顺铂加氟尿嘧啶化疗同步放疗食管癌患者毒副反应的护理

对32例食管癌患者采用顺铂加氟尿嘧啶化疗同步放射治疗(放疗),经过1个疗程放疗和2个周期化疗,放射性食管炎发生率为100%,放射性气管炎发生率为59.4%,白细胞减少和恶心、呕吐发生率均为68.8%,血小板减少和腹泻发生率均为9.4%。经过积极对症治疗,均顺利完成疗程。提出对化疗同步放疗食管癌患者,密切观察其毒副反应,做好健康教育,采取针对性措施减轻患者不适,预防感染和营养不良是保证患者顺利完成治疗,提高生活质量的关键。     

结直肠癌术后顺铂和5-氟尿嘧啶化疗及枢复宁对胃肠动力的影响

14例结直肠癌术后化疗病人进行胃肠动力采用PC Polygraf HR台式高分辨八导消化道动力监测系统进行测压；第一天为对照期，第二天为化疗期，方案为顺铂40mg如和5-FU 500mg；第三天为枢复宁期，继续化疗药物，化疗前5min静推枢复宁8mg。结果 显示对照期MMC个数为9．14±2．54个从，化疗期增至13．14±3．96个从(P<0.01)。枢复宁期MMC数为13．07±360个／人。MMC周期对照期为170±50min．化疗期期缩短至122±47min(P<0．05)。枢复宁期为124±65min。MMC移行速度对照期为0．114±0.028cm／sec，化疗期加快至0.161±0．049cm／sec，枢复宁期MMC的移行速度平均为0．13±0.017cm／sec。MMCⅢ相收缩波数对照期为453±109个/人。化疗期增加至664±196个从(P<0.01)。枢复宁期MMCⅢ相收缩渡数为646±209个／人。MMCⅢ相收缩波幅植对照期为409±0．99kPa，化疗期为4．13±1．13kPa(P<0．05)。枢复宁期为3．92±1．19kPa。应用化疗药物后14例病人中9例发生呕吐，发生呕吐的时间为280±28min。应用枢复宁后，无病人再发生呕吐(P<0.05)，但不增强胃肠道平滑肌的收缩强度。枢复宁可抑制化疗药物引起的呕吐，化疗药物引起胃肠动力加快和呕吐属于两不同的机制，两间无因果关系。     

奈达铂对比顺铂联合氟尿嘧啶治疗食管癌疗效和安全性的系统评价与Meta分析

目的 系统评价奈达铂对比顺铂联合氟尿嘧啶治疗食管癌的疗效和安全性。方法 计算机检索PubMed、EMbase、Web of Science、The Cochrane Library、中国知网、万方、维普和中国生物医学文献数据库,搜集关于奈达铂联合氟尿嘧啶对比顺铂联合氟尿嘧啶治疗食管癌的随机对照研究,检索时限均为建库至2021年1月。采用RevMan 5.4软件进行Meta分析。结果 最终纳入12个随机对照研究,共含744例患者。Meta分析结果显示,奈达铂组的总有效率优于顺铂组（P<0.05）;在毒副作用方面,奈达铂组恶心呕吐、腹泻、肾功能损伤发生率比顺铂组低（P<0.05）,但白细胞减少、血红蛋白降低发生率较顺铂组高（P<0.05）。两组肝功能损伤和血小板减少发生率差异无统计学意义（P>0.05）。结论 奈达铂联合氟尿嘧啶比顺铂联合氟尿嘧啶治疗食管癌更有优势,并且恶心呕吐以及腹泻的发生率更低,对肾功能的损害也更小。     

