依立替康联合顺铂二线治疗小细胞肺癌的临床观察

为观察依立替康(lrinotecan，CPT-Ⅱ)联合顺铂(DDP)二线治疗小细胞肺癌(small-cell lung cancer，SCLC)的疗效和不良反应，对22例既往经一线化疗方案治疗失败的SCLC患者采用CP-Ⅱ60mg／m^2，静脉滴入，d1、d8、d15，DDP60mg／m^2，静脉滴入，d1化疗。28d为1个周期，至少完成2个周期以上。22例患者中除1例出现Ⅳ度腹泻退出化疗，21例患者均完成所需周期化疗。其中1例CR，8例PR，有效率(CR PR)42．9％(9／21)。常见治疗毒性为乙酰胆碱综合征(9．1％，2／22)、延迟性腹泻(18．2％，4／22)、Ⅱ～Ⅲ度白细胞减少(81．8％，18／22)和Ⅱ～Ⅲ度中性粒细胞减少(72．7％，16／22)、仅1例出现Ⅳ度腹泻，主要为血液学毒性。初步研究结果提示，CPT-Ⅱ联合DDP作为二线化疗方案治疗SCLC有效，毒副反应可以耐受。     

拓扑替康联合顺铂治疗小细胞肺癌疗效观察

目的:探讨拓扑替康(topotecan,TPT)联合顺铂(DDP)治疗小细胞肺癌(smallcelllungcancer,SCLC)的疗效。方法:35例初治SCLC患者应用TPT1mg/(m2·d),静脉滴入30min;联合DDP20mg/(m2·d),静脉滴入,连用5d,每3周为1个周期,2～3个周期后评价疗效和不良反应。结果:TPT与DDP联合用于初治SCLC有效率为74.3%(26/35),其中CR20.0%(7/35),PR54.3%(19/35)。主要不良反应为骨髓抑制,其中Ⅲ～Ⅳ度中性粒细胞缺乏为54.3%(19/35),Ⅲ～Ⅳ度血小板下降为34.3%(12/35),Ⅲ～Ⅳ度血红蛋白下降为20.0%(7/35),非血液学毒性较轻。结论:TPT联合DDP是治疗SCLC疗效较好方案,主要不良反应为血液学毒性。     

多西他赛联合顺铂治疗晚期非小细胞肺癌48例临床分析

目的:观察多西他赛(docetaxel)联合顺铂(DDP)的治疗方案(简称DP方案)对晚期非小细胞肺癌(nonsmallcelllungcancer,NSCLC)的近期疗效和毒副反应。方法:对经病理学或细胞学确诊的48例晚期NSCLC患者,采用DP方案化疗:多西他赛35mg/m2,静脉滴入1h,d1、d8;DDP75mg/m2,静脉滴入,d1。21d为1个周期,至少2个周期评价疗效。结果:48例完全缓解(CR)3例,部分缓解(PR)22例,无变化(NC)16例,进展(PD)7例,总有效率(RR)为52.08%。其中初治组有效率为63.64%(14/22),有2例CR;复治组有效率为42.31%(11/26),有1例CR,两组差异有统计学意义,P=0.029。毒副反应主要为骨髓抑制、消化系统反应和脱发。大部分患者为Ⅰ、Ⅱ度反应,耐受良好。骨髓抑制为剂量限制性毒性,其中白细胞减少占64.58%,Ⅲ～Ⅳ度占16.15%。结论:多西他赛联合DDP治疗晚期NSCLC具有近期疗效好、毒副反应轻和耐受好的特点,且初治者疗效优于复治者,值得进一步研究推广。     

多西他赛联合顺铂和氟尿嘧啶治疗进展期胃癌48例临床分析

目的:观察多西他赛(docetaxel)联合顺铂(DDP)和氟尿嘧啶(5FU)方案(简称DCF方案)对进展期胃癌的近期疗效和毒副反应。方法:对经病理学或细胞学确诊的48例进展期胃癌患者,采用DCF方案化疗:多西他赛40mg/m2,静脉滴入1h,d1、d8、d15;DDP20mg/m2,静脉滴入,d1～d5;5FU750mg/m2用便携式微量输液泵持续静脉输注,d1～d5;28d为1个周期,至少2个周期评价疗效。结果:48例完全缓解(CR)3例,部分缓解(PR)22例,无变化(NC)16例,进展(PD)7例,总有效率(RR)为52.08%。其中初治组有效率为68.18%(15/22),有2例CR;复治组有效率为38.46%(10/26),有1例CR,两组差异有统计学意义,P=0.04。毒副反应主要为骨髓抑制、消化系统反应和脱发。大部分患者为Ⅰ、Ⅱ度反应,耐受良好。骨髓抑制为剂量限制性毒性,其中白细胞减少占64.58%,Ⅲ～Ⅳ度占16.67%。结论:多西他赛联合DDP和5FU治疗进展期胃癌具有近期疗效好,毒副反应轻,耐受好的特点,且初治者疗效优于复治者,值得进一步研究推广。     

