周剂量多西紫杉醇、奥沙利铂联合5-氟尿嘧啶/亚叶酸钙治疗晚期胃癌疗效观察

目的:观察周剂量多西紫杉醇、奥沙利铂联合5-氟尿嘧啶/亚叶酸钙治疗晚期胃癌的近期疗效,毒副作用及生活质量改善情况.方法:18例晚期胃癌患者以多西紫杉醇25mg/m2d1、d8、d15静脉滴注1小时,奥沙利铂65mg/m2d1、d8静脉滴注3小时,亚叶酸钙100mgd1～d5静脉滴注2小时,5-氟尿嘧啶500mg/m2d1-d5静脉滴注4小时.4周为1个周期, 2周期为1个疗程.所有病人至少接受2周期以上.客观疗效(CR PR)和毒副作用按WHO进行评价,生活质量按临床受益反应(CBR)进行评价.结果:18例均可评价疗效,完全缓解(CR)0例,部分缓解(PR)10例,总有效率55.6%,临床受益反应有效率72%,中位TTP 5.6月.主要毒副反应为骨髓抑制,消化道反应和神经毒性,大部分为Ⅰ～Ⅱ级,可以耐受.结论:每周低剂量多西紫杉醇、奥沙利铂联合5-氟尿嘧啶/亚叶酸钙治疗晚期胃癌近期疗效好,毒副反应轻,耐受性好,病人生活质量明显改善.     

脂质体紫杉醇联合顺铂及氟尿嘧啶一线治疗43例晚期胃癌的临床研究

[目的]评价脂质体紫杉醇（力扑素）联合顺铂、氟尿嘧啶（5-Fu）组成的PCF方案一线治疗43例晚期胃癌的临床疗效和毒副反应。[方法]脂质体紫杉醇135～175mg/m2,静滴3h,d1;顺铂20mg/m2,静滴2h,d1～5;5-Fu750mg/m2持续静脉滴注d1～5。21d为1个周期。按RECIST标准评定疗效,按WHO标准评价毒副反应,Kaplan-Meier法绘制生存曲线。[结果]全组共完成化疗167个周期,中位治疗3个周期。39例患者完成2个周期以上化疗并可评价疗效,其中CR1例,PR19例,SD11例,PD8例,总有效率51.3%。中位无进展生存时间6.0个月,中位总生存时间11.5个月,1年生存率41.0%。主要的Ⅲ~Ⅳ级血液学毒性为白细胞减少及中性粒细胞减少,发生率分别为16.2%和25.6%。全组仅1例发生过敏反应。无患者因毒性反应而停药,无治疗相关性死亡发生。[结论]脂质体紫杉醇联合顺铂及氟尿嘧啶一线治疗晚期胃癌疗效肯定,毒副反应轻,对患者生活质量改善明显。     

紫杉醇联合顺铂、氟尿嘧啶治疗晚期胃癌35例临床分析

目的研究紫杉醇联合顺铂、氟尿嘧啶方案(PCF)治疗晚期胃癌的疗效及安全性。方法回顾性分析2002年11月～2006年11月北京协和医院肿瘤内科收治的使用PCF方案化疗的所有晚期胃癌患者,共35例。化疗方案:紫杉醇(PTX)150mg/m2,静滴3h,第1天给药;顺铂(DDP)12mg/m2,静脉滴注,第1～5天;氟尿嘧啶(5-Fu)3000mg/m2,持续静脉输注120h;每21天为1周期。分别化疗2～6周期后按RECIST标准评价疗效,按NCI-CTC标准评价毒副反应。结果15例局部晚期胃癌患者,术后PCF辅助化疗,中位无进展生存时间(PFS)11.0月,中位总生存时间(OS)18.6月。20例远处转移胃癌患者,15例可评估,完全缓解0例(0),部分缓解3例(20%),疾病稳定9例(60%),疾病进展3例(20%)。中位疾病进展时间(TTP)为7.0月,中位总生存时间(OS)9.0月。3/4度不良反应主要是恶心(18.1%),中性粒细胞减少(9.4%)和乏力(7.9%)。9.5%的患者出现中性粒细胞减少性发热。结论PCF方案的不良反应可以耐受,疗效值得进一步研究。     