结直肠癌术后顺铂和5-氟尿嘧啶化疗及枢复宁对胃肠动力的影响

14例结直肠癌术后化疗病人进行胃肠动力采用 PC Polygraf HR 台式高分辨八导消化道动力监测系统进行测压;第一天为对照期,第二天为化疗期,方案为顺铂40mg 和5-FU 500mg;第三天为枢复宁期,继续化疗药物,化疗前5min 静推枢复宁8mg。结果显示对照期 MMC 个数为9.14±2.54个/人,化疗期增至13.14±3.96个/人(P<0.01)。枢复宁期MMC 数为13.07±3.60个/人。MMC 周期对照期为170±50min,化疗期期缩短至122±47min(P<0.05)。枢复宁期为124±65min。MMC 移行速度对照期为0.114±0.028cm/sec,化疗期加快至0.161±0.049cm/sec,枢复宁期 MMC 的移行速度平均为0.13±0.017cm/sec。MMCⅢ相收缩波数对照期为453±109个/人。化疗期增加至664±196个/人(P<0.01)。枢复宁期 MMCⅢ相收缩波数为646±209个/人。MMCⅢ相收缩波幅植对照期为4.09±0.99kPa,化疗期为4.13±1.13kPa(P<0.05)。枢复宁期为3.92±1.19kPa。应用化疗药物后14例病人中9例发生呕吐,发生呕吐的时间为280±28min。应用枢复宁后,无病人再发生呕吐(P<0.05),但不增强胃肠道平滑肌的收缩强度。枢复宁可抑制化疗药物引起的呕吐,化疗药物引起胃肠动力加快和呕吐属于两不同的机制,两者间无因果关系。     

氟尿嘧啶和伊立替康联合顺铂与S-1治疗晚期胃癌的比较

晚期胃癌（已发生远处转移）的最佳化疗方案尚未明确,有报道显示,伊立替康联合顺铂及口服S-1（替加氟、5-氯-2,4-二羟基吡啶和奥替拉西钾）具有良好的应用前景。     

诱导睡眠护理干预减轻顺铂化疗致呕吐的效果

目的观察诱导睡眠的护理干预对减轻癌症患者大剂量顺铂化疗致呕吐的效果。方法将118例癌症化疗患者随机分为观察组(60例)与对照组(58例),对照组接受常规化疗护理,观察组在常规化疗护理的基础上实施诱导睡眠的护理干预。结果观察组患者化疗期间呕吐程度显著轻于对照组(P<0.05)。结论诱导睡眠的护理干预可有效预防及减轻顺铂化疗所致呕吐程度,提高患者化疗期间的生活质量。     

顺铂化疗辅助治疗胃癌术后的疗效分析

目的探讨顺铂化疗辅助治疗胃癌术后的临床疗效和毒副反应。方法将60例胃癌术后患者随机分为观察组和对照组,各22例,观察组给予去甲长春花碱（NVB）、顺铂（DDP）静脉滴注联合顺铂腹腔灌注化疗,对照组仅给予甲长春花碱、顺铂静脉滴注治疗。结果观察组有效率（CR＋PR）30.0%,3年内疾病进展率为16.7%,5年总生存时间为83.3%,对照组有效率为20.0%,3年内疾病进展率为30.0%,5年总生存时间为70.0%,P〈0.05,差异有统计学意义。两组间毒副反应无显著差异性。结论顺铂化疗辅助治疗胃癌术后能改善疗效,值得推广。     

