长春瑞滨联合顺铂一线治疗晚期非小细胞肺癌疗效观察

目的观察长春瑞滨联合顺铂治疗Ⅲb或Ⅳ期初治非小细胞肺癌（NSCLC）的疗效和毒副作用。方法初治的Ⅲb或Ⅳ期初治非小细胞肺癌（NSCLC）23例，采用长春瑞滨（盖诺）25mg／m^2d，也静滴，顺铂30mg／m^2静滴第1-3d，21d为1个周期。结果23例患者中，CR病例1例，PR11例，SD9例，PD2例，客观有效率（CR＋PR）为52．16％中位生存期11．8个，1年生存率35％（8／23）中位肿瘤进展时间7个月，毒副作用为白细胞下降和消化道反应。结论长春瑞滨联合顺铂一线治疗晚期NSCLC有效率较高，有生存优势，毒副作用可耐受。     

吉西他滨联合顺铂治疗复发或难治性非霍奇金淋巴瘤

目的评价吉西他滨联合顺铂治疗复发或难治性非霍奇金淋巴瘤的疗效和安全性。方法15例复发或难治性淋巴瘤接受吉西他滨联合顺铂方案化疗：吉西他滨1000mg／m^2第1天和第8天，顺铂25mg／m^2第1～3天，21d为1个周期。结果15例患者中CR4例（26．7％），PR6例（40．0％），SD4例（26．7％），PD1例（6．6％），完全缓解率66．7％，毒性反应主要为血液学毒性和恶心呕吐反应。结论吉西他滨联合顺铂方案是治疗复发或难治性非霍奇金淋巴瘤安全、有效的化疗方案。     

贝伐单抗联合紫杉醇加卡铂一线治疗ⅢB～Ⅳ期非鳞非小细胞肺癌的临床观察

目的：观察贝伐单抗联合紫杉醇加卡铂一线治疗ⅢB～Ⅳ期非鳞非小细胞肺癌的临床疗效及不良反应。方法：回顾性分析哈尔滨医科大学附属肿瘤医院肿瘤内科2011年5月至2012年5月病理学确诊的ⅢB～Ⅳ期非鳞非小细胞肺癌病例31例,其中12例接受贝伐单抗联合紫杉醇加卡铂方案治疗6个周期,并单药贝伐单抗进行维持治疗直至病情进展（研究组）;19例接受紫杉醇加卡铂方案治疗6个周期（对照组）,观察其疗效及不良反应,并进行随访。结果：研究组和对照组的中位无进展生存期分别为8．4个月和5．9个月（P〈0．05）,中位生存期分别为17．2个月和16．6个月（P〉O．05）;研究组较对照组增加的不良反应主要是高血压。结论：贝伐单抗联合紫杉醇加卡铂治疗非鳞非小细胞肺癌可延长患者的无进展生存期,且耐受性较好,具有很好的临床应用前景。     

奈达铂联合羟基喜树碱治疗晚期食管癌的临床观察

目的 观察奈达铂（NDP）联舍羟基喜树碱（HCPT）治疗晚期食管癌的近期疗效和不良反应。方法 46例晚期食管癌患者采用奈达铂（NDP）80～100mg／m^2,静脉滴注，第1天；羟基喜树碱（HCPT）6mg／m^2,静脉滴注，第1～5天。28天为1个周期。化疗2个周期后评价近期疗效和不良反应。结果 46例均可评价，总有效率为71．7％。26例初治患者中，有效率73．1％；20例复治患者中，有效率70．0％，两组差异无统计学意义（P〉0．05）。主要不良反应为胃肠道反应和血液学毒性，胃肠道反应均为Ⅰ～Ⅱ度。发生率为37．0％（17／46）；血液学毒性方面为白细胞和血小板减少，Ⅲ＋Ⅳ度发生率分别为13．0％（6／46）和6．5％（3／46）。结论 奈迭铂联舍羟基喜树碱治疗晚期食管癌近期疗效高，毒副作用可以耐受。     