紫杉醇联合卡培他滨二线治疗晚期胃癌38例

[目的]评价紫杉醇联合卡培他滨二线治疗晚期胃癌的疗效及安全性。[方法]经病理证实的进展期胃癌患者38例,紫杉醇160～175mg/m2静脉滴注3h,d1;联合卡培他滨1250mg/m2,口服,2次/d,d1～14,服用2周后休息1周;21d为1个周期。[结果]36例可评价疗效患者,PR9例,有效率为23.7%(95%CI:10.2%～37.2%)。中位TTP和OS分别为4.4(95%CI:3.4～5.4)个月和7.2(95%CI:6.6～12.1)个月。Ⅲ/Ⅳ度毒副反应主要为骨髓抑制、手足综合征及脱发。[结论]紫杉醇联合卡培他滨方案二线治疗晚期胃癌疗效确切,毒副作用小。     

紫杉醇脂质体联合奥沙利铂、氟尿嘧啶治疗晚期胃癌

[目的]观察紫杉醇脂质体联合奥沙利铂、氟尿嘧啶方案(POF)治疗晚期胃癌的临床疗效和不良反应。[方法]对48例晚期胃癌患者采用POF方案治疗,具体用法:紫杉醇脂质体135mg/m2,第1d静滴3h;奥沙利铂135mg/m2,第2d静滴2h;氟尿嘧啶500mg/m2,化疗泵内持续推注,d1～5。21d为1个周期,每2个周期评价疗效。[结果]48例患者均可评价疗效及毒性,其中完全缓解(CR)2例(4.2%),部分缓解(PR)23例(47.9%),稳定(SD)14例(29.2%),进展(PD)9例,总有效率(RR)52.1%,中位疾病进展时间(TTP)6.2个月,中位生存时间(MST)11.5个月。临床受益反应评价总有效率75.0%(36/48)。不良反应主要是骨髓抑制和消化道反应,Ⅲ～Ⅳ度骨髓抑制发生率为22.9%;其他外周神经毒性、肌肉酸痛、脱发,多为Ⅰ～Ⅱ度;无化疗相关性死亡病例。[结论]紫杉醇脂质体联合奥沙利铂、氟尿嘧啶(POF)治疗晚期胃癌的疗效确切,不良反应患者能够耐受,可以作为晚期胃癌的一线或二线治疗方案。     

紫杉醇联合氟尿嘧啶和顺铂方案治疗晚期胃癌

目的：观察紫杉醇联合氟尿嘧啶及顺铂（PFC）方案治疗国人晚期胃癌的临床疗效和毒副反应.方法：晚期胃癌患者25例,给予紫杉醇（PTX）50mg/m^2,静滴3小时,第1、8、15天给药;氟尿嘧啶（5-FU）750mg/m^2,持续静脉输注24小时,第1～5天;顺铂（CDDP）20mg/m^2,静脉滴注,第1～5天,28天为1周期.分别化疗2～6周期后按WHO标准评价疗效和毒副反应.结果：全组25例均可评价疗效,获得CR 2例,PR 11例,SD 7例,PD 5例,近期客观有效率52.0%,中位TTP为6.5月.主要毒副反应为骨髓抑制、恶心呕吐和脱发.结论：PFC方案治疗国人晚期胃癌疗效较高,毒副反应轻,多数患者耐受良好,值得推广应用.     

紫杉醇联合希罗达治疗晚期胃癌36例临床分析

[目的]探讨紫杉醇联合希罗达治疗晚期胃癌的疗效及安全性。[方法]紫杉醇（pa-clitaxel）135mg/m2,d1,8,静滴,希罗达1200mg/（m2.d）,分2次口服,21～28d为1个周期,至少2个周期开始评价疗效,获CR、PR患者1个月后确认。[结果]全组36例病例中能评价疗效35例,无CR,PR16例,总有效率为45.71%,中位TTP为6.1个月;其中初治23例中PR11例,总有效率为47.82%,中位TTP为6.2个月;复治13例中可评价疗效12例,PR5例,总有效率为41.67%,中位TTP为5.6个月。毒副反应主要为血液学毒性及消化道反应,多为Ⅰ～Ⅱ度。[结论]紫杉醇联合希罗达治疗晚期胃癌疗效肯定,特别对初治患者,毒副反应较轻,患者均能耐受,值得临床进一步扩大研究。     

紫杉醇每周疗法联合奥沙利铂、氟尿嘧啶治疗32例晚期胃癌

目的观察紫杉醇每周疗法联合奥沙利铂,氟尿嘧啶治疗晚期胃癌的近期疗效及毒副反应.方法紫杉醇60 mg/m2,第1、8、15 d,静脉输注3 h;奥沙利铂85 mg/m2,第2、9 d,静脉输注2 h;第3 d氟尿嘧啶1 000 mg腹腔灌注(每周1次,共6～8次),以上方案应用于32例晚期胃癌患者,静脉化疗3周为1个周期,2周期后评定疗效.结果全组32例病例:CR5例,PR14例,NC11例,PD2例,总有效率为59.3%,获益率93.7%,其中肝转移患者治疗有效率达69.2%,淋巴结转移治疗有效率达63.1%.毒副反应主要为骨髓抑制、脱发、神经毒性及恶心、呕吐等,患者均可耐受.结论紫杉醇每周疗法联合奥沙利铂,氟尿嘧啶治疗晚期胃癌是一个疗效高,毒副反应可耐受的好方案.     

