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1.
孔琳  张有望  胡超苏 《癌症》2010,29(5):551-555
Background and Objective:Concurrent chemoradiation therapy(CCRT) is the standard treatment for patients with locally advanced nasopharyngeal carcinoma(NPC).The effect of neoadjuvant chemotherapy followed by CCRT has not been determined.Therefore,we conducted 2 phase Ⅱ studies to evaluate the efficacy and safety of neoadjuvant chemotherapy with a regimen of docetaxel,cisplatin,and 5-fluorouracil(5-Fu)(TPF) followed by radiotherapy and concurrent cisplatin in patients with stage-Ⅲ and -Ⅳ(A -B) NPC.This articl...  相似文献   

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Not only the improvement of overall survival, but also the control of local recurrence, a unique type of recurrence, is an important issue in the treatment of advanced local rectal cancer. Total mesorectal excision is internationally accepted to be a standard procedure that lowers the rate of local recurrence. In 1999, the National Institutes of Health in the United States recommended "resection plus postoperative chemoradiotherapy" as the standard treatment for pathological stage II and III rectal cancer. In Japan, however, few large clinical trials of adjuvant radiotherapy have been performed because the rate of local recurrence in patients undergoing surgery alone is lower than that in Western countries. Multicenter, randomized, controlled studies with total mesorectal excision as a control are ongoing in Japan, and the results are awaited. We describe the current status of adjuvant chemoradiotherapy for advanced local rectal cancer in Japan and other countries, along with a review of the literature.  相似文献   

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Background

The most accepted treatment for locally advanced pancreatic adenocarcinoma (LAPA) is chemoradiotherapy (CRT). We sought to determine the benefit of pancreaticoduodenectomy (PD) in patients with LAPA initially treated by neoadjuvant CRT.

Methods

From January 1996 to December 2006, 64 patients with LAPA (borderline, n = 49; unresectable, n = 15) received 5-fluorouracil-cisplatin-based CRT. Of the 64 patients, 47 had progressive disease at restaging. Laparotomy was performed for 17 patients, and PD was performed in 9 patients (resected group). Fifty-five patients had CRT followed by gemcitabine-based chemotherapy (unresected group).

Results

The median survival and overall 5 years survival duration of all 64 patients were 14 months and 12%, respectively. The mean delay between diagnosis and surgical resection was 5.5 months. Mortality and morbidity from PD were 0% and 33%, respectively. The median survival of the resected group vs. the unresected group was 24 months vs. 13 months. Three specimens presented a major pathological response at histological examination. No involved margins were found and positive lymph nodes were found in one patient. Resected patients developed distant metastases.

Conclusions

PD after CRT was safe and resected patients had interesting survival rates. However, resected patients developed metastatic disease and new neoadjuvant regimens are needed to improve the survival of these patients.  相似文献   

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Objective  

Hepatocellular carcinoma (HCC) is among the most common and rapidly increasing cancers in Pakistan. There is currently no standard management for advanced HCC. There is currently no standard management for advanced HCC. The aim of the study was to assess response rate and toxicity of concomitant gemcitabine and external radiation therapy (ERT) in locally advanced HCC.  相似文献   

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The effectiveness of local hyperthermia was investigated in 56 patients with locally advanced carcinoma of the rectum (T4N0M0). All received combined heat and radiation therapy as a pre-operative treatment. The control group consisted of 59 patients with the same stage of disease as those who were only irradiated. Both groups of patients underwent the same surgical procedure. The total tumour dose of ionizing radiation was 40 Gy in 10 fractions, three times a week. The tumour was heated four or five times to a maximum of 42-43 degrees C by electromagnetic waves with a frequency of 905 MHz before irradiation. Each heating session lasted 60 min. Patients were selected on the principle of randomization: 16.1% of patients (n = 9; n: actual number of patients) showed complete response and 53.6% (n = 30) showed significant regression of the primary tumour compared with 1.7% (n = 1) and 33.9% (n = 20) in the control group, respectively. The differences were significant (p less than 0.05). It was found that thermoradiotherapy allowed the 5-year survival rate of patients to increase up to 35.6% (n = 12) compared with 6.6% (n = 7) in the control group (p less than 0.05).  相似文献   

