膀胱腺癌(附27例报告)

目的　提高膀胱腺癌的诊治效果。方法　12 例脐尿管腺癌中,7 例行扩大性膀胱部分切除;15 例原发膀胱腺癌中,11 例行膀胱部分切除术。结果　膀胱腺癌总的5 年生存率25 .9 % 。脐尿管腺癌中,7 例行扩大性膀胱部分切除者,无一例局部复发,12 例中有4 例生存5 年。原发膀胱腺癌的治疗主要为膀胱部分切除术,生存5 年者3 例,局部复发4 例,均在原肿瘤部位。1 例原发膀胱腺癌皮下和腹股沟淋巴结转移患者和2 例脐尿管腺癌肺转移患者经化疗 放疗后分别生存24 ,28 和60个月。结论　脐尿管腺癌宜采用扩大性膀胱部分切除术,原发膀胱腺癌宜采用根治性膀胱全切除术。对复发转移患者应积极采取综合治疗,以提高生存率。     

膀胱腺癌

目的 提高膀胱腺癌的诊治效果。方法 １２例脐尿管腺癌中,７例行扩大性膀胱部分切除;１５例原发膀胱腺癌中,１１例行膀胱部分切除术。结果 膀胱腺癌总的５年生存率２５．９％．脐尿管腺癌中,７例行扩大性膀胱部分切除者,无一例局部复发,１２例中有４例生存５年。原发膀胱腺癌的治疗主要为膀胱部分切除术,生存５年者３例,局部复发４例,均在原肿瘤部位。     

丝裂霉素、失碳长春碱、顺铂联合治疗晚期非小细胞肺癌32例

目的观察丝裂霉素（MMC）、失碳长春碱（NVB）、顺铂（DDP）联合（MNP）治疗晚期非小细胞肺癌（NSCLC）的临床疗效。方法用MNP方案治疗NSCLC32例，男性22例，女性10例，鳞癌12例，腺癌19例，鳞腺癌1例。IIIA期4例，IIIB期12例，IV期16例。初治19例．复治13例。结果PR19例，SD10例，PD3例，总有效率594％，其中鳞癌有效率66．7％，腺癌有效率57．9％，疗效相仿。IIIB期与IV期的有效率分别为58．3％和56．3％。两者疗效无差异。初治者的疗效（68．4％）好于复治者（46．2％）。中位缓解期5．6个月，中位生存期10．3个月。剂量限制性毒性为骨髓抑制，白细胞下降为93．8％，其中III－IV度占50．0％。静脉毒性为31．3％，应予注意。结论MNP方案治疗晚期NSCLC疗效较高，毒性可耐受，值得临床进一步推广使用。     

卵 巢癌体表淋巴结转移

From March 1958 to June 1988, 53 cases of ovarian cancer with superficial lymph node metastasis (SLM) were treated in our hospital comprising 5.6% of patients with malignant ovarian tumors in the same period. Of 53 cases, 31 were proven by histopathology, and 27 had serous adenocarcinoma. Of these 31 cases, 15 with Stage IV lesion had SLM at time when first seen in the clinic and the others developed SLM during treatment or afterwards. The median survival was 34.7, 11.8 and 12.9 months in Grades I, II and III, respectively. Prognosis is related to pathological grade. The median survival was 36.5 months in 10/31 patients treated with surgery combined with chemotherapy and radiotherapy, 9.1 months in 6/31 treated with surgery plus chemotherapy, 22.4 months in 3/31 treated with radiotherapy only and 8.5 months in 6/31 treated with chemotherapy only. It is suggested that aggressive treatment can improve survival.     

Adjuvant (cisplatin, etoposide, and 5-fluorouracil) chemotherapy after curative resection of gastric adenocarcinomas involving the esophagogastric junction.