紫杉醇联合草酸铂、卡培他滨三药方案治疗晚期转移性鼻咽癌的临床研究

目的探讨紫杉醇联合草酸铂、卡培他滨三药方案治疗晚期转移性鼻咽癌的疗效及不良反应。方法2002年1月至2005年1月，110例晚期转移性鼻咽癌病人入组：试验组55例患者．第1天应用紫杉醇135mg／m^2、草酸铂130mg／m。静脉滴注，口服卡培他滨1650mg／m^2／d，连服l-14d，每3周为一个周期，连用2-4个周期；对照组55例患者，第1-5天应用DDP 20mg／m^2、5-Fu 0．5g／m^2静脉注射，3周为一个周期，连用2-4个周期；治疗结束2-4周后评价疗效。结果试验组疗效可评价55例，对照组疗效可评价53例。试验组与对照组有效率分别为（CR＋PR）50．9％（28例）和32．1％（17例），两者差异有统计学意义（P〈0．05）。试验组和对照组中位生存时间为10．6个月和8．6个月，两者差异有统计学意义（t〈0．05）。安全性方面：试验组Ⅳ反应主要为手足综合征8例（14．5％）、骨髓抑制2例（3．6％）和消化道毒性4例（7.3％）；对照组Ⅳ反应主要为消化道毒性8例（15.1％）、骨髓抑制2例（3.8％）。结论紫杉醇联合草酸铂、卡培他滨三药方案对晚期转移性鼻咽癌的疗效较DDP＋5-Fu有优势，且不良反应可以耐受。     

伊立替康或多西他赛联合奥沙利铂治疗晚期非小细胞肺癌的临床观察

目的：观察伊立替康或多西他赛联合奥沙利铂治疗晚期非小细胞肺癌（NSCLC）的近期疗效及毒副作用。方法1晚期非小细胞肺癌68例中,伊立替康联合奥沙利铂组（A组）36例,采用伊立替康100mg／m2,第1、8天;奥沙利铂130mg／m2,第2天,静脉滴注。多西他赛联合奥沙利铂组（B组）32例,采用多西他赛75mg／m2,第1天;奥沙利铂130mg／m2,第2天,静脉滴注。21天为1周期,连用2周期后评定疗效。结果：A组和B组有效率分别为41．67％和31．25％,两组差异无统计学意义（P〉0．05）。A组迟发性腹泻和胆碱性综合征发生率明显高于B组（P〈0．01）,但A组粒细胞减少发生率明显低于B组（P〈0．05）。结论：伊立替康或多西他赛联合奥沙利铂治疗晚期非小细胞肺癌有较好的疗效,不良反应可以耐受,安全性好,可以考虑作为晚期非小细胞肺癌治疗方案之一。     

血清S100IRMA对黑色素瘤的临床应用价值

Ｓ１００是一种广泛分布于神经组织中的钙离子结合蛋白。我们用ＩＲＭＡ检测了１２６例黑色素瘤患者血清Ｓ１００浓度。转移组（Ⅲ／Ⅳ）阳性率为４１．３％（１９／４６），其中Ⅲ期患者为８．７％（２／２３），Ⅳ期为７３．９％（１７／２３）；而非转移组（Ⅰ／Ⅱ）为１．２５％（１／８０）。在２３例Ⅳ期患者中，Ｓ１００阳性患者（１７例）的存活期（中位数：８个月）低于Ｓ１００阴性患者（６例，中位数：〉２０个月）；对４     