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The effectiveness of local hyperthermia was investigated in 56 patients with locally advanced carcinoma of the rectum (T4N0M0). All received combined heat and radiation therapy as a pre-operative treatment. The control group consisted of 59 patients with the same stage of disease as those who were only irradiated. Both groups of patients underwent the same surgical procedure. The total tumour dose of ionizing radiation was 40 Gy in 10 fractions, three times a week. The tumour was heated four or five times to a maximum of 42–43°C by electromagnetic waves with a frequency of 905 MHz before irradiation. Each heating session lasted 60 min. Patients were selected on the principle of randomization: 16.1% of patients (n = 9; n: actual number of patients) showed complete response and 53.6% (n = 30) showed significant regression of the primary tumour compared with 1.7% (n = 1) and 33.9% (n = 20) in the control group, respectively. The differences were significant (p < 0.05). It was found that thermoradiotherapy allowed the 5-year survival rate of patients to increase up to 35.6% (n = 12) compared with 6.6% (n = 7) in the control group (p < 0.05).  相似文献   

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鼻咽癌新辅助化疗的系统评价—Meta分析   总被引:3,自引:3,他引:0  
目的比较局部晚期鼻咽癌新辅助化疗联合放疗与单纯放疗的差别,进一步明确新辅助化疗在局部晚期鼻咽癌中的作用。方法按照国际Cochrane协作网的系统评价方法,检索近年来发表在国内及国外的所有关于鼻咽癌新辅助化疗的随机对照试验。检索数据库包括:Cochrane图书馆临床对照试验库、Medline(ovid)、Medline(PubMed)、EMbase、中国生物医学文献数据库(CBM)、中文期刊全文数据库(CNKI)、中文科技期刊数据库(VIP)以及所有能检索到相关文章的参考文献。由两位评价员独立地筛选文献,对符合纳入标准的试验进行质量评价和数据提取。采用以下指标对新辅助化疗在局部晚期鼻咽癌中的作用进行严格的评价:5年生存率、5年无瘤生存率、5年局部复发率、5年远处转移率。Meta分析采用RevMan5.0软件完成。结果纳入10个随机对照试验,共1 765例患者,所有试验质量经评价为不清楚(unclear)。Meta分析结果表明部分新辅助化疗+放疗能提高局部晚期鼻咽癌患者的5年总生存率,部分不能,所有新辅助化疗+放疗能提高患者5年无瘤生存率,降低5年局部复发率和5年远处转移率。结论本研究纳入的文献数量不多,方法学质量属不清楚,且尚不能证明新辅助化疗+放疗是否能提高患者的5年总生存率、5年无瘤生存率,降低5年局部复发率、5年远处转移率。  相似文献   

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AIMS: To evaluate a single unit's experience with neoadjuvant chemotherapy for treating locally advanced non-metastatic initially resectable and unresectable oesophago-gastric cancer. METHODS: The medical records of all patients with either locally advanced carcinoma of the lower oesophagus or cardia treated with neoadjuvant chemotherapy between August 1999 and January 2003 were reviewed. RESULTS: Sixty-four patients with initially resectable tumours (T2-3 or N+) and 38 patients with initially unresectable tumours (T4 or M1a) received neoadjuvant chemotherapy (83% combination Epirubicin, Cisplatin and 5-Fluorouracil). Symptomatic grade III/IV toxicity was observed in 33% of patients. Chemotherapy was not completed in 20 patients because of death (5.9%) and inadequate tumour response/toxicity (13.7%). Forty-three patients (67.3%) with initially resectable tumours and 19 patients (50%) with initially unresectable tumours underwent surgery. CONCLUSIONS: Chemotherapy in this study was associated with appreciable toxicity. Patients with initially unresectable locally advanced disease can be downstaged with neoadjuvant chemotherapy.  相似文献   

