老年乳腺癌术后多西紫杉醇联合环磷酰胺辅助化疗的毒副作用研究

Objective: The aim of this study was to investigate the side effects of docetaxel with cyclophosphamide as postoperative adjuvant chemotherapy for elderly breast cancer patients. Methods: Thirty-six operable elderly breast cancer patients at intermediate risk based on the St Gallen risk classification underwent modified radical mastectomy and then were given four cycles of TC regimen (docetaxel 75 mg/m2 i.v. on day 1; cyclophosphamide 600 mg/m2 i.v. on day 1; every 21 days ). Primary prophylaxis granulocyte...     

Long-term side effects of chemotherapy for testicular cancer

Since the advent of cisplatin-based chemotherapy in the 1970s, a majority of metastatic testicular cancer patients have been cured with chemotherapy and surgery. The high curability of testicular cancer, along with the young age of afflicted patients, can result in patients living for many years after the chemotherapy. Thus, the assessment of late effects of chemotherapy is clinically important in testicular cancer patients. This article summarizes the literature regarding the long-term side effects, and reviews approaches to the amelioration of these side effects.     

乳腺癌术后TC方案辅助化疗的不良反应观察

目的:研究TC方案(多西紫杉醇75mg/m2,d1+环磷酰胺600mg/m2,d1)在乳腺癌术后辅助化疗中的近期不良反应。方法:84例乳腺癌患者,行乳腺癌改良根治术,St Gallen复发风险分级为中危,术后给予TC方案辅助化疗,每3周1周期,共4周期,观察近期不良反应。结果:TC方案的主要不良反应为粒细胞减少,其次为恶心呕吐。无心脏毒性、过敏反应发生。<65岁与≥65岁的患者相比,粒缺性发热的发生率、减量化疗率的差异均具有统计学意义。结论:<65岁的患者可以耐受标准剂量的TC方案辅助化疗,而≥65岁的患者则需预防性应用G-CSF或化疗减量。     

乳腺癌术后TC方案辅助化疗的不良反应观察

目的：研究TC方案（多西紫杉醇75mg/m2,d1＋环磷酰胺600mg/m2,d1）在乳腺癌术后辅助化疗中的近期不良反应。方法：84例乳腺癌患者,行乳腺癌改良根治术,St Gallen复发风险分级为中危,术后给予TC方案辅助化疗,每3周1周期,共4周期,观察近期不良反应。结果：TC方案的主要不良反应为粒细胞减少,其次为恶心呕吐。无心脏毒性、过敏反应发生。〈65岁与≥65岁的患者相比,粒缺性发热的发生率、减量化疗率的差异均具有统计学意义。结论：〈65岁的患者可以耐受标准剂量的TC方案辅助化疗,而≥65岁的患者则需预防性应用G-CSF或化疗减量。     

乳腺癌相关信号转导通路的研究进展

乳腺癌的术后辅助全身化疗总是取得不断的进展。从环磷酰胺、甲氨喋呤和氟尿嘧啶的三联ＣＭＦ方案减低患者术后复发和死亡风险开始,辅助化疗方案在不断更新,蒽环类药物以及随后的紫杉醇类药物序贯或者联合应用已经成为目前主打的辅助化疗策略。患者的机体状况、肿瘤特定的生物学表型以及药物的疗效和毒性是制定辅助化疗方案必须综合考虑的因素。传统的预后指标评估患者复发风险仍然十分重要,此外新的基因组工具（如ＯｎｃｏｔｙｐｅＤＸ和Ｍａｍｍａｐｒｉｎｔ）便于我们更有选择地为不同的患者制定个体化的术后辅助治疗。     

Profiles of tamoxifen-related side effects by race and smoking status in women with breast cancer

Background: Tamoxifen (TAM) is a selective estrogen receptor modulator (SERM) that is widely used as adjuvant therapy in breast cancer patients; however, it is also associated with undesirable side effects. The goal of this study was to investigate TAM-related side effects, and determine profiles of side effects by race and by smoking status. Methods: A secondary data analysis was conducted using cross-sectional study data from 138 African American and Caucasian women with breast cancer taking TAM 20 mg daily for at least 30 days prior to enrollment. Participants completed questionnaires that obtained information about demographic characteristics, reproductive history, health and lifestyle characteristics, TAM use and its related side effects. Logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals. Results: Compared to never smokers, a significantly greater percentage of current smokers reported ever experiencing TAM-related nausea (28.0% versus 5.0%, P = 0.007), depression (40.0% versus 7.1%, P = 0.001) and migraines (19.2% versus 1.7%, P = 0.02). These differences remained statistically significant after controlling for race, age, obesity, tumor stage, and duration of TAM treatment. No significant differences by race were noted in women reporting TAM side effects. Conclusion: The findings from this study suggest that current smokers with breast cancer should be informed of the increased probability of reporting TAM-related side effects such as nausea, depression and migraines, and counseled about smoking cessation which may reduce the incidence of these side effects.     