奈达铂联合多西他赛治疗晚期食道癌的临床观察

目的：观察奈达铂联合多西他赛治疗晚期食道癌的近期疗效及不良反应。方法：将80例晚期食道癌患者随机分为治疗组和对照组,每组40例,治疗组：采用奈达铂联合多西他赛治疗,其中奈达铂25mg／（m2·d）第1～3天给予;对照组：采用顺铂联合多西他赛治疗,其中顺铂25mg／（m2·d）第1～3天给予,两组均在第1天给予多西他赛75mg／m2,21天为1个周期。化疗2个周期后按WHO标准评价疗效及毒副作用。结果：治疗组完全缓解2例,部分缓解14例,稳定18例,进展6例,有效率为40．0％（16／40）;对照组完全缓解2例,部分缓解16例,稳定16例,进展6例,有效率45．0％（18／40）,两组有效率比较差异无统计学意义（P〉0．05）。治疗组和对照组消化道不良反应分别为10．0％和30．0％;肾毒性分别为0和15．0％,血小板下降分别为30．0％和5．0％,差异有统计学意义（P〈0．05）;白细胞减少分别为70．0％和65．0％,差异无统计学意义（P〉0．05）。结论：奈达铂联合多西他赛方案与顺铂联合多西他赛方案治疗晚期食道癌的疗效相近,在毒副作用方面多西他赛联合奈达铂方案耐受性良好,具有优势。     

改良疾病累计评分表在多西他赛联合顺铂化疗中的应用

目的：应用改良疾病累计评分表（modified cumulative illness rating scale, MCIRS）评价合并症,观察晚期非小细胞肺癌（non-small-cell lung cancer, NSCLC）患者多西他赛联合顺铂化疗毒副反应发生率。方法：选择NSCLC患者60例,采用MCIRS评估合并症,根据MCIRS评分、年龄及KPS分层研究多西他赛联合顺铂化疗毒副反应发生率。结果：60例NSCLC患者MCIRS评分为2～20（9.250±3.917）分。其化疗毒副反应胃肠道反应、骨髓抑制、疲劳及脱发的发生率随MCIRS评分的升高而增高,差异具有统计学意义(P<0.05);随年龄增加和KPS评分降低而略增高,但无统计学意义(P> 0.05)。结论：MCIRS能较好地评价晚期非小细胞肺癌患者合并症,化疗毒副反应发生率随MCIRS评分的升高而增高。     

多西他赛联合顺铂及氟尿嘧啶(DCF)改良方案治疗晚期胃癌疗效观察

目的 研究多西他赛联合顺铂及氟尿嘧啶改良方案(mDCF)治疗晚期胃癌的疗效及安全性.方法 2006年1月起,采用改良DCF方案治疗45例晚期胃癌患者.化疗方案:多西他赛60 mg/m2,d1;顺铂12 mg/m2,d1 ～5;氟尿嘧啶2500 mg/m2,持续输注(civ) 120 h;每21天一个周期.主要研究终点:无进展生存期(PFS).次要研究终点:总生存期(OS),总缓解率(ORR)及不良反应.结果 接受一线解救化疗患者40例,完全缓解0例(0％),部分缓解7例(17.5％),疾病稳定19例(47.5％),疾病进展14例(35.0％),总缓解率17.5％(95％ CI 7.5％ ～30.0％),疾病控制率65.0％ (95％ CI 50.0％ ～77.5％).中位PFS 5.2个月(95％ CI 3.6～6.8月),中位OS 11.0个月(95％CI6.9～15.1月).接受二线解救化疗患者5例,疾病稳定3例,疾病进展2例,中位PFS 5.3个月(95％ CI 0 ～11.3月),中位OS 8.5个月(95％ CI0～17.1月).主要不良反应为血液学毒性,Ⅲ～Ⅳ度粒细胞减少及粒细胞减少伴发热发生率分别为26.7％及11.1％,Ⅲ～Ⅳ度恶心、呕吐及腹泻发生率分别为8.9％、8.9％及11.1％.结论 改良DCF方案有效,不良反应可耐受.     