Gastric adenocarcinomas involving the esophagogastric junction represent a particular therapeutic problem because they lie in the border area between two body cavities: the thorax and the abdomen. The prognosis of gastric adenocarcinomas involving esophagogastric junction is poor because there is widespread lymphatic metastasis, making curative resection difficult. Even in patients with localized disease who are potentially curable, the 5-year survival rate is approximately 20% with curative resection only, somewhat lower than for those with cancer elsewhere in the stomach. The authors conducted a pilot study to evaluate the safety and possible efficacy of adjuvant chemotherapy with cisplatin, etoposide, and 5-fluorouracil (PEF) after curative resection of gastric adenocarcinoma involving esophagogastric junction. Three cycles of adjuvant PEF chemotherapy with cisplatin (20 mg/m2/day intravenously on days 1-5), etoposide (100 mg/m2/day intravenously on days 1, 3, and 5), and 5-fluorouracil (800 mg/m2/day continuous intravenous infusion on days 1-5) were given every 3 weeks after curative resection of gastric adenocarcinoma involving the esophagogastric junction. Between November 1989 and June 1995, a total of 50 patients with postoperative stage II, IIIA, or IIIB disease entered this trial. In 14 of 50 patients (28%), the disease recurred during the follow-up of 4-83 months (median 26 months). Disease-free survival was 4-83+ months (median 48 months), and the actuarial 5-year disease-free survival rate was 48% (95% CI: 41% to 55%). Overall survival was 4-83+ months (median 62 months), and the actuarial 5-year survival rate was 54% (95% CI: 40% to 68%). The prognostic factor analysis showed that the postoperative N stage and the interval between surgery and chemotherapy affected disease-free survival and overall survival. The toxicities of PEF adjuvant chemotherapy were leukopenia, nausea/vomiting, and alopecia, but they were mostly mild and reversible except in one patient who died because of treatment-related sepsis. Adjuvant chemotherapy with three cycles of PEF regimen was well tolerated and seems to be a promising treatment for gastric adenocarcinoma involving the esophagopstric junction, in comparison with previous treatments. To define the efficacy of adjuvant PEF chemotherapy for gastric adenocarcinoma involving esophagogastric junction, prospective randomized trials are warranted.     

Chemoradiation for adenocarcinoma of the anus

PURPOSE: To assess the efficacy and limitations of definitive chemoradiation for adenocarcinoma of the anal canal and to propose a treatment strategy that addresses the limitations of treatment. METHODS AND MATERIALS: Between 1976 and 1998, 16 patients with localized adenocarcinoma of the anal canal were treated with radiotherapy with or without chemotherapy with curative intent. Available histologic slides were reviewed for evidence of primary adenocarcinoma of anal duct origin. The treatment results for these patients were compared with those of a group of patients with epidermoid histologic features who were all treated with definitive chemoradiation (55 Gy with concurrent 5-fluorouracil and cisplatin, n = 92) between 1989 and 1998. The hospital records were reviewed for all patients. Patients with epidermoid carcinoma presented with more advanced primary tumors (42% vs. 19% Stage T3 or greater). All adenocarcinoma patients were treated with radiotherapy (median dose 55 Gy): 11 received concurrent 5-fluorouracil-based chemotherapy and 5 received radiotherapy alone. The initial surgical procedures included abdominoperineal resection, excisional biopsies (n = 5), and local excision (n = 1). Abdominoperineal resection was performed as salvage therapy after local recurrence in 5 patients. The Kaplan-Meier method was used to calculate 5-year actuarial pelvic control, distant disease control, disease-free survival, and overall survival. The median follow-up was 45 months (range 5-196) for patients with adenocarcinoma and 44 months (range 9-115) for patients with epidermoid histologic features. RESULTS: Both local and distant recurrence rates were significantly greater in the adenocarcinoma patients. Of 16 patients with adenocarcinoma, 7 (5-year actuarial rate 54%) had recurrence at the primary site compared with 16 (5-year actuarial rate 18%) of 92 patients with epidermoid histologic features (p = 0.004). Distant disease developed in more patients with adenocarcinoma (5-year actuarial rate 66%) than in patients with epidermoid carcinoma (5-year actuarial rate 10%, p <0.001). The 5-year actuarial disease-free survival and overall survival rate for adenocarcinoma patients was 19% and 64%, respectively, compared with 77% (p <0.0001) and 85% (p = 0.017) for those with epidermoid carcinoma. CONCLUSION: Patients with localized adenocarcinoma of the anus treated with definitive chemoradiation had high rates of pelvic failure and distant metastasis compared with comparably staged patients with epidermoid histologic features treated similarly. On the basis of these limitations, we recommend preoperative chemoradiation followed by abdominoperineal resection to maximize pelvic disease control and consideration of adjuvant chemotherapy to address the problem of micrometastatic disease.     