Population-based assessment of hospitalizations for toxicity from chemotherapy in older women with breast cancer.

PURPOSE: There are no population-based data on hospitalization rate for toxicity from breast cancer chemotherapy, and even large clinical trials often do not report this information. Medicare data, linked to the Surveillance, Epidemiology, and End-Results (SEER) tumor registries, are now used to assess rates of hospitalization for chemotherapy-related toxicity in a population-based setting. PATIENTS AND METHODS: A total of 35,060 women diagnosed with stages I through IV breast cancer aged >or= 65 from 1991 through 1996 were identified from the SEER-Medicare linked program and studied. Patients were defined as being hospitalized for adverse effects of chemotherapy if there was a Medicare inpatient claim for neutropenia, fever, thrombocytopenia, or adverse effect of systemic therapy less than 7 months after diagnosis of breast cancer. RESULTS: More than 9% of women with breast cancer who received chemotherapy were admitted with the diagnosis of neutropenia, fever, thrombocytopenia, or adverse effect of systemic therapy, compared with 0.5% of women with breast cancer who did not receive chemotherapy. The rates for stage I to IV were 6.3%, 8.1%, 12.3%, and 13.2% in those treated with chemotherapy, and 0.4%, 0.6%, 0.7%, and 1.5% in women not treated with chemotherapy. The hospitalization rates for adverse effects increased significantly with comorbidity score and varied more than two-fold across the nine SEER areas but did not vary by age. Use of anthracycline-containing chemotherapy agents was associated with greater odds of these toxicities (eg, odds ratio, 2.53 for neutropenia; 95% confidence interval, 1.97 to 3.26). CONCLUSION: This study demonstrated the feasibility of using Medicare data to assess rates of hospitalization for serious toxicity associated with cancer chemotherapy. Rates in actual practice were higher than those reported in clinical trials and did not vary by age.     

Information preferences of women receiving chemotherapy for breast cancer

The aim of this cross-sectional survey was to identify a possible relationship between the information-seeking behaviour of patients receiving chemotherapy for breast cancer with source, type, amount and satisfaction of health information accessed. The sample (n = 36) were drawn from the medical oncology department of a large city centre teaching hospital. Participants were recruited through consecutive attendance to the medical oncology department. Eighty-six patients were invited to participate (response rate 42%). An anonymous self-report questionnaire and the Miller Behavioural Style Scale were used to measure attitudes towards 10 different sources of information and identify information-seeking behaviour. The study found that high information-seeking behaviour influenced the type of information sources used to find out about chemotherapy, but did not influence the level of satisfaction with the information sources used. Healthcare professionals were the most frequently used sources of information, but the majority of the sample used a variety of information sources. The Internet was the most frequently used mass media source of information (50% of the sample), especially by those under 50 years old (P = 0.033). Patients' behavioural signature needs to be considered when addressing their information needs. Oncology services need to provide patients with details of recommended high-quality websites to access for information about their chemotherapy.     

Side effects of chemotherapy and combined chemohormonal therapy in women with early-stage breast cancer.

The decision to receive chemotherapy or chemohormonal therapy involves careful consideration of both the potential benefits and possible risks of therapy. There are substantial short- and long-term side effects from chemotherapy. By convention, short-term side effects include those toxic effects encountered during chemotherapy, while long-term side effects include later complications of treatment arising after the conclusion of adjuvant chemotherapy. These side effects vary, depending on the specific agents used in the adjuvant regimen as well as on the dose used and the duration of treatment. There is also considerable variability in side effect profile across individuals. This review will focus on the short- and long-term toxicity seen with the most commonly used adjuvant chemotherapy and chemohormonal therapy regimens.     

