胞下降发生率为80.0%,3级为20.0%;1～2级急性胃肠道反应发生率为90.0%,3级为5.0%。结论区域性动脉灌注化疗联合三维适形放疗是治疗局部晚期胰腺癌的1种有效方法。     

经动脉灌注健择化疗联合三维适形放射治疗局部晚期胰腺癌的临床研究

Objective： To evaluate the clinical effect of transarterial infusion chemotherapy of gemcitabine plus three dimensional conformal radiotherapy on patients with local advanced pancreatic cancer. Methods： Fifty-one patients with local advanced pancreatic cancer from June 2002 to February 2004 were enrolled, twenty-four patients of combined group were treated with transarterial infusion chemotherapy of gemcitabine plus three dimensional conformal radiotherapy, while twenty-seven patients of control group were treated only with transarterial infusion chemotherapy of gemcitabine. Results： There were significant statistical differences between two groups in clinical benefit response （91.7% versus 74.1%, P 〈 0.01） and overall remission rate （70.8% versus 33.3%, P 〈 0.01）. The 6-month survival rate, 12-month survival rate and 24-month survival rate of combined group were 83.3%, 62.5% and 37.5% respectively, while that of control group were 55.6%, 33.3% and 11.1% respectively. This showed significant difference between the two groups. Conclusion： Transarterial infusion chemotherapy of gemcitabine plus three dimensional conformal radiotherapy may be better than single transarterial infusion chemotherapy of gemcitabine in improving survival rates and elongating survival time of patients with local advanced pancreatic cancer.     

中晚期胰腺癌三维适形放疗辅助高强度聚焦超声的临床观察

目的观察高强度聚焦超声（HIFU）与三维适形放疗（3D-CRT）联合治疗中晚期胰腺癌的近期疗效及价值。方法 48例中晚期胰腺癌患者（Karnofsky评分60~85分）随机分为两组,每组24例,A组行HIFU＋3D-CRT;B组单纯放疗。两组均采用三维适形放疗,常规分割（2.0 Gy/次,每周5次）,DT40~50 Gy/20~25 Fx。A组患者均予4~8次高强度聚焦超声治疗。结果 A组近期有效率37.5%,B组20.8%,A组临床受益率52.2%,B组为21.7%。两组比较差异有显著性（P〈0.05）。主要毒性反应为白细胞减少和红细胞减少。结论 HIFU＋3D-CRT联合治疗中晚期胰腺癌有较好的疗效,且耐受性较好。     

选择性动脉插管持续灌注化疗治疗晚期胰腺癌的疗效分析

背景与目的：晚期胰腺癌化学治疗效果差。本研究目的是探讨选择性动脉插管持续灌注化疗治疗晚期胰腺癌的临床疗效与应用价值。方法：20例晚期胰腺癌经选择性动脉插管持续灌注化疗。采用Seldinger技术经股动脉插管留置导管12例,经左锁骨下动脉插管植入药盒导管系统8例。导管选择至肿瘤供血动脉持续灌注化疗药物。9例采用THP-ADM HCPT 5-FU／CF方案,11例采用GEM CBP 5-FU／CF方案,4天为一疗程。4～6周重复1次疗程。治疗后观察客观缓解率、临床受益疗效(CBR)和病人的生存时间。结果：客观缓解率10％(CR、PR各1例),临床受益疗效70．0％,6个月及9个月生存率分别为58．8％和39．2％,中位生存期8．8个月。无出现插管合并症。结论：选择性动脉插管持续灌注化疗治疗晚期胰腺癌安全可靠。临床受益疗效良好,可提高患者的生存质量和生存期。值得临床进一步观察研究。     

卡铂加放射治疗食管癌的前瞻性研究

目的:探讨卡铂提高食管癌放射治疗疗效的方法。方法:180例食管癌患者根据入选标准随机分组,90例进入卡铂+放射治疗(卡放组),90例进入单纯放射治疗(单放组),卡放组放疗第1、4周同时用卡铂100mg/d,静脉滴入,每周连用5d,2个周期总量为1000mg,单放组放疗方法同卡放组。单放组60Coγ射线常规三野照射6周,共60Gy/30次。结果:近期疗效显示,卡放组完全缓解率达52.2%,单放组为36.7%,两者差异有统计学意义,P<0.05;卡放组和单放组5年生存率分别为22.2%和10%,两者差异有统计学意义,P<0.05;10年生存率分别为14.4%和6.7%,两者差异无统计学意义,P>0.05。卡放组毒副反应明显高于单放组,但患者能耐受,两组的主要死亡原因是局部复发。结论:卡铂加放射治疗食管癌可以提高疗效。毒副反应虽然有所增加,但所有患者均可耐受。     

3D radiotherapy can be safely combined with sandwich systemic gemcitabine chemotherapy in the management of pancreatic cancer: factors influencing outcome