腺病毒介导LRIG1过表达联合顺铂对膀胱癌细胞株EJ的抑制作用

目的 观察腺病毒介导的LRIG1过表达是否能增强顺铂对膀胱癌细胞株EJ的损伤作用.方法 构建重组腺病毒载体包装pLRIG1-GFP质粒,采用逆转录-聚合酶链反应(RT-PCR)及Western blot法鉴定其是否能在膀胱癌细胞株EJ中上调LRIG1表达,并下调表皮生长因子(EGFR)的表达水平.通过采用单细胞凝胶电泳实验、流式细胞技术、免疫细胞化学染色及Matrigel侵袭实验,对比对照组、顺铂单药组、顺铂联合腺病毒载体组和顺铂联合腺病毒介导的LRIG1过表达组间细胞DNA损伤,细胞凋亡、增殖及侵袭能力.结果与对照组比较,顺铂在联合腺病毒介导的LRIG1过表达后,能下调细胞EGFR表达水平,同时显著增强肿瘤细胞DNA损伤程度(OTM值,对照组:2.54±0.54;CDDP组:4.57±0.79;CDDP/Ad-GFP组:5.38±1.16;CDDP/Ad-LRIG1组:9.45±2.64);引起细胞周期抑制[S期抑制,对照组:(40.82±2.11)%;CDDP组:(37.31±1.12)%,CDDP/Ad-GFP组:(37.57±2.52)%,CDDP/Ad-LRIG1组:(55.04±4.28)%];诱导细胞凋亡[细胞凋亡率,对照组:(2.63±2.49)%,CDDP组(3.49±1.94)%,CDDP/Ad-GFP组:(3.96±4.68)%,CDDP/Ad-LRIG1组:(12.56±0.77)%];抑制细胞增殖[细胞计数,对照组:(371.33±16.17)个;CDDP组:(224.67±88.06)个;CDDP/Ad-GFP组:(176.33±69.79)个;CDDP/Ad-LRIG1组:(138.33±8.39)个]并逆转细胞侵袭性[细胞侵袭数量,对照组:(259.40±9.21)个;CDDP组:(175.00±25.78)个;CDDP/Ad-GFP组:(157.20±22.79)个;CDDP/Ad-LRIG1组:(114.20±25.11)个].结论 腺病毒介导LRIG1过表达能增强顺铂对膀胱肿瘤细胞株EJ的损伤作用.     

开普拓与顺铂联合化疗辅助治疗宫颈癌的护理

对14例宫颈癌病人，应用开普拓与顺铂联合辅助治疗。结果11例随访6个月至1年无复发；2例姑息治疗者病情控制；1例复发者盆腔淋巴结消退。提示严密观察化疗毒副反应．对病人行全面护理．是预防或减少并发症、提高疗效的基础。     

The clinical efficacy of neoadjuvant chemotherapy in squamous esophageal cancer: A prospective nonrandomized study of pulse and continuous-infusion regimens with cisplatin and 5-fluorouracil

Background We evaluated cisplatin and 5-fluorouracil as preoperative adjuvant chemotherapy for patients with locally advanced squamous esophageal cancer and compared two different infusion regimens. The outcomes were also compared with those of our historical control patients treated by surgery alone. Methods From 1991 to 1997, 83 consecutive esophageal cancer patients underwent surgical exploration after completion of two cycles of cisplatin and 5-fluorouracil chemotherapy regimens, either in pulse or in continuous infusion cycles. Outcomes were compared with those of 76 historical control patients. Both groups were comparable in demographic characteristics and tumor stages. The resection rates, operative morbidity, mortality, and survival rates were compared. Results Partial response was achieved in 50% of patients who received chemotherapy. There was no chemotherapy-related mortality. The resection, morbidity, and mortality rates and median survival between the surgery-alone group and the chemotherapy group were 71.1% vs. 82%, 51% vs. 55%, and 4% vs. 10.8%, 12.0 vs. 13.5 months, respectively (P>.05). There was also no statistically significant difference between the two regimens. Conclusions Preoperative adjuvant chemotherapy with cisplatin and 5-fluorouracil infusion, in pulse or continuous regimens, followed by surgery for squamous esophageal cancer patients had no added benefit in the overall survival. Presented in part at the Eddie Wang International Surgical Symposium, Hong Kong, December 10–12, 1999.     

食管癌细胞MUC1过表达对5-氟尿嘧啶及顺铂化疗效果的影响

目的探讨食管癌细胞MUC1过表达对5-氟尿嘧啶及顺铂化疗效果的影响。方法构建MUC1过表达及稳定沉默食管癌细胞株,建立食管癌细胞裸鼠移植瘤模型;顺铂（8mg／kg,d1,d7）及5-氟尿嘧啶（20mg／kg,d1～d6）腹腔注射,测量肿瘤体积及裸鼠体重,绘制生长曲线及体重曲线;计算肿瘤抑瘤率。结果顺铂与5-氟尿嘧啶均能抑制MUC1过表达食管癌移植瘤的生长,裸鼠体重及肿瘤体积与对照组比较,差异有统计学意义（P〈0．05）,且顺铂的抑制效应更明显（P〈0．05）;在MUC1稳定沉默裸鼠无明显的抑制效应。结论顺铂与5-氟尿嘧啶都能抑制MUC1过表达食管癌移植瘤的生长,顺铂的抑制效应更明显,同时对体重的影响也更明显。     