Changing patient perceptions of the side effects of cancer chemotherapy

BACKGROUND: Quality-of-life (QoL) issues have become increasingly important as the number of newly diagnosed patients with cancer increases and survival improves. In 1983, Coates et al. reported a survey of patient perceptions of the side effects of cancer chemotherapy and showed the importance of including patient feedback for the accurate assessment of QoL (Eur J Cancer Clin Oncol. 1983;19:203-208.). The authors carried out a similar survey in 100 patients with cancer with the objectives of 1) investigating the changes in patient perceptions that have occurred and 2) evaluating the impact of new treatments on the profile of chemotherapy side effects among patients receiving anticancer drugs. METHODS: One hundred patients attending the outpatient Medical Oncology Department of the Pitié Salpêtrière Hospital Group were surveyed between August 1998 and February 2000 by trained interviewers who were blinded to the patients' treatment. Patients identified all side effects associated with their treatment using a set of 45 cards that named physical side effects (Group A) and a set of 27 cards that named nonphysical side effects (Group B), and the patients ranked these side effects according to severity. The top 5 cards from each group were then combined, and the resulting 10 cards were rated again by severity, regardless of group. Results were analyzed for the entire cohort and for demographic, social, and clinical subgroups. RESULTS: The participants included 65 women and 35 men; the most common malignancies were breast carcinoma (40 patients), gastrointestinal carcinoma (19 patients), lung carcinoma (7 patients), and ovarian carcinoma (9 patients). Patients rated affects my family or partner as the most severe side effect, alopecia was second, and fatigue was the third most severe. Effects on work or home responsibilities, effects on social activities, and loss of interest in sex were ranked fourth, fifth, and sixth, respectively. The results contrasted with those of Coates et al., in which affects my family or partner was ranked 10th, and fatigue was ranked 8th. CONCLUSIONS: Patient perceptions of the side effects of cancer chemotherapy have changed markedly. In the current study, fatigue and psychosocial QoL concerns predominated, compared with emesis, nausea, and negative reactions to the treatment visit in the original survey. The current findings are consistent with the progress that has been made in reducing certain chemotherapy-associated toxicities. Fatigue, however, although it often is related to anemia and is treatable with recombinant human erythropoietin, remains a major concern. The emotional, social, and sexual consequences of cancer treatment present continuing challenges in efforts to optimize QoL and to develop effective supportive care.     

Prevention and treatment of the side effects of cancer chemotherapy

Management of the side effects of chemotherapy in cancer patients is important because side effects can affect the tolerability and continuation of therapy, in addition to lowering the quality of life of patients. A significant efficacy of serotonin receptor antagonists against nausea and vomiting due to cancer chemotherapy, and granulocyte colony-stimulating factor against neutropenia secondary to chemotherapy, has been recently demonstrated. New chemoprotective drugs have been developed, such as amifostine for cisplatin-induced nephrotoxicity and neurotoxicity, and dexrazoxane for cardiac toxicity due to anthracyclines. Antiviral agents including lamivudine and interferons suppress virus replication, preventing the development of fulminant hepatitis during chemotherapy in cancer patients who have chronic hepatitis B infection. Various supportive therapies have resulted in the advance of cancer chemotherapy.     

乳腺癌化疗效果的超声研究

目的 比较彩色多普勒超声检查和三维超声成像技术对乳腺癌新辅助化疗效果的评价价值.方法选取82例女性乳腺癌患者为研究对象,所有患者均采用TAC化疗方案(吡柔比星注射液、多西他赛注射液、环磷酰胺注射液),化疗前后均进行彩色多普勒超声检查和三维超声成像检查.比较超声检查结果与病理学检测结果,同时比较化疗前后患者的血管血流指数(VFI)、平均灰阶值(MG)、平均能量值(MP)和血管指数(R).结果彩色多普勒超声检查与病理学检测结果显示,只有部分缓解患者发生率比较,差异无统计学意义(P﹥0.05);完全缓解、无缓解患者发生率及有效率比较,差异均有统计学意义(P﹤0.05).三维超声成像检查与病理学检测结果显示,只有无缓解患者发生率比较,差异有统计学意义(P﹤0.05);完全缓解、部分缓解患者发生率及有效率比较,差异均无统计学意义(P﹥0.05).三维超声成像结果显示,化疗后患者的VFI、MG、MP和R均下降,与化疗前比较,差异均有统计学意义(P﹤0.05).结论相较于彩色多普勒超声检查,三维超声成像对乳腺癌患者化疗效果的评价更具参考价值,值得临床推广应用.     

Adjuvant chemotherapy (CMF) for breast carcinoma: hematological side effects

Seventy-five patients accepted postmastectomy adjuvant CMF chemotherapy for stage II and III carcinoma of the breast. All patients, irrespective of age, were started on the same drug dosages. About 42% of the patients had leukopenia during the first two cycles; this rate was similar for patients who dropped out of the program early and those who stayed on for six or more months. Patients who developed leukopenia early are more likely to receive less than 65% of mean total CMF dosages (MTD). Otherwise, 30% of patients that never had leukopenia or had leukopenia that appeared late received more than 85% of the prescribed CMF. In our series, postmenopausal patients did not have more problem with leukopenia than premenopausal patients (thrombocytopenia occurred rarely in both groups). Among the 58 patients who had CMF for 6 months or longer, 79% had less than 85% MTD or CMF. The dosages had to be reduced for drug-related and other reasons, and leukopenia only accounted for 22% of patients who had reduced CMF dosages.