P53表达预测非小细胞肺癌化疗的耐药性及养肺解毒方的干预治疗

目的 探讨P53表达对预测非小细胞肺癌(NSCLC)化疗耐药性的意义及采用中药养肺解毒方对其的干预治疗.方法 选择Ⅲ、Ⅳ期NSCLC患者96例,经纤维支气管镜或者CT引导下95经皮细针肺活检获取标本,通过免疫组织化学、RT-PCR检测P53表达.依据其结果,分为P53阳性组(n=54)和P53阴性组(n=42).依据治疗方案的不同,每组再分为吉西他滨(健择,1250 mg/m2)+顺铂(70mg/m2)治疗组(T1组,P53阳性,27例;T2组,P53阴性,21例)和健择(1250mg/m2)+顺铂(70mg/m2)+养肺解毒方(随症加减,1剂/d,1次/d)治疗组(T3组,P53阳性,27例;T4组,P53阴性,21例).治疗周期为21 d,共4个周期.观察各组病例治疗后的有效率和中位生存期(MST).结果 阳性组P53 mRNA相对吸光度A值(57.65±4.78)明显高于阴性组(24.83±1.81)(P＜0.05).T2组治疗有效率42.9%(9/21)高于T1组29.6%(8/27),MST(9.55±0.54)个月也长于T1组(7.82±0.48)个月(均P＜0.05).T4组治疗有效率57.1%(12/21)高于T3组37.0%(10/27),MST(11.03±0.63)个月长于T3组的(8.78±0.51)个月(均P＜0.05).而且T3组的治疗有效率和MST明显优于T1组,T4组优于T2组(均P＜0.05).结论 P53蛋白和mRNA基因高表达可以预测非小细胞肺癌的耐药性.中药养肺解毒方可能通过降低非小细胞肺癌化疗耐药来提高疗效.     

Cancer of unknown primary site: a review of 28 cases and the efficacy of cisplatin/docetaxel therapy at a single institute in Japan

We evaluated the efficacy and toxicity of cisplatin/docetaxel (CDDP/TXT) chemotherapy and identified prognostic factors in Japanese patients with cancer of unknown primary site (CUP). Twenty-eight consecutive patients seen at a single institute were reviewed retrospectively. Sixteen patients were treated with TXT 80 mg/m2, followed by CDDP 75 mg/m2. The overall response rate to CDDP/TXT treatment was 62.5%, with a median survival time (MST) of 22.7 months. Common adverse reactions were myelosuppression and hyponatremia. The MST of all 28 patients with CUP was 8.3 months, and the 1-year overall survival rate was 45.6%. Univariate analysis identified 5 prognostic factors:performance status, liver involvement, bone involvement, pleural involvement, and lymph node involvement. In conclusion, CDDP/TXT chemotherapy is effective with tolerable toxicity in patients with CUP. Japanese patients with CUP might be chemosensitive and may survive longer.     

Daily low-dose cisplatin and concurrent thoracic irradiation for poor-risk patients with unresectable non-small-cell lung cancer

A pilot study was conducted to assess the efficacy and feasibility of daily low-dose cisplatin with concurrent thoracic irradiation for clinically unresectable non-small-cell lung cancer (NSCLC). Patients with inoperable NSCLC who had poor risk factors such as advanced age, poor performance status, poor lung function, or concomitant active malignancy were entered into the study. Low-dose cisplatin (6 mg/m2) was administered daily before concurrent thoracic irradiation (2 Gy/day; total dose of 60 Gy) was given. Twenty-five patients were registered. The majority of the patients had either stage IIIA (24.0%) or stage IIIB (60.0%) disease. Fifteen patients (60.0%) completed the planned treatment. Both chemotherapy and radiotherapy were stopped in 3 patients (12.0%) due to poor response, and 7 patients (28.0%) partly received radiotherapy alone as a result of their toxicity response. The proportion of total administered dose to planned dose was 90.9% for chemotherapy and 99.3% for radiotherapy, which were comparable to those in previous studies for LA-NSCLC patients without poor risk factors. Grade 3 leukopenia and neutropenia developed in 14 patients (56.0%) and 10 patients (40.0%), respectively, but grade 4 toxicity was not encountered. Grade 3 pneumonitis and esophagitis were observed in 4 patients (16.0%) and 2 patients (8.0%), respectively. The overall response rate was 60.0%. The median survival time was 22 months, and the 2-year survival rate was 50.3%. Daily low-dose cisplatin and concurrent thoracic irradiation were well tolerated even by poor-risk patients with NSCLC, and showed a therapeutic efficacy similar to that for good-risk patients.     