酪氨酸激酶抑制剂与化疗交替联合治疗晚期肺腺癌的临床疗效

[目的]探讨酪氨酸激酶抑制剂（TKI）与化疗异时联合治疗晚期肺腺癌患者的疗效和不良反应。[方法]收集66例晚期肺腺癌患者,应用含铂2药化疗．疾病进展时予TKI吉非替尼或厄罗替尼治疗,或TKI初始治疗进展后使用化疗;交替进行。总生存时间及不良反应为主要观察指标;[结果]66例患者中,58例是化疗-TKI治疗模式,再化疗的有效率为15．5％,8例是TKI-化疗模式,再次TKI的有效率为25．0％,稍高于化疗-化疔模式患者中第二次治疗的有效率（12．7％）（χ2=2．6,,P=0．08）。化疗-TKI治疗与TKI-化疗患者的中位总体生存期（OS）无明显差异（18．3个月VS17．5个月）（P=-0．44）,但明显长于化疗-化疗患者（6．9个月）（P=0．0001）。交替治疗患者的3-4度不良反应与对照人群相似。[结论]晚期肺腺癌患者TKI与化疗交替联合治疗能提高有效率,明显延长生存时间,与交替方式（给药顺序）无关。     

Chemotherapy in neuroendocrine/Merkel cell carcinoma of the skin: case series and review of 204 cases.

PURPOSE: To study the use of chemotherapy for Merkel cell carcinoma (MCC) of the skin. PATIENTS AND METHODS: Twenty-five cases of MCC were treated at the London Regional Cancer Center between 1987 and 1997. Thirteen cases treated with chemotherapy were reviewed with 191 cases from the literature. RESULTS: At presentation, 24 patients had localized skin lesions (stage I) and one had locoregional involvement (stage II). Among the nine cases with recurrent nodal disease, six had chemotherapy as a component of salvage treatment. They were all free of disease at a median of 19 months (range, 12 to 37 months). In contrast, two patients who had salvage radiotherapy alone died of disease. Overall survival (OS) and disease-free survival (DFS) were 59% and 43%, respectively, at two years. Median OS and DFS were 29 months (range, 1 to 133 months) and 9 months (range, 1 to 133 months), respectively. Nodal disease developed in 12 (50%) of 24 patients with stage I disease, and distant metastases developed in six (25%) of 24. Including those from the literature, there were 204 cases treated with chemotherapy. Cyclophosphamide/doxorubicin (or epirubicin)/vincristine combination +/- prednisone was the most commonly used chemotherapy regimen (47 cases), with an overall response rate of 75.7% (35.1% complete, 35. 1% partial, and 5.4% minor responses). Etoposide/cisplatin (or carboplatin) was the next most commonly used regimen (27 cases), with an overall response rate of 60% (36% complete and 24% partial responses). The difference in response rate was not statistically significant (P =.19). Among the 204 cases, there were seven (3.4%) toxic deaths. CONCLUSION: Chemoradiation for locally recurrent or advanced disease may be an option for patients with a good performance status.     

托瑞米芬联合长春瑞滨和顺铂二线治疗中晚期非小细胞肺癌的疗效

目的:前瞻性研究托瑞米芬(toremifene, TOR)联合NP方案(顺铂加长春瑞滨)二线治疗含铂联合化疗方案一线治疗失败的中晚期非小细胞肺癌(non-small cell lung cancer, NSCLC)患者的疗效和安全性.方法:2004年1月-2006年2月,44例接受含铂联合化疗方案一线治疗失败的ⅡB～Ⅳ期NSCLC患者接受了TOR联合NP方案的二线治疗.化疗2个周期后评价疗效和不良反应,并分析生存情况.结果:44例患者的中位化疗周期数为1.8个(范围:1～3个),其中可评价疗效者为37例(既往曾经接受NP方案化疗者21名,接受其他含铂联合化疗方案者16例).37例患者接受二线治疗后,4例获得部分缓解,19例为疾病稳定,14例为疾病进展,无完全缓解者,总有效(完全缓解+部分缓解)率为10.8%(4/37),疾病控制(完全缓解+部分缓解+疾病稳定)率为62.2%(23/37).其中,肺鳞癌患者的有效率和疾病控制率分别为27.3%(3/11)和72.7%(8/11),高于肺腺癌患者的0%(0/18)和44.4%(8/18)(P<0.05).44例患者的中位生存期为8.2个月,中位疾病稳定时间为4.0个月(1.0～10.2个月),总的1年生存率为24.4%.其中,肺鳞癌患者的中位生存期和1年生存率分别为9.2个月和33.3%,肺腺癌患者的中位生存期和1年生存率分别为7.1个月和27.7%,两者比较差异均无统计学意义(P>0.05).男性与女性患者的生存差异也无统计学意义.化疗中,1例患者因肝功能损害(高胆红素血症)中止治疗.化疗不良反应主要包括胃肠反应、骨髓抑制和肝功能损害等,无严重不良反应发生.结论:TOR联合NP方案二线治疗NSCLC患者的疗效与目前的一线含铂联合化疗方案相似,尤其对于肺鳞癌患者而言,且不良反应未见明显增加.     

