以顺铂为主联合化疗用于头颈部癌的诱导化疗疗效观察

目的：探讨以顺铂为主的联合化疗在头颈部癌手术前诱导化疗中的价值，对手术前诱导化疗的疗效进行了回顾性分析。方法：1986年-1998年，在对213例头颈部癌进行手术前诱导化疗，以顺铂 平铂霉素 甲氨蝶呤（DPM方案）或以顺铂 5-氟脲嘧啶（DF方案），用1-2个周期，结果：诱导化疗后的有效率为：DPM组为42.4%，DF组为45%，两组差异无显著性，总的3个生存率为51.5%。5年生存率为44.8%。结论：以顺铂为主的联合化疗方案对头颈部癌是安全有效的，综合治疗对头颈部癌是有效的治疗方法。     

方克联合顺铂治疗食管癌的临床观察

20 0 2年 9月～ 2 0 0 3年 9月 ,无棣县人民医院共收治食管癌患者 46例 (均为初治患者 ) ,分别采用顺铂 (DDP)联合 5 -氟尿嘧啶 ( 5 FU)与DDP联合替加氟水针剂 (方克 )的方案治疗 ,并应用亚叶酸钙 (CF)增敏 ,结果总结报道如下。1　对象与方法1.1　病例选择及一般资料46例患者 ,男 3 1例 ,女 15例。年龄 5 5～ 75岁 ,中位年龄 67岁。以上病例经病理组织学确诊均为鳞癌 ,而且均有X线、CT等检查 ,所有病例在接受药物治疗前 ,均未接受放射治疗。完成 2个周期者 ,进行疗效及不良反应评估。所有患者按非随机法分为A组 :DDP 5 FU CF方…     

头颈部癌的术前化疗

早期头颈部癌无论采用手术或放疗,或手术加放疗的综合治疗,都可能获得较满意的效果;但对其晚期癌瘤,手术或放疗,或二者的综合治疗,其控制率仅为15％。癌瘤的局部复发和远处转移是一个棘手的问题,局部失败率可达25%～50％,远处转移率可达10%～20％。如何在手术加放疗综合治疗的基础上合理的应用化学治疗,以期进一步减少局部复发,防止远处移转,提高生存率,这是近10余年来国内外学者研究的一个重要课题。本文目的旨在复习有关术前化疗的文献资料,力求总结探讨一些有规律性的问题,供同道参考。     

方克联合顺铂治疗食管癌的临床观察

2002年9月～2003年9月，无棣县人民医院共收治食管癌患者46例(均为初治患者)，分别采用顺铂(DDP)联合5-氟尿嘧啶(5-FU)与DDP联合替加氟水针剂(方克)的方案治疗，并应用亚叶酸钙(CF)增敏，结果总结报道如下。     

草酸铂为主联合化疗治疗晚期胃肠道肿瘤54例疗效观察

为观察草酸铂和羟基喜树碱、5-氟尿嘧啶（5-FU）联合化疗方案治疗晚期胃癌结肠癌的近期疗效和不良反应,制定化疗方案如下：草酸铂130 mg/m^2,静脉滴入2 h,d1;羟基喜树碱6～8 mg/m^2,静脉滴入,d1～d5;甲酰四氢叶酸钙200 mg/m^2,静脉滴入,d1～d5.5-FU 500 mg/m^2,静脉滴入,d1～d5.21 d为1个周期,完成3个周期后判定疗效.全组病例54例,胃癌36例有效率为50.0%（18/36）,结肠癌18例有效率为44.4%（8/18）,胃癌和结肠癌总的有效率48.1%（26/54）.主要不良反应为轻度的血液学毒性,恶心、呕吐和外周感觉神经异常.初步观察结果显示,草酸铂、羟基喜树碱和5-FU是治疗晚期胃肠道肿瘤有效且毒性较少的联合化疗方案.     