Chemotherapy of advanced non-small cell lung cancer with the combination of gemcitabine and cisplatin

The aim of the study was to assess the efficacy of a combination of gemcitabine and cisplatin in advanced non-small cell lung cancer. Twenty-five patients were included (13--IIIB, and 12--IV stage). Gemcitabine--1000 mg/m2 was given intravenously on days 1, 8, and 15, and cisplatin--100 mg/m2 on day 2. In 13 patients partial remission was obtained, in 8--stabilisation, and in 4--progression. Median survival was 12 months (range: 1.5-32 months). Mean time to progression was 6 months. Toxicity was tolerable and included mainly thrombocytopenia, neutropenia and anemia. In 11 patients pain relief was obtained. Furthermore cough, dyspnoea and hemoptysis disappeared in a proportion of patients. These results indicate the efficacy of the combination of gemcitabine and cisplatin regimen in advanced non-small cell lung cancer, and its acceptable toxicity.     

NP方案治疗老年晚期非小细胞肺癌20例

目的观察NP方案治疗老年晚期非小细胞肺癌患者的，临床疗效及不良反应。方法对住院治疗的20例老年晚期非小细胞肺癌患者采用NVB联合顺铂化疗方案（NP方案），NVB25mg／m2，iv．第1、8天，顺铂100mg／m2，iv．drop，第1天。每4周重复，至少治疗两周期，按标准评价疗效和毒副反应。结果可评价患难者20例，有效率为45％，中位和存期7个月，1年生存率为30％。主要毒性反应为骨髓移植、消化道反应及静脉炎，多数为Ⅰ-Ⅱ度反应。结论NVB联合顺铂方案治疗老年晚期非小细胞肺癌临床疗效较好，恶性反应可以耐受。     

同步放化疗对局部晚期鼻咽癌患者近远期预后的影响

目的:探讨多西他赛联合顺铂化疗同步调强适形放疗(intensity modulated radiation therapy,IMRT)对局部晚期鼻咽癌患者近远期预后的影响.方法:选取局部晚期鼻咽癌患者100例,按照随机数字表的方法将患者分为研究组和对照组,每组各50例.研究组给予IMRT,对照组给予常规放疗,在上述基础上两组均给予多西他赛联合顺铂化疗.观察两组鼻咽癌患者近远期预后情况.结果:完成放疗后3个月,研究组的临床治疗有效率高于对照组,差异有统计学意义(χ2=12.000,P<0.05);研究组III~IV口腔黏膜反应和III~IV急性口感发生情况明显较对照组少,差异有统计学意义(χ2=6.139,13.279;均P<0.05);两组患者远期疗效比较,研究组患者随访第2年局部区域控制和总生存情况与对照组比较差异具有统计学意义(χ2=13.255,13.255;均P<0.05).结论:多西他赛联合顺铂化疗同步IMRT对局部晚期鼻咽癌患者近远期临床效果满意,IMRT可以减少并发症的发生,有效保护人体正常组织.     

Induction chemotherapy with paclitaxel, ifosfamide, and cisplatin followed by concurrent chemoradiotherapy for unresectable locally advanced head and neck cancer

Objective:

Induction chemotherapy (IC) and concurrent chemoradiotherapy (CCRT) for locally advanced head and neck cancer has been studied in many clinical trials. This study was conducted to determine the response rate of IC with paclitaxel, ifosfamide, and cisplatin followed by CCRT with cisplatin for this group of patients, and the effect of the entire treatment on survival and time to disease progression.