TEP方案治疗小细胞肺癌21例临床分析

探讨拓扑替康 (topotecan ,TPT)联合依托泊苷 (etoposide ,Vp 16)、顺铂 (cisplatin ,DDP)组成的TEP方案治疗小细胞肺癌 (small celllungcancer ,SCLC)的临床疗效。 2 1例初治SCLC患者接受治疗 ,Vp 1670mg/ (m2 ·d) ,连用 5d ;TPT0 7mg/ (m2 ·d) ,于Vp 16后 1h应用 ,静脉滴入 3 0min ,连用 5d ;DDP 80mg/m2 ,分 3d静脉滴入。 2 1d为 1个周期 ,至少化疗 2个周期。 2 1例患者均可评价疗效。其中CR 8例 ,PR 8例 ,有效率 (RR)为 76 2 % ( 16/ 2 1) ,局限期 (LD)RR为90 0 % ( 9/ 10 ) ,广泛期 (ED)RR为 63 6% ( 7/ 11) ,其中 4例脑转移者PR 1例 ,SD 1例 ;全组患者中位生存期 11 5个月 ,1、2年生存率分别为 42 9% ( 9/ 2 1)和 19 0 % ( 4 / 2 1) ;2 1例患者均可评价不良反应 ,主要不良反应为骨髓抑制 ,Ⅲ～Ⅳ度白细胞减少的发生率 76 2 % ( 16/ 2 1) ,血小板减少的发生率为 61 9% ( 13 / 2 1) ,非血液学毒性主要为恶心、呕吐、脱发、乏力、肝肾功能异常等。TEP方案疗效肯定 ,能改善SCLC的生存期及生存率 ,可作为SCLC的一线治疗方案 ;主要不良反应为骨髓抑制 ,非血液学毒性轻微     

羟基喜树碱联合顺铂治疗晚期恶性肿瘤的初步临床研究

目的:观察羟基喜树碱(hydroxycamptothecin,HCPT)联合顺铂(DDP)治疗晚期食管癌和鼻咽癌的疗效及毒副反应。方法:50例晚期食管癌和鼻咽癌患者应用HCPT4.68～7.04mg/(m2·d)[中位剂量为5.6mg/(m2·d)],静脉滴入,连续3d,DDP58.5～100mg/m2(中位剂量为70mg/m2),静脉滴入,d1,21d为1个周期,至少治疗2个周期,全组化疗共161个周期。结果:46例可评价患者中有效率为45.7%(21/46),CR2例,PR19例,SD18例,PD7例;食管癌有效率为42.9%(12/28),鼻咽癌有效率50.0%(9/18)。主要毒副反应为骨髓抑制,恶心呕吐及腹泻;一过性肝、肾功能轻度损伤。Ⅲ/Ⅳ度白细胞下降,恶心呕吐、血小板下降及腹泻发生率分别为29.2%(47/161)、21.7%(35/161)、13.0%(21/161)和2.5%(4/161)。结论:HCPT联合DDP治疗食管癌和鼻咽癌疗效好,毒副反应可以耐受。     

健择为主联合方案治疗晚期非小细胞肺癌临床研究

目的观察健择为主联合化疗方案治疗晚期非小细胞肺癌的临床疗效及毒副反应.方法42例晚期非小细胞肺癌,26例采用健择1 000 mg/m2,d1、d8;DDP 30 mg/m2,d1～d3.16例采用健择1 000 mg/m2,d1、d8;紫杉醇60 mg/m2,d1、d8.两方案均3个周重复,3个周期以上评价疗效.结果42例中CR 1例,PR 20例,SD 14例,PD 7例,有效(CR+PR)率50%(21/42),初治有效率54.2%(13/24),复治有效率44.4%(8/18).健择+DDP组(其中24例为初治),CR 1 例,PR 12例,有效率50%(13/26).健择+紫杉醇组有效率50%(8/16).毒副反应主要为骨髓抑制和消化道反应,126个周期中Ⅲ～Ⅳ度粒细胞下降19例次(15.0%),Ⅲ～Ⅳ度血小板下降32例次(25.4%),Ⅲ～Ⅳ度消化道反应45例次(35.7%);Ⅱ～Ⅲ度肝功能损害50例次(39.6%).结论健择为主联合化疗方案治疗晚期非小细胞肺癌有较好疗效,毒副反应可耐受,特别是健择+紫杉醇治疗复治非小细胞肺癌有较高疗效,值得临床进一步研究观察.     