术中放疗联合区域动脉灌注治疗晚期胰腺癌

目的 评价术中放疗联合区域动脉灌注治疗晚期胰腺癌的效果。方法 17例晚期胰腺癌减黄手术时行IORT，胃网膜右动脉插管采用5—氟尿嘧啶(5—FU) 表阿霉素(E—ADM) 丝裂霉素(MMC)方案行区域灌注化疗，其中6例术后行外照射放疗。结果 疼痛缓解率70．59％(12／17)，临床受益指数35．29％(6／17)，局部病灶部分缓解23．53％(4／17)。中位生存11个月，1年生存率35．29％(6／17)。结论 IORT结合区域动脉灌注化疗毒副作用轻微，可明显提高临床受益率，延长生存期。     

吉非替尼治疗91例晚期非小细胞肺癌疗效分析

目的 总结表皮生长因子受体酪氨酸激酶抑制剂吉非替尼治疗91例晚期非小细胞肺癌患者的疗效、中位肿瘤进展时间（TTP）、中位生存期和毒副反应,分析与疗效、生存期可能相关的因素。方法 91例化疗失败的晚期非小细胞肺癌患者,中位化疗周期数为6（1～17）周期,68例（74．7％）患者至少经过二线方案化疗,疾病仍进展;Ⅳ期76例（83．5％）,其中42例（46．2％）至少有2个转移部位。口服吉非替尼剂量为250mg／d。运用SPSS11．5统计软件进行统计分析。结果 全组客观有效率为20．9％（19／91）,疾病控制率为63．7％（58／91）,症状改善率为72．7％（40／55）,ECOG评分稳定及改善为71．4％（65／91）。腺癌、至少接受二线方案化疗及出现皮肤毒性者与疾病控制率呈明显正相关（P值分别为0．04、0．02及0．00）。中位TTP 5．0个月（95％CI为3．26～6．74）,中位随访7．5（1～18．5）个月,1年生存率为56．4％。目前仍存活56例（61．5％）,其中29例（51．8％）仍处于疾病控制中,20例生存期已超过1年（12～18．5个月）。对生存有益的单因素为不吸烟、疾病控制、出现皮肤毒性及吉非替尼治疗过程中控制转移灶。经Cox回归分析发现,不吸烟、疾病控制是独立预后因素（P值分别为0．01和0．00）。毒副反应主要为Ⅰ、Ⅱ度皮肤毒性。结论 靶向治疗药物吉非替尼对传统治疗失败的晚期难治性非小细胞肺癌患者有明显疗效,有改善症状及延长生存期作用,且耐受性好。     

顺铂分别联合培美曲塞和吉西他滨治疗晚期非小细胞肺癌的临床疗效分析

目的探讨顺铂分别联合培美曲塞和吉西他滨治疗晚期非小细胞肺癌（NSCLC）的临床疗效和不良反应。方法将2009年3月至2011年2月收治并入选的86例晚期NSCLC患者随机分为A组（n=44例）和B组（n=42例）,A组患者采用顺铂＋培美曲塞方案治疗,B组患者采用顺铂＋吉西他滨方案治疗,两组患者均化疗4个周期,化疗结束后进行2年的随访观察,记录并分析两组患者化疗结束后1个月的临床疗效、生活质量评分、化疗期间药物不良反应及化疗以后2年生存率。结果（1）化疗结束后,两组患者临床疗效构成和总体有效率未见明显差异,A组腺癌患者化疗后1个月KPS评分高于B组（P=0．030）。（2）两组患者化疗期间药物不良反应类型及发生率相近,A组患者粒细胞减少比例（31．8％）低于B组患者（54．8％）,差异有统计学意义（P=0．032）。（3）两组患者化疗后2年生存率与病死者平均生存月数无明显差异,但A组腺癌患者2年生存率与病死者平均生存月数均高于B组腺癌患者（均P〈0．05）。结论顺铂联合培美曲塞治疗晚期NSCLC的疗效与顺铂联合吉西他滨相当,但腺癌患者的临床疗效优势明显,药物不良反应发生率相对较低。     