A Randomized Phase 2 Trial of Neoadjuvant Chemotherapy in Resectable Pancreatic Cancer: Gemcitabine Alone Versus Gemcitabine Combined with Cisplatin

Background Survival after surgery for pancreas cancer remains low. This improves with adjuvant chemotherapy, but up to 30% patients do not receive the prescribed treatment. Neoadjuvant therapy may increase the proportion of patients who receive all treatment components, may downstage disease before surgery, and may provide early treatment of micrometastases. This randomized phase 2 study compares gemcitabine-based chemotherapy regimens to identify the most promising regimen for future study. Methods Fifty patients with potentially resectable pancreas lesions were enrolled onto the study. Twenty-four patients were randomized to gemcitabine (1000 mg/m²) every 7 days for 43 days; 26 patients were randomized to gemcitabine (1000 mg/m²) and cisplatin (25 mg/m²), 7 to the original schedule (omitting day 22) and 19 to a revised schedule due to neutropenia (omitting days 15 and 36). The primary outcome measure was resection rate. Results Patients who were allocated to gemcitabine received a median of 85% of the planned dose. Patients who were allocated to combination treatment received a median of 88% and 92% of the planned gemcitabine and cisplatin doses, respectively. There were 10 episodes of grade III/IV hematological toxicity in each group. Twenty-seven patients (54%) underwent pancreatic resection, 9 (38%) in the gemcitabine arm and 18 (70%) in the combination arm, with no increase in surgical complications. To date, 34 patients (68%) have died. Twelve-month survival for the gemcitabine and combination groups was 42% and 62%. Conclusions Chemotherapy can be safely administered before pancreatic surgery. Combination therapy with gemcitabine and cisplatin is associated with a high resection rate and an encouraging survival rate, suggesting that further study is warranted.     

Limited Cardiotoxicity after Extensive Thoracic Surgery and Intraoperative Hyperthermic Intrathoracic Chemotherapy with Doxorubicin and Cisplatin

Background Recently, pleural mesothelioma has been treated by cytoreductive surgery and intraoperative hyperthermic intrathoracic chemotherapy with doxorubicin and cisplatin. The well-established cardiotoxicity of doxorubicin and distressing data from an animal study raised concern about its impact on cardiac function. In the present study, early cardiotoxicity of this treatment modality was prospectively analyzed. Patients and Methods In 13 pleural mesothelioma patients, cardiotoxicity was monitored by clinical examination, electrocardiography, Troponin levels, cardiac ultrasonography, and estimation of left ventricular ejection fraction (LVEF) by radionuclide ventriculography before and during the first 6 months after cytoreductive surgery and intraoperative hyperthermic intrathoracic chemotherapy with doxorubicin (25–54 mg/m²) and cisplatin (65–120 mg/m²). Results No clinical cardiac failure or treatment-related death was observed. In two patients transient atrial fibrillation was noted; one associated with pulmonary emboli. Early posttreatment Troponin release was not of predictive value. Ultrasonography did not reveal significant alterations. LVEF decreased significantly (mean 0.07 or 11%, P = .001) during the first 3 months and remained stable thereafter. In univariate analysis, the degree of LVEF reduction was statistically related to maximal intrathoracic doxorubicin concentration (P = .031) and total cisplatin dose (P = .029). Direct exposure of the heart to the drugs as a result of partial pericardectomy was not associated with greater LVEF decrease. On the contrary, partial pericardectomy seemed to be associated with a smaller LVEF decline than when the pericardium remained intact (P = .045). In this small series, no statistically significant correlation between other treatment or pharmacokinetic parameters and LVEF decline was found. Notably, higher doxorubicin plasma concentrations and exposure were not associated with increased LVEF reduction. Conclusions Early cardiotoxicity is limited after this treatment modality using substantial doses of doxorubicin and cisplatin. Hence, this study suggests that intrathoracic chemotherapy with doxorubicin and/or cisplatin may be used for primary and secondary pleural malignancies, even immediately after extensive thoracic surgery, without concern of severe early cardiotoxicity.     