拓扑替康治疗小细胞肺癌的临床疗效观察

目的探讨以拓扑替康(Topotecan)为主联合方案治疗小细胞肺癌(SCLC)的疗效及安全性.方法初治和复治患者30例,拓扑替康1.20 mg/(m2*d),静脉滴入30 min,1次/d,连用5 d,21 d为1个周期.2个周期评价疗效,1个周期可评价不良反应.结果在30例患者中,CR 4例,PR 15例,有效率63.3%.主要不良反应为骨髓抑制,非血液学毒性较轻微,一般均可耐受.结论以拓扑替康为主联合化疗方案治疗SCLC有效,可作为SCLC一线或二线用药,局限期疗效优于广泛期.     

TP与EP方案治疗晚期非小细胞肺癌疗效比较

TP组给紫杉醇 135 mg/m2,静脉滴入,3 h,d1;DDP 75 mg/m2,静脉滴入,d1 (水化、止吐).EP组给Vp-16 100 mg/m2,静脉滴入, d1～d5;DDP 75 mg/m2,静脉滴入,d1 (水化、止吐).两组均21 d为1个周期,完成2～3个周期后评价疗效及毒副反应.结果TP组CR 1例,PR 9例,CR+PR 55%,中位生存时间10.6个月,1年生存率39%;EP组PR 5例,CR+PR 33%,中位生存时间7.5个月,1年生存率18%.两组毒副反应主要表现为胃肠道反应及脱发,剂量限制性毒副反应为骨髓抑制,用集落细胞刺激因子可减轻骨髓毒性作用.TP方案是治疗晚期非小细胞肺癌的有效化疗方案.     

长春瑞滨联合顺铂治疗多柔比星耐药的晚期转移性乳腺癌疗效观察

观察长春瑞滨（NVB）联合顺铂（DDP）治疗多柔比星（ADM）耐药的晚期转移性乳腺癌的疗效及毒性.32例既往使用ADM治疗后复发转移的晚期乳腺癌患者,其中单纯癌5例,浸润性导管癌25例,大汗腺样癌1例,硬癌1例.采用NVB 25 mg/m^2,静脉滴入,d1、d8;DDP 25 mg/m^2,静脉滴入,d1～d3.21 d为1个周期,每2～3个周期评定疗效.完全缓解（CR）1例,部分缓解（PR）17例,稳定（SD）7例,进展（PD）7例,总有效率为56.3%（18/32）.主要毒性为骨髓抑制,Ⅲ～Ⅳ度白细胞下降发生率为53.1%（17/32）.其他为恶心、呕吐、贫血、静脉炎等.初步研究结果提示,NvB联合DDP治疗ADM耐药的晚期转移性乳腺癌疗效确切,毒性反应可耐受,值得临床应用.     

High-dose treatment

High dose administration of anticancer drugs was discussed putting an emphasis on methotrexate and cytosine arabinoside. High dose methotrexate in combination with leucovorin rescue was effective on various kinds of cancer which had become resistant to conventional doses of anti-cancer drugs. The administration of high-dose methotrexate, however, should be performed with meticulous precautions to prevent serious side effects. Side effects included gastrointestinal mucositis, hepatic dysfunction, nausea and vomiting. Central nervous system manifestations were sometimes observed. High-dose cytosine arabinoside of 3 g/m2 per 12 hours X 12 was given by 2-hours infusion to patients with acute leukemia who had become resistant to conventional combination chemotherapy, or to relapsed patients. This regimen in combination with L-asparaginase or anthracyclines resulted in a fairly high remission rate among those intractable cases. High-dose cytosine arabinoside in combination with anthracyclines has recently been tried on patients with acute leukemia as an initial treatment for remission induction and consolidation. In this case, no intensification treatment was performed to maintain remission. Patients treated with this regimen as an initial medication showed a high remission induction rate and long remission duration. Forty percent of the patients were still alive after 3 years.     