First-line chemotherapy with irinotecan plus capecitabine for advanced colorectal cancer

OBJECTIVE: The aim of this study was to evaluate efficacy and safety of the combination chemotherapy with irinotecan plus capecitabine in patients with advanced colorectal adenocarcinoma. METHODS: Patients with histologically proven advanced colorectal adenocarcinoma received a first-line chemotherapy with irinotecan 240 mg/m2 on day 1 and capecitabine 2,000 mg/m2/day as an intermittent regimen of 2 weeks of treatment followed by a 1-week rest. Treatment was repeated every 3 weeks. RESULTS: Thirty-nine patients were registered, and 36 were assessable for responses. Sixteen objective responses (44%) were observed with a median response duration of 6.9 months. Stable disease was documented in 14 cases (39%). The median time to progression was 6.7 months. The median overall survival was not reached at the time of analysis, and the 1-year survival rate was 67%. Two patients died: 1 due to sepsis not complicating myelosuppression, and 1 patient, known as a hepatitis B virus carrier prior to chemotherapy, died of hepatic failure, the cause of which was not clinically verified. Frequently encountered therapy-related events were leukopenia and gastrointestinal side effects including diarrhea. Severe hand-and-foot syndrome was observed in only 1 patient. CONCLUSIONS: The combination chemotherapy of irinotecan and capecitabine is an active and tolerable regimen for advanced colorectal adenocarcinoma, but the observed deaths suggest a future randomized trial that requires a cautious patient selection.     

Combination chemotherapy with mitomycin C, methotrexate, cisplatin, and vinblastine in the treatment of non-small cell lung cancer

The combination of mitomycin C, methotrexate, cisplatin, and vinblastine was administered to 45 patients with unresectable non-small cell lung cancer. Thirty-nine patients satisfied criteria for assessment of response to chemotherapy. All patients had a performance status of greater than 50%, had evaluable disease, and had not received previous chemotherapy. The overall response rate was 54% with responses seen in 12 of 19 squamous cell, 8 of 16 adenocarcinoma, and 1 of 4 undifferentiated large cell lung cancer patients. Median survival was increased by 3 months in those patients with an objective response to chemotherapy. Drug-associated toxicity was rare, but apparent mitomycin C-related pulmonary fibrosis was observed in two patients. This four-drug combination was shown to be an active regimen in the treatment of non-small cell bronchogenic carcinoma.     

Mature survival results with preoperative cisplatin,protracted infusion 5-fluorouracil,and 44-Gy radiotherapy for esophageal cancer