Methods:

Thirty patients with advanced and unresectable head and neck cancer were treated with 2 cycles of induction paclitaxel/ ifosfamide/ cisplatin. If the primary tumor had a complete or partial response, patients were treated with 2 more cycles of IC followed by radiotherapy 70 Gy plus 3 cycles of cisplatin. For those with less than partial response or disease progression were treated according to the discretion of the physicians.

Results:

Ninety percent of patients had stage IV disease and 40% of them had primary tumor at maxillary sinus and nasal cavity. One patient (3%) achieved complete response (CR) and 18 patients had partial responses (PR) to IC. CCRT enhanced the response rate, resulting in a total of 3 CR (10%) and 16 PR (53%) to treatment. The median time to progression was 11.5 months. The median overall survival was 27 months. The most severe hematologic toxicity occurred during IC was grade3-4 neutropenia (40%). Grade 3-4 mucositis occurred in 68% of patients during CCRT.

Conclusion:

This novel combined-modality treatment program, is toxic but feasible, and can be administered for selected patients with advanced and unresectable head and neck cancer. © 2010 Biomedical Imaging and Intervention Journal. All rights reserved.     

多西紫杉醇联合替吉奥治疗晚期胃癌的临床观察

目的观察多西紫杉醇联合替吉奥治疗晚期胃癌的临床疗效及不良反应。方法将84例晚期胃癌患者随机分为实验组和对照组,每组42例。试验组接受多西紫杉醇75mg／m2静脉滴注,第1天,替吉奥80mg／m2,分2次,餐后口服。第1,14天,21d为1个周期,至少化疗2个周期;对照组化疗方案为顺铂25mg／m2,静脉滴注,第1～3天,醛氢叶酸钙200mg／m2,静脉滴注,第l～5天,5一氟尿嘧啶500mg／m2,第l～5天（在cF之后）,28d为1个周期,至少化疗2个周期。评价两组疗效及不良反应。结果试验组有效率为57．1％,中位疾病进展时间9．3个月,中位生存期14．3个月,1、2年生存率分别为57．1％和21．4％;对照组有效率为42．9％,中位疾病进展时间6．1个月,中位生存期10．2个月,1、2年生存率分别为38．1％和9．5％。两组疗效差异有统计学意义（P〈0．05）。主要毒副反应为骨髓抑制和胃肠道反应,大部分患者可耐受。结论多西紫杉醇联合替吉奥治疗晚期胃癌的近期疗效好,且不良反应可以耐受,值得进一步研究。     

Bevacizumab Plus Platinum-Based Chemotherapy

? Bevacizumab is a recombinant, humanized vascular endothelial growth factor (VEGF) monoclonal antibody that inhibits tumor growth and tumor metastases. VEGF stimulates angiogenesis in tumors, is involved in early metastatic processes, and is overexpressed in non-small cell lung cancer (NSCLC). ? The addition of bevacizumab to standard chemotherapy significantly delayed disease progression in two large, randomized, phase III trials in chemotherapy-naive patients with advanced, nonsquamous NSCLC. In the open-label E4599 trial, median overall survival duration was significantly extended by 2 months and median progression-free survival was significantly increased by 1.7 months when intravenous bevacizumab 15mg/kg once every 3 weeks was added to first-line carboplatin/paclitaxel therapy compared with carboplatin/paclitaxel alone. ? In the double-blind AVAiL trial, median progression-free survival was significantly increased (by 0.6 and 0.4 months) by the addition of intravenous bevacizumab 7.5 or 15mg/kg once every 3 weeks to first-line cisplatin/gemcitabine therapy compared with placebo plus cisplatin/gemcitabine. However, median overall survival duration was not significantly improved (13.6 and 13.4 months vs 13.1 months). ? Response rates in the E4599 and AVAiL trials were 30–35% in patients receiving bevacizumab plus platinum-based chemotherapy compared with 15% and 20% without bevacizumab. ? The safety and tolerability profile of bevacizumab-containing treatment regimens in patients with advanced NSCLC was generally manageable in the E4599 and AVAiL trials, and in two large, ongoing, trials (the open-label SAiL and the observational ARIES studies).