大鼠腹部穿支皮瓣动物模型的建立

目的 研究穿支皮瓣动物模型的建立方法,初步探讨其微血管构筑的形式.方法 建立大鼠腹壁上动脉穿支皮瓣动物模型,术后7天时比较其与随意皮瓣成活率的差异;乳胶灌注皮瓣,制作血管透明标本.结果 穿支皮瓣成活率明显较随意皮瓣高(p＜0.01),透明标本提示"穿支血管树"及树间吻合支是其微血管构筑的主要形式.结论 在大鼠腹部建立穿支皮瓣动物模型是可行的.     

丹参及5-氟尿嘧啶胃癌术后早期腹腔化疗的临床应用

目的：探讨丹参联合5－氟尿嘧啶（5－FU）对胃癌切除术后早期腹腔化疗（EPIC）的可行性及近期疗效。方法：136例胃癌后病人分为EPIC、早期静脉化疗（EPVC）、对照3组，EPIC组胃癌切除术后2－3d丹参、5－FU腹腔注射；EPIC组胃癌切除术后2－3d丹参、5－FU静脉注射；对照组术后早期不用任何方式化疗，术后3周常规化疗，分别观察：（1）EPIC组和EPVC组消化道反应、骨髓抑制和肝肾功能损害等毒副反应；（2）EPIC组和对照组有EPVC组术后切口感染或裂开，吻合口瘘，腹腔脓肿或出血，化学性腹膜和粘连性肠梗阻等并发症发生；（3）3组术后近期生存率及腹腔复发率。结果：（1）EPVC组比较，EPIC组消化道反应，骨髓抑制和肝肾功能损害等毒副反应明显降低（P＜0．05）；（2）和对照组及EPVC组比较，EPIC组切口感染或裂开，吻合口瘘，腹腔脓肿或出血，化学性腹膜炎和粘连性肠梗阻等各项并发症无明显增加（P＞0．05），（3）EPIC组1年、2年生存率明显高于另外两组（P＜0．01）而术后2年腹腔复发率明显低于另两组（P＜0．05）。结论：丹参联合5－FU胃癌术后早期腹腔化疗不仅是安全可行的，而且较静脉化毒副反应小，腹腔复发率低，近期生存率满意，有较大治疗上的优势。     

Basaloid-Squamous Carcinoma of the Esophagus Treated by Preoperative Chemotherapy: Report of Two Cases

Basaloid squamous carcinoma (BSC) of the esophagus has been associated with a poor outcome after surgery. We herein report two patients with esophageal BSC treated by preoperative chemotherapy. Patient 1 was a 55-year-old man who presented with a tumor of the middle esophagus diagnosed as BSC. He was treated by chemotherapy using a combination of 5-fluorouracil (5-FU: 750 mg/m², 1st–5th day, 24-h continuous infusion) and cisplatin (CDDP: 75 mg/m², 1st day, drip infusion per 2 h) before surgery, because of lymph node metastases of the mediastinum and around the left gastric artery. Even though the metastatic nodes were reduced and an esophagectomy was performed, the patient died of recurrence 12 months after chemotherapy. Patient 2 was a 57-year-old man who demonstrated BSC of the esophagus with direct invasion to the discending aorta, who was treated by preoperative chemotherapy using the same regimen as that of patient 1. The esophageal tumor was reduced, and a curative esophagectomy was performed. The patient is now alive without recurrence 38 months after chemotherapy. In conclusion, preoperative chemotherapy using a combination of 5-FU and CDDP may thus be an effective treatment for patients with advanced BSC of the esophagus. Received: September 19, 2001 / Accepted: May 7, 2002 RID="*" ID="*" Reprint requests to: N. Koide     