PURPOSE: To assess the long-term survival results after cisplatin, protracted infusion 5-fluorouracil, and concurrent radiotherapy (RT) followed by surgical resection of esophageal cancer. METHODS AND MATERIALS: Ninety-two patients with esophageal cancer (65 with adenocarcinoma and 27 with squamous cell carcinoma) were treated in two sequential protocols of preoperative chemoradiotherapy. The patients had tumor confined to the esophagus and regional nodes, including celiac nodes for middle and distal lesions. In trial A (1989-1994), 50 patients were treated with 44 Gy RT (2 Gy/d) along with concurrent 5-fluorouracil 300 mg/m(2)/d given by protracted venous infusion on Days 1-30 and cisplatin 26 mg/m(2) on Days 1-5 and 26-30. In trial B (1995-1997, 42 patients), the chemotherapy dosages during RT were reduced to 5-fluorouracil 225 mg/m(2)/d protracted venous infusion and cisplatin 20 mg/m(2)/d on Days 1-5 and 16-30; three cycles of paclitaxel 135 mg/m(2)and cisplatin 75 mg/m(2) were given postoperatively. Surgery generally occurred 4-6 weeks after completion of the planned preoperative therapy. Transhiatal resection was performed whenever possible. RESULTS:Of the 92 patients, 86 (93%) underwent surgery (1 refused, 2 died preoperatively, and 3 developed evidence of metastatic disease). Of the 92 patients, 80 (87%) had complete resections with negative margins (3 had positive margins and 3 had distant metastases discovered at surgery). The pathologic complete response rate was 33% (30 of 92). The median follow-up was 63.5 months. The median survival and disease-specific survival for all enrolled patients was 35 and 59 months, respectively. The 5-year survival and disease-specific survival rate was 40% and 49%, respectively. Patients with a pathologic complete response had a 67% survival rate at 5 years (median not reached), and the remainder of patients had a 5-year survival rate of 27% (median 21 months; p <0.001). For 21 patients alive after 5 years (60-121 months), 2 died of their disease and all others were disease free. Eight patients with pathologic Stage I tumor at the time of surgery had survival similar to those with a complete response to preoperative therapy. The median survival for patients with pathologic Stage IIA, IIB, III, and IV disease at the time of surgery was 22, 13.5, 18, and 4.9 months, respectively. The pattern of initial failure was local/regional alone in 6% (5 of 90), local/regional plus distant in 3% (3 of 90), and distant alone in 47% (42 of 90). No differences were noted in survival or response rate between those with adenocarcinoma or squamous cell carcinoma. CONCLUSION: The promising 5-year survival results and low rate of late cancer-related deaths suggest that these regimens of intensive neoadjuvant therapy may improve the overall cure rate. The pathologic stage after neoadjuvant therapy is an important predictor of survival and may be useful in selecting patients for novel adjuvant therapies. Isolated local failure is uncommon, indicating that efforts to improve the therapeutic outcome should focus on optimizing systemic therapy rather than intensifying the RT. Additional randomized data are needed to assess the benefits of this therapeutic approach fully.     

卡培他滨节拍化疗在晚期三阴性乳腺癌维持治疗中的疗效观察北大核心

目的:探讨卡培他滨节拍化疗在晚期三阴性乳腺癌患者维持治疗中的近远期疗效、生活质量以及不良反应。方法:将经联合化疗有效的58例晚期三阴性乳腺癌患者随机分为卡培他滨节拍化疗组和卡培他滨常规剂量组两组,每组患者各29例。节拍化疗组患者给予卡培他滨节拍化疗,常规剂量组患者给予常规剂量卡培他滨化疗。治疗2个月后评价近期疗效,每个月评价不良反应,并统计两组患者的中位疾病进展时间、中位生存时间、1年生存率、2年生存率和生活质量的变化。结果:58例患者均可评价疗效。节拍化疗组患者中CR 0例,PR 5例,SD 22例,PD 2例,客观缓解率(ORR)和疾病控制率(DCR)分别为17.2%和93.1%;常规剂量组患者中CR 0例,PR 6例,SD 20例,PD 3例,客观缓解率(ORR)和疾病控制率(DCR)分别为20.7%和89.7%。两组患者的ORR和DCR相比差异无统计学意义(P>0.05)。节拍化疗组患者的中位肿瘤无进展生存时间(PFS)为7.1个月,与常规剂量组患者(6.9个月)比较,差异无统计学意义(P>0.05);节拍化疗组患者的1年、2年生存率分别为72.4%、58.6%,与常规剂量组患者(69.0%、55.2%)比较,差异无统计学意义(P>0.05)。生活质量改善方面,节拍化疗组患者显著优于常规剂量组患者(P<0.05);节拍化疗组患者的主要不良反应为骨髓抑制、消化道反应和手足综合征等,均以Ⅰ-Ⅱ度为主,均可耐受,常规剂量组患者的消化道反应、骨髓抑制、手足综合征等不良反应的发生率和严重程度均显著高于节拍化疗组(P<0.05)。结论:卡培他滨节拍化疗作为晚期三阴性乳腺癌患者的维持治疗,其近远期疗效与常规剂量维持化疗相当,同时可提高患者生活质量,不良反应轻且发生率低,值得临床推广应用。     

5-Fluorouracil, adriamycin, and mitomycin-C (FAM) chemotherapy for adenocarcinoma of the lung.

Twenty-five patients with advanced measurable adenocarcinoma of the lung were treated with combination chemotherapy consisting of 5-fluorouracil, adriamycin, and mitomycin-C (FAM). Objective response (1CR, 8PR) was obtained in 36% of patients. The median duration of response was 7.0 months and the median survival for responders is greater than 8.5 months. Five responders are alive 5.5 to 23.5 months after starting therapy. Three of four patients evidencing stabilization of disease are alive at 10-23 months. Non-responding patients had a median survival of 2.5 months and none lived beyond seven months. Tumor response and survival suggested correlation with initial performance status and limited disease. The FAM regimen was tolerated well, with moderate bone marrow suppression and gastrointestinal symptoms being the only clinically significant toxicities. These results indicate that patients with advanced pulmonary adenocarcinoma can obtain objective tumor regression with FAM chemotherapy.     