LFD化疗方案联合HCPT治疗晚期直肠癌46例临床观察

应用LFD方案＋HCPT治疗46例晚期直肠癌者，疗效CR2例，PR28例，有效率65．2％，毒副反应主要表现为骨髓抑制，脱发，胃肠道反应，均能逆转且患者能耐受，研究结果显示，对于直肠癌术后，常规化疗后复发，转移发治的晚期直肠癌患者，LFD方案联合HCPT仍可获得较高的缓解率。     

LFD化疗方案联合HCPT治疗晚期直肠癌46例临床观察

应用LFD方案 HCPT治疗 46例晚期直肠癌患者 ,疗效CR 2例 ,PR 2 8例 ,有效率 6 5 2 % ;毒副反应主要表现为骨髓抑制、脱发、胃肠道反应 ,均能逆转且患者能耐受。研究结果显示 ,对于直肠癌术后 ,常规化疗后复发、转移或初治的晚期直肠癌患者 ,LFD方案联合HCPT仍可获得较高的缓解率     

草酸铂为主联合化疗治疗晚期胃肠道肿瘤54例疗效观察

为观察草酸铂和羟基喜树碱、5-氟尿嘧啶(5-FU)联合化疗方案治疗晚期胃癌结肠癌的近期疗效和不良反应,制定化疗方案如下:草酸铂130mg/m2,静脉滴入2h,d1;羟基喜树碱6~8mg/m2,静脉滴入,d1~d5;甲酰四氢叶酸钙200mg/m2,静脉滴入,d1~d5。5-FU500mg/m2,静脉滴入,d1~d5。21d为1个周期,完成3个周期后判定疗效。全组病例54例,胃癌36例有效率为50·0%(18/36),结肠癌18例有效率为44·4%(8/18),胃癌和结肠癌总的有效率48·1%(26/54)。主要不良反应为轻度的血液学毒性,恶心、呕吐和外周感觉神经异常。初步观察结果显示,草酸铂、羟基喜树碱和5-FU是治疗晚期胃肠道肿瘤有效且毒性较少的联合化疗方案。     

金葡液联合顺铂胸腔灌注治疗恶性胸腔积液的临床疗效观察

恶性胸腔积液是晚期胸部恶性肿瘤的一种并发症。因其蛋白含量高、增长迅速等特点，严重损害了患者的呼吸、循环功能，从而对患者的生活质量及生存期产生不可忽视的影响。因此，有效地控制胸腔积液对改善患者的生活质量、延长生存期及为其他治疗争取时机具有重要意义。     

The Efficacy of Induction Chemotherapy with Docetaxel,Cisplatin and 5-fluorouracil Combined with Cisplatin Concurrent Chemoradiotherapy for Locally Advanced Head and Neck Squamous Cell Carcinoma: A Matched Pair Analysis

AimsThe role of induction chemotherapy (ICT) for head and neck squamous cell carcinoma (HNSCC) is controversial. The aim of the study was to assess the benefit of ICT with docetaxel, cisplatin and 5-fluorouracil (5-FU) (TPF) when combined with concurrent cisplatin chemoradiotherapy (CRT) for HNSCC.Materials and methodsPatients with HNSCC treated between January 2005 and December 2010 with radical intent with either TPF or cisplatin and 5-FU (PF) ICT and documented intention to proceed with concurrent cisplatin CRT were identified retrospectively. The use and choice of ICT regimen was at the clinician's discretion. In total, 68 patients treated with TPF were identified and were matched for T and N stage and tumour site to 68 patients treated with PF. A survival analysis was carried out using Kaplan–Meier and the Cox proportional hazards model.ResultsThe median follow-up was 29.9 versus 36.3 months for the TPF and PF groups, respectively. Three year locoregional relapse-free survival (RFS), distant RFS, RFS, cancer-specific survival and overall survival rates for the TPF and PF groups were 84.2, 91.6, 82.6, 81.3 and 74.9% versus 73.7, 84.9, 71.9, 72.1 and 62.9%, respectively. On multivariate analysis, treatment with TPF predicted for improved locoregional RFS (P = 0.03) and overall survival (P = 0.05).ConclusionThe addition of docetaxel to a cisplatin doublet ICT regimen before concurrent CRT may improve disease control for locally advanced HNSCC.     

Cisplatin as Second Line Chemotherapy in Advanced or Recurrent Squamous Cell Carcinoma of Head and Neck Region

Thirty-two patients with advanced or recurrent carcinoma of the head and neck were treated with cis-dichlorodiaminoplatinum II (CDDP) 75 mg/m² every third week as second line chemotherapy. The response rate was 3 per cent with one complete and no partial responders, 16 patients with no change and 10 with progressive disease. Five were not evaluated concerning response. Median time to progression was 12 weeks (confidence limits 10--17 weeks) and median survival time 21 weeks (confidence limits 10 to 33 weeks, range 4 to 109). No severe hematologic toxicity was seen. Two patients had progressive polyneuropathy, one had a severe decline in Cr-EDTA-clearance and in one decline in auditory function was suspected. It is concluded that CDDP in this schedule has no role as second line chemotherapy in advanced cancer of head and neck.     