PURPOSE: The aim of this Phase II study was to examine whether concurrent continuous infusion 5-fluorouracil (CI 5FU) plus three-dimensional conformal planning radiotherapy sandwiched between gemcitabine chemotherapy is effective, tolerable, and safe in the management of pancreatic cancer. METHODS AND MATERIALS: Patients were enrolled in two strata: (1) resected pancreatic cancer at high risk of local relapse (postsurgery arm, n = 22) or (2) inoperable pancreatic cancer in head or body without metastases (locally advanced arm, n = 41). Gemcitabine was given at 1,000 mg/m(2) weekly for 3 weeks followed by 1 week rest then 5-6 weeks of radiotherapy and concurrent CI 5FU (200 mg/m(2)/day). After 4 weeks' rest, gemcitabine treatment was reinitiated for 12 weeks. RESULTS: For the two arms combined, treatment-related Grade 3 and 4 toxicities were reported by 25 (39.7%) and 7 (11.1%) patients, respectively. No significant late renal or hepatic toxicity was observed. In the postsurgery arm (R1 54.5%), median time to progressive disease from surgery was 11.0 months, median time to failure of local control was 32.9 months, and median survival time was 15.6 months. The 1- and 2-year survival rates were 63.6% and 31.8%. No significant associations between outcome and mutations in K-ras or TP53 or microsatellite instability were identified. Post hoc investigation of cancer antigen 19-9 levels found baseline levels and increases postbaseline were associated with shorter survival (p = 0.0061 and p < 0.0001, respectively). CONCLUSIONS: This three-dimensional chemoradiotherapy regimen is safe and promising, with encouraging local control for a substantial proportion of patients, and merits testing in a randomized trial.     

局部晚期和复发直肠癌放射治疗配合动脉灌注化疗疗效分析

目的探讨动脉灌注化疗提高局部晚期和复发直肠癌放射治疗疗效。方法62例直肠癌随机分为放射治疗配合动脉灌注化疗(综合组)31例,单纯放射治疗(单放组)31例。动脉插管化疗采取经肠系膜下动脉和髂内动脉灌注,每次氟尿嘧啶600mg/m2,顺铂70mg/m2,2～3周重复,共2～3次。放射治疗采用8～18MVX射线照射,总量达DT40～50Gy时争取手术,不能手术者加量至DT60～70Gy。结果综合组有效率为83.9%,单放组有效率为54.8%(P<0.01)。综合组1、3、5年生存率分别为90.3%、68.8%、52.0%,单放组分别为80.7%、50.6%、29.8%(P<0.05),综合组和对照组中位生存时间分别为65个月和39个月。综合组副反应大,但患者均能耐受。结论放射治疗辅以动脉灌注化疗为局部晚期和复发直肠癌有效治疗方法。     

奈达铂联合甲地孕酮同步放化疗治疗中晚期宫颈癌的近期疗效分析

目的 探讨奈达铂联合甲地孕酮同步放化疗治疗中晚期宫颈癌的近期疗效.方法 42例中晚期(Ⅱb～Ⅳa期)宫颈癌患者随机分为单纯放疗组(RT组,21例),奈达铂联合甲地孕酮同步放疗组(RT+C组,21例),两组放疗方法相同.RT+C组在放疗开始后,每周1次奈达铂30 mg/m2,静脉滴注,第1天,共4～5周,并常规给予止吐药物及适当水化,患者从治疗开始均每天服用甲地孕酮160mg至治疗结束.结果 RT+C组患者中,完全缓解(CR)17例(81.0%),部分缓解(PR)4例(19.0%),有效率为100%;RT组患者中,CR 8例(38.1%),PR 9例(42.9%),有效率81.0%.RT+C组的CR及有效率均高于RT组,差异有统计学意义.RT+C组患者的1年生存率为100%(21/21),RT组患者的1年生存率为81.0%(17/21),差异有统计学意义(x2=4.42,P＜0.05).结论 奈达铂联合甲地孕酮同步放化疗可提高中晚期宫颈癌的近期疗效,虽毒性反应有所增加,但患者可以耐受.

Abstract：

Objective To investigate the early efficacy of nedaplatin combined with megestrol in concurrent chemoradiotherapy for advanced cervical cancer. Methods Forty-two cases of cervical cancer (FIGO Ⅱb to Ⅳa) were divided randomly into two groups: radiotherapy alone (21 cases) and radiation plus chemotherapy (Nedaplatin) group. The same radiotherapy was given to the two groups. Patients of the RT + C group received nedaplatin 30 mg/m2 in intravenous drip infusion once weekly on day 1, for 4 to 5 weeks, and megestrol 160 mg orally every day during the radiation therapy. Results The early outcome:the complete remission rate was 81.0% and partial remission rate was 19.0% in the RT + C group,significantly better than the CR (38.1%) and PR (42.9%) in the RT group. The 1-year survival rates in the two groups were 100% (21/21) and 81.0% ( 17/21 ), respectively, with a significant difference between the two groups ( P ＜ 0.05 ). Conclusions The combination of nedaplatin and megestrol with concurrent chemoradiotherapy can improve the early outcome of advanced cervical cancer, with somewhat increased but tolerable adverse effects.     

中晚期食管癌同时放、化疗疗效观察

目的：观察放疗联合TP方案同时化疗治疗中晚期食管癌的疗效。方法：放疗联合TP方案（Taxel＋DDP）同时化疗综合治疗中晚期食管癌33例,单纯放射治疗中晚期食管癌3 3例。结果 ：放化组和单放组的近期疗效总有效率分别为84.8%和66.7%,1、2、3年生存率分别为75.7%、51.5%、39.4%和57.8%、30.3%、24.2%,放化组明显优于单放组（P〈0.05）。两组间远处转移率无显著性差异（P〉0.05）。同时放化组的毒副反应高于单放组,经对症处理后患者能耐受,不影响治疗。结论：同时放化疗优于单纯放射治疗,可明显提高中晚期食管癌的疗效。