甲磺酸阿帕替尼三线或三线以上治疗晚期胃腺癌的临床观察

目的 探讨甲磺酸阿帕替尼三线或三线以上治疗晚期胃腺癌的临床疗效和安全性。方法 回顾性分析2014年12月至2016年1月接受过二线及二线以上化疗方案治疗失败的20例晚期胃腺癌患者,给阿帕替尼500 mg／天口服,持续用药至肿瘤进展或出现不可耐受的不良反应。结果 20例胃腺癌患者的有效率（RR）和疾病控制率（DCR）分别为10.0％和40.0％,中位无进展生存时间（PFS）和中位总生存时间（OS）分别为2.7个月和4.3个月。患者耐受性良好,常见的毒副反应为1～3级高血压、手足综合征和蛋白尿。结论 对于接受过二线及二线以上化疗方案治疗失败的晚期胃腺癌患者,阿帕替尼具有良好的疗效和安全性。     

Primary adenocarcinoma of the small intestine: presentation, prognostic factors and clinical outcome

Background: Malignant small intestine tumor accounts for 0.1–0.3%of all malignancies. Although primary adenocarcinoma is themost common histologic subtype, there is no report of the clinicalcharacteristics and natural history in the Asian population. Methods: We conducted retrospective analysis for the patients with thesmall intestine adenocarcinoma to explore the clinical characteristicsand prognosis. All patients with adenocarcinoma of small intestinediagnosed between March 1997 and March 2007 in the CatholicMedical Center in Korea were identified through the cancer registry.The medical records were reviewed for patient characteristics,treatment and outcome data. Results: Data on 53 patients were available. Twenty-six patients (49.0%)underwent curative resection and 13 patients receiving adjuvantchemotherapy. Fifteen patients received palliative chemotherapy.Median of overall survival of all patients was 12 months (95%confidence interval (CI): 8.5–15.1 months). Three-yearsurvival and relapse-free survival rates after curative resectionwas 66.1 and 50.8%, respectively. Median survival of patientsreceived palliative chemotherapy was 8.0 months (95% CI: 3.5–12.4). Conclusions: The prognosis of primary adenocarcinoma of small intestine waspoor, especially in cases where curative resection could notto be performed. Further study on the methods for early detectionand effective systemic chemotherapy should be investigated.     

Combining gemcitabine and capecitabine in patients with advanced biliary cancer: a phase II trial.

PURPOSE: Biliary cancer has a poor prognosis, and chemotherapy has had little impact. The objectives of this trial were to determine the response rate, time to disease progression, survival, and safety profile of the combination of gemcitabine and capecitabine (GemCap) in patients with advanced biliary cancer. PATIENTS AND METHODS: Eligible patients had pathologically proven, locally advanced or metastatic adenocarcinoma arising from the intra- and extrahepatic bile ducts or gallbladder with no prior chemotherapy. Patients were treated on a 3-week cycle consisting of capecitabine at 650 mg/m(2) orally twice a day for 14 days and gemcitabine at a fixed dose of 1,000 mg/m(2) intravenously over 30 minutes on days 1 and 8. RESULTS: Forty-five patients were enrolled between July 2001 and January 2004. Fifty-three percent of patients had cholangiocarcinoma, 47% had gallbladder cancer, and 89% had metastatic disease. The overall objective response rate was 31%, with an additional 42% of patients with stable disease, for a disease control rate of 73%. The median overall survival time was 14 months (95% CI, 7.3 months to not available), and the median progression-free survival time was 7 months (95% CI, 4.6 to 11.8 months). This chemotherapy combination was generally well tolerated. Transient neutropenia, thrombocytopenia, fatigue, and hand-foot syndrome were commonly observed but were easily managed without discontinuing further treatment. CONCLUSION: The significant antitumor activity combined with a mild toxicity profile seen in this study argue that GemCap chemotherapy may benefit patients with advanced biliary cancer. This regimen warrants further evaluation in a randomized study with survival and quality of life end points.