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An esophagectomy with three-field lymph node dissection is the standard therapy for esophageal cancer in many countries, including Japan. However, the results of esophagectomy are still unsatisfactory in comparison to the results of surgical treatment for gastric cancer or colon cancer. On the other hand, definitive chemoradiation therapy has recently shown progress as a treatment modality for resectable esophageal cancer, with data indicating the potential efficacy of combination therapy with chemoradiation and an esophagectomy. In fact, preoperative chemoradiotherapy for resectable esophageal cancer is becoming a standard therapy in Europe and North America. The latest metaanalysis concerning neoadjuvant chemoradiotherapy for resectable esophageal cancer concluded that a significant survival benefit was evident with preoperative chemoradiotherapy. However, there are still no supportive data for neoadjuvant chemoradiation and surgery from a well-designed large-scale randomized control trial (RCT). A well-designed large-scale RCT is needed to determine the utility of neoadjuvant chemoradiation. Future trials based on precise diagnosis and surgical procedures are required for the adequate interpretation of the results of treatment for resectable esophageal cancer. Of course, quality control of the operation is a very important factor, because operative mortality influences these results.  相似文献   

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局部晚期直肠癌单纯手术后局部复发率高,近年的随机对照Ⅲ期临床研究提示,局部晚期直肠癌的新辅助治疗可明显提高局部控制率,对于治疗后病理完全缓解者还可提高生存率,在欧美国家已成为局部晚期直肠癌的标准治疗.但化疗药物的选择、热疗等的应用等尚需进一步临床研究.  相似文献   

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综合治疗在局部晚期直肠癌治疗中日益受到重视,术前同期放化疗具有降期、降级、保肛、提高局部控制率和生存率的优点,已逐步成为直肠癌综合治疗的标准方案用于临床。  相似文献   

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局部晚期宫颈癌的新辅助化疗   总被引:1,自引:0,他引:1  
宫颈癌的手术和放射治疗取得了很大的成功,但仍有部分患者治疗失败,近年来,宫颈癌的新辅助化疗日益受到关注,并且其临床疗效已被多数学者所肯定.新辅助化疗可减小肿块体积,消除亚临床转移,降低盆腔淋巴结的转移率,以期延长宫颈癌患者的生存期.  相似文献   

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新辅助治疗是指在成功的术后辅助治疗经验基础上提出的术前辅助治疗,其目的 在于增加手术切除肿瘤的可能性并提高患者的生存率,包括新辅助化疗、新辅助放疗和新辅助放化疗.新辅助放化疗在促进切除率和提高生存率上可能成为局部晚期食管癌新辅助治疗的首选方案.  相似文献   

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After a single dose of cisplatin, the ability of peripheral blood mononuclear cells (PBMC) to generate lymphokine-activated killer (LAK) cells was significantly augmented in cancer patients. Based on this clinical finding, the patients with locally advanced esophageal carcinoma were thus treated with a combination of cisplatin and low-dose interleukin-2 (IL-2) in a neoadjuvant setting. Four patients with squamous cell carcinoma of the esophagus (T3 or T4 disease) were preoperatively treated with a regimen consisting of 50 mg/m2 cisplatin on day 1, followed by IL-2 from day 4 through day 8, when the ability of PBMC to generate LAK cells had been shown to be significantly augmented. After two to four courses of the preoperative therapy, one patient achieved a histologic CR, one showed PR and one MR. No severe toxicity was encountered. All patients thereafter underwent surgery. The median survival of these patients was 47.5 months and three of the patients had been disease free for 43 to 62 months after the initiation of the therapy. The combination of cisplatin and low-dose IL-2 administered in a neoadjuvant setting seems to result in an improved survival of locally advanced squamous cell carcinoma of the esophagus.  相似文献   

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