周剂量多西紫杉醇联合顺铂、氟尿嘧啶二线治疗晚期胃癌32例

[目的]研究周剂量多西紫杉醇（TXT）联合顺铂（DDP）、氟尿嘧啶（5-Fu）持续滴注二线治疗晚期胃癌的疗效和不良反应。[方法]32例晚期胃癌患者接受DCF方案二线化疗：TXT30mg/m2,d1,8,15,DDP25mg/m2,d1～3,5-Fu500mg/m2持续静脉滴注,d1～5,28d为1个周期。至少完成2个周期后评价有效率、不良反应、疾病进展时间（TTP）和总生存时间（OS）。[结果]32例患者均可评价疗效,客观缓解率21.9%（7/32）,中位TTP及OS分别为2.7个月和7.6个月。主要不良反应为骨髓抑制、胃肠道反应和脱发。[结论]周剂量TXT联合DDP、5-Fu持续滴注二线治疗晚期胃癌疗效显著,不良反应可以耐受。     

周剂量紫杉醇联合5-氟尿嘧啶/醛氢叶酸二线治疗晚期胃癌疗效观察

目的观察周剂量紫杉醇联合5-氟尿嘧啶/醛氢叶酸二线治疗晚期胃癌的近期疗效,毒副作用及生活质量的改善情况.方法25例晚期胃癌病人接受紫杉醇(PTX)60mg/m2静点3小时,第1,8,15天;醛氢叶酸(LV)200mg/次静点2小时,第1~5天;5-氟尿嘧啶(5-Fu)350mg/m2静点4~6小时,第1~5天。3周为1周期,2周期为1疗程。所有病人至少接受2周期以上。客观疗效(CR PR)与毒副作用按WHO标准进行评价,生活质量按临床受益疗效评价。结果25例均可评价疗效,完全缓解(CR)0例,部分缓解(PR)12例,总有效率48%,临床受益反应有效率76%。中位TTP为5.8月。主要毒副反应为骨髓抑制,消化道反应及神经毒性均为I~II级,可以耐受。结论周剂量紫杉醇联合5-氟尿嘧啶 醛氢叶酸二线治疗晚期胃癌近期疗效明显。病人生活质量明显改善,耐受性好。     

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.     

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     

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.     

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.     

再放疗并同步使用Docetaxel在鼻咽癌放疗后复发病人中的应用

目的:不能手术切除的鼻咽癌放疗后再复发的病人,其治疗困难,化疗疗效差,而单独再放疗只能挽救一小部分病人,本文探讨再放疗并同步使用多西紫彬醇(Docetaxel)在鼻咽癌首次放疗后复发病人中可行性及毒副反应,并评价其疗效。方法:对11例鼻咽癌足量放疗后经组织病理学证实复发、而无法行手术及腔内放疗的患者进行了同步放化疗。放疗采用三维适形放疗,外照射鼻咽部,分次量为1.8Gy,总剂量为36Gy-39.6Gy。化疗采用Docetaxel,15mg/m2,每周一次,静脉滴注。结果:10%、33%的患者分别出现Ⅲ度、Ⅳ度皮肤反应,18%、10%的病人分别出现Ⅲ度、Ⅳ度黏膜反应,18%患者出现Ⅲ度恶心呕吐,27%的患者出现Ⅲ度-Ⅳ度白细胞下降,10%患者出现Ⅲ度血小板下降。1例患者因严重的黏膜反应致使治疗延迟2周。治疗结束后,9例(82%)患者达到CR,2例(18%)达到PR,反应率为100%。结论:对于放疗后局部复发的鼻咽癌患者,采用同步放化疗,3D-CRT同时每周使用Docetaxel是可行的,其毒性反应在可以接受的范围内,短期疗效显著。     

Protothecosis successfully treated with amikacin combined with tetracyclines

Summary We report a case of protothecosis in an 18-year-old female student caused by Prototheca zopfii successfully treated with amikacin combined with tetracyclines. Zusammenfassung Es wird über eine Protothecose, verursacht durch Prototheca zopfii, bei einer 18-j?hrigen Studentin berichtet, die erfolgreich mit Amikacin in Kombination mit Tetracyclinen behandelt wurde.