头颈部腺样囊性癌血行转移的临床研究

目的 :观察头颈部腺样囊性癌远处转移情况、影响因素以及其对生存的影响。方法 :回顾性分析 5 1例头颈部腺样囊性癌的临床资料。结果 :远处转移率为 4 1 2 % (2 1 5 1) ;单部位和多部位远处转移分别占 71 4 % (15 2 1)和 2 8 6% (6 2 1) ;肺、骨、肝和脑的转移依次占 81 0 % (17 2 1)、2 3 8% (5 2 1)、14 3% (3 2 1)和 9 5 % (2 2 1)。远处转移的平均发生时间在首次治疗后 5 36年。远处转移组和未远处转移组的生存期、10年生存率分别为 9 81年和 14 31年 ,5 3 8%和 4 1 0 %。远处转移后平均生存期为 2 5 5年 ,2年生存率为 4 7 8%。单纯肺转移组与肺外转移组Log rank检验生存差异有显著性 (P =0 0 32 ) ,其平均生存期、2年生存率分别为 3 4 8年和 1 4 9年 ,72 7%和 2 0 0 %。分析结果还表明 ,远处转移率与患者的性别、年龄、病程长短以及侵犯解剖部位多少无关 ,但与首次手术是否规范 (P =0 0 2 5 )、术后综合治疗是否规范 (是否术后辅以放疗 ) (P =0 0 4 5 )以及是否局部复发 (P =0 0 4 3)相关。结论 :头颈部腺样囊性癌生存期长 ,远处转移率高 ,远处转移出现的时间较晚 ,出现远处转移后患者仍可长期生存。通过根治性手术加术后放疗可能能够降低远处转移率     

头颈部肿瘤体积在放射治疗中的意义

肿瘤体积是影响放疗疗效的预后因素之一。综述了肿瘤体积的测量方法 ,在不同头颈部肿瘤放疗中对疗效的影响作用以及可能的机制 ,并提出将来临床工作中的解决方法。     

静脉持续滴注氟尿嘧啶联合顺铂治疗晚期头颈部鳞癌30例的临床分析

目的探讨持续静脉滴注氟尿嘧啶联合顺铂,治疗复发和远处转移头颈部鳞癌的疗效和安全性。方法30例复发和转移头颈部癌予5-Fu750mg/（m^2.d）持续静脉滴注120h,每天DDP25mg/m^2,第1～3天,3W为1个周期,2个周期后评价疗效。结果CR1例,PR12例,近期客观有效率为44.8%（13/29）。中位TTP7.8个月。初治与复治有效率分别为76.9%（10/13）、18.7%（3/16）,差异有统计学意义（χ^2=9.814,P=0.02〈0.05）。主要不良反应为骨髓抑制,胃肠道反应和黏膜炎。结论持续静脉滴注氟尿嘧啶联合顺铂治疗晚期头颈部癌安全有效。     

Nimotuzumab Combined with Neoadjuvant or Induction Chemotherapy for Head and Neck Squamous Cell Carcinoma: A Retrospective Study

Objective: To assess the efficacy and toxicity of nimotuzumab combined with neoadjuvant or induction chemotherapy for head and neck squamous cell carcinoma (HNSCC). Methods: Patients received intravenous nimotuzumab (400 mg, weekly for 1–3 weeks) combined with chemotherapy (5-fluorouracil/paclitaxel/docetaxel +nedaplatin/cisplatin for 1–2 cycles), prior to definitive surgical resection, radiotherapy or other treatments. Theprimary endpoint was the objective response rate (ORR). The secondary endpoints were tumor downstaging,complete response rate (CRR), partial response rate (PRR), disease control rate (DCR), R0 resection rate, pathological complete response (pCR), larynx preservation rate, overall survival (OS), progression-free survival (PFS),and safety. Results: A total of 71 HNSCC patients with T_1-4N_0-2M₀ were enrolled. After neoadjuvant/inductionchemotherapy, the ORR in patients with hypopharyngeal and laryngeal cancer was 100% and 76.1%, respectively.The DCR was 100% in both groups. The T downstaging in patients with hypopharyngeal and laryngeal cancerwas 64.0% and 50.0%, the N downstaging was 28.0% and 2.2% (p = 0.001), respectively. At the early stage andlocally advanced stage, the T downstaging was 66.7% and 50.0%, the N downstaging was 0% and 16.0% (p =0.128), respectively. The R0 resection rate and pCR in 39 patients receiving surgery were 94.9% and 20.5%, respectively. The larynx preservation rate was 73.2%. The median PFS was 29.2 months in patients with laryngeal cancer. A mild rash occurred in a single patient and no grade 4 adverse events were encountered. Conclusion:Nimotuzumab combined with neoadjuvant or induction chemotherapy achieved similar short-term efficacyand less adverse events compared with previous studies. The N downstaging rate in patients with hypopharyngealcancer was significantly higher compared with patients with laryngeal cancer.     