Three-dimensional treatment planning for postoperative treatment of rectal carcinoma

The role of three-dimensional (3-D) treatment planning for postoperative radiation therapy was evaluated for rectal carcinoma as part of an NCI contract awarded to four institutions. It was found that the most important contribution of 3-D planning for this site was the ability to plan and localize target and normal tissues at all levels of the treatment volume, rather than using the traditional method of planning with only a single central transverse slice and simulation films. There was also a slight additional improvement when there were no constraints on the types of plans (i.e., when noncoplanar beams were used). Inhomogeneity considerations were not important at this site under the conditions of planning, i.e., with energies greater than 4 MV and multiple fields. Higher beam energies (15-25 MV) were preferred by a small margin over lower energies (down to 4 MV). The beam's eye view and dose-volume histograms were found quite useful as planning tools, but it was clear that work should continue on better 3-D displays and improved means of translating such plans to the treatment area.     

Ion beam treatment: a new medical treatment system

Ion beam treatment consists of a device and form of medical treatment. The device is a comprehensive system that consists of an irradiation system, a treatment planning system and a treatment verification system. The medical system consists of treatment criteria and a clinical path including daily treatment and care for patients. On April 1, 2001, HIBMC was opened as the world's first facility to provide both proton and carbon-ion radiotherapy. We have treated more than 1,300 patients with a variety of malignant tumors including those of the skull base, head and neck, lung, liver and prostate. Excellent local control for these tumors has been obtained with minimum side effects. During the clinical trials and general practice, many tumors including radio-resistant tumors were treated with proton or carbon-ion. This autumn we will start the prospective randomized trial of two beams and we will analyze the difference between them. In future we would like to start new combination treatment with both beams.     

Adjuvant treatment of GIST: patient selection and treatment strategies

Tyrosine kinase inhibitors that target the key molecular drivers of gastrointestinal stromal tumour (GIST) are effective treatments of advanced-stage GIST. Yet, most of these patients succumb to the disease. Approximately 60% of patients with GIST are cured by surgery, and these individuals can be identified by risk stratification schemes based on tumour size, mitosis count and site, and assessment of rupture. Two large randomized trials have evaluated imatinib as adjuvant treatment for operable, KIT-positive GIST; adjuvant imatinib substantially improved time to recurrence. One of these trials reported that 3 years of adjuvant imatinib improves overall survival of patients who have a high estimated risk for recurrence of GIST compared with 1 year of imatinib. The optimal adjuvant strategy remains unknown and some patients might benefit from longer than 3 years of imatinib treatment. However, a strategy that involves GIST risk assessment following surgery using a validated scheme, administration of adjuvant imatinib for 3 years, patient monitoring during and after completion of imatinib to detect recurrence early, and reinstitution of imatinib if GIST recurs is a reasonable choice for care of patients with high-risk GIST.     

Oral cancer treatment

Opinion statement Oral cancer is the sixth most common cancer in the world, and it continues to represent a serious public health problem. Oral cancer is a preventable disease, related to behavioral and lifestyle factors, including tobacco and alcohol. Prevention and early detection of oral cancer remain the goals of national efforts to reduce the impact of this disease on the public. Surgical treatment is the mainstay of therapy for patients with oral cancer, particularly in advanced stages of cancer. External beam radiation therapy and brachytherapy have been used successfully as the primary modality for treating patients with early stage oral cancer, and they are the standard of care for use as adjuvant therapy in postoperative cases of patients with advanced stage oral cancer. There is an emerging trend for the use of chemotherapy in combination with radiation therapy and surgery for patients with advanced, recurrent, and metastatic head and neck cancer, although evidence is limited regarding survival benefit when used for treating patients with oral cavity carcinoma. Any report on the treatment of oral cancer is incomplete without consideration of functional and aesthetic outcomes, particularly addressing speech, swallowing, masticatory efficiency, and dental rehabilitation. Future generations will continue to fight these dreadful diseases until scientists and clinicians are provided the opportunities to expand efforts to prevent, detect (early), and eradicate oral and other head and neck cancers.     

Realistic treatment planning

Some ionizing radiations in specified energy ranges have physical properties which make them useful in treating human cancers, although this method of treatment has limitations. The author describes the limitations which make radiation therapy difficult as compared with such methods as surgery. The advantages and problems of the application of high-energy x-rays and electron sources are discussed. The author discusses specialized instruments and techniques developed for use in modern radiation therapy. The application of these techniques has required the development of systems for comprehensive treatment planning to be made available to many patients.