Effect of Induction Chemotherapy on Swallowing in Head and Neck Cancer Patients

Objective: To evaluate the effect of induction chemotherapy on swallowing and swallowing-related quality of lifeof patients with oropharyngeal, laryngeal and hypopharyngeal cancer. Study design: Prospective study of 33 patientswith locally advanced tumors who were eligible for treatment with neoadjuvant chemotherapy followed by radiotherapyand concurrent chemotherapy. A multidimensional assessment of swallowing was performed using the followingtools: (1) Clinical analysis, numerical scale for general pain and painful swallowing, American Speech and HearingAssociation (ASHA) Functional Communication Measures (FCM) swallowing assessment scales, (2) assessmentof Swallowing-Related Quality of Life (The MD Anderson Dysphagia Inventory - MDADI), and (3) swallowingvideofluoroscopy. Results: There was a reduction in general pain scale (p=0.021), and quality of life (emotional,functional and physical) improved from average limitation (score of 61-80) to minimal limitation (81-100) afterinduction chemotherapy. According to the swallowing videofluoroscopy results, 26 (78.7%) of the patients had somedegree of dysphagia pre-treatment, which decreased to 21 (63.6%) after induction. Conclusion: Our results suggestthat induction chemotherapy improves numerous aspects of swallowing and has a positive impact on the quality oflife of pre-chemoradiotherapy patients.     

头颈鳞癌的术前化疗效果

[目的]研究术前化疗能否提高手术切除率,降低局部复发率。［方法］104例头颈鳞癌病人分成试验组（58例）：术前化疗 手术 术后放疗组;对照组（46例）：手术 术后放疗,但不用术前化疗。手术方式为原发癌切除 颈淋巴结清扫术,用或不用肌皮瓣修复头颈部组织缺损。术后放疗剂量50Gy～60Gy。术前化疗用PFP方案即DDP＋5－Fu＋PYM。［结果］试验组部分缓解67.2%,微效17.2%。试验组和对照组3年局部复发率分别为27.6%、52．2％（P＜0.01）;但3年内远处转移率无差异,分别为34．5%、34．8%,中位生存期分别为23个月和22个月,3年生存率分别为65．5%和56．5%（P＞0.05）。［结论］术前新辅助化疗,可以缩小瘤体,提高手术切除率,减少局部复发。     

Response Rate of Cisplatin Plus Docetaxel as Primary Treatment in Locally Advanced Head and Neck Carcinoma (Squamous Cell Types)

Objective: To evaluate the response rate of Cisplatin plus Docetaxel in the treatment of locally advanced head and neck squamous cell carcinomas (HNSCC) at a tertiary care hospital in Karachi, Pakistan. Materials and Methods: It was a longitudinal study, conducted at the Department of Medical Oncology, Jinnah Postgraduate Medical Center, Karachi, Pakistan from December 2018 to June 2019. One hundred patients of age 14-66 years of age of either gender with histologically proven Squamous Cell Carcinoma of Head and Neck, Stage III and IV (locally advanced) with no distant metastases were included in the study. Patients who were declared unresectable by the otolaryngologist and those with delayed appointment for radiation were given 3 cycles of Induction Chemotherapy with Cisplatin and Docetaxel, both at a dose of 75mg/m2 3 weekly. After 3 cycles, CT scan was repeated to assess the clinical response. Those patients who had partial or complete response as per RECIST criteria were re-assessed by the otolaryngologist and were planned for surgery if disease became resectable while other patients were referred for Concurrent Chemo-Radiation Therapy (CCRT). SPSS version 23 was used to analyze data. Results: The partial response was achieved in majority of the patients after Induction Chemotherapy with Docetaxel and Cisplatin (62%) with a complete response in 12 %. However, 22% showed progression of the disease, and 4% showed stable disease. The most frequent side effects observed were diarrhea (62%) and neutropenia (57%). Conclusion: Induction chemotherapy with Cisplatin and Docetaxel is a promising regimen with good response and favorable toxicity profile and can be considered as a potentially effective outpatient regimen for locally advanced squamous cell carcinoma of head and neck.