Accuracy of the Combination of Mammography and Sonography in Predicting Tumor Response in Breast Cancer Patients After Neoadjuvant Chemotherapy

Background Residual tumor size after neoadjuvant chemotherapy is an important consideration in surgical planning. We examined the accuracy of the combination of mammography and sonography in predicting pathologic residual tumor size.Methods Tumor size was evaluated by physical examination, mammography, and sonography at diagnosis and before surgery in 162 breast cancer patients who received neoadjuvant chemotherapy. Agreement between the predicted and the pathologic responses and the predicted and the pathologic tumor sizes was calculated. The effect of invasive lobular carcinoma, high nuclear grade, hormone receptor positivity, and the presence of an extensive intraductal component on the accuracy of mammography and sonography in predicting pathologic residual tumor size was analyzed.Results Forty-two patients (25.9%) had a pathologic complete response (pCR). Overall agreement between predicted and pathologic responses was 53% for physical examination, 67% for mammography plus sonography, and 63% for physical examination plus mammography and sonography. The sensitivity of mammography and sonography in predicting pCR was 78.6%, and the specificity was 92.5%; the accuracy was 88.9%. Residual tumor size determined by mammography and sonography correlated with pathologic residual tumor size (r = .662); pathologic tumor size was within .5 cm of predicted in 69.1% of patients. Multivariate analysis showed that pathologic residual tumor size was underestimated for lobular carcinoma and overestimated for poorly differentiated tumors.Conclusions The combination of mammography and sonography has a high accuracy in predicting pCR after neoadjuvant chemotherapy. Agreement of residual tumor size in mammography and sonography with pathologic residual tumor size was moderate.Presented in part at the American Society of Breast Surgeons Seventh Annual Meeting, Baltimore, Maryland, April 5–9, 2006.     

5-氟尿嘧啶与双嘧达莫联合对肾癌细胞生长的影响

目的探讨5-氟尿嘧啶（5-Fu）与双嘧达莫（DPM）作用对肾癌细胞生长的影响。方法以人’肾癌细胞系（RCC925）为研究对象，运用长春新硷（VLB；Velban）作为参照的有／无核苷酸体外条件培养体系来研究不同浓度5-Fu（0．6、6．0、60．0mg／L）与DPM的作用。结果当DPM浓度不变时，不同浓度5．Fu（0．6、6．0、60．0mg／L）分别对应的肾癌细胞生长抑制率组间比较差异有统计学意义（P〈0．05）；当5-Fu浓度不变时，不同浓度DPM（0、1．25、2．50、5．00、10．00mg／L）分别对应的肾癌细胞生长抑制率组问比较差异有统计学意义（P〈0．05）；而且6、60mg／L浓度的5-Fu与5mg／LDPM联合应用，与单用0．078mg／LVLB对肾癌细胞的生长抑制率比较差异有统计学意义（P〈0．05）。结论5-Fu与DPM联合应用可优化肾癌治疗。     

Omental Chemotherapy Effects as a Prognostic Factor in Ovarian Cancer Patients Treated With Neoadjuvant Chemotherapy and Delayed Primary Surgical Debulking

Background We sought to assess the prognostic significance of chemotherapy effect on upper abdominal metastatic disease. Methods Retrospective chart reviews were carried out from 1997 to 2005 to identify ovarian cancer patients treated with neoadjuvant chemotherapy. Pathologic examinations of resected omental and ovarian tumors for the presence of chemotherapy effect were performed. Cox proportional hazard models were built to model time to progression and death by using predictor variables of age, tumor grade, amount and location of largest residual disease, and the presence of chemotherapy effects on resected tumors. Results Sixty-six patients with available slides and clinical information were identified. The presence of omental chemotherapy effects was observed in 58 patients (88%). Identified independent statistically significant predictors for progression-free survival included presence of omental chemotherapy effect (hazard ratio [HR], .38; 95% confidence interval [95% CI], .17–.89; P = .026) and suboptimal tumor residuals in upper abdominal location compared with pelvic location (HR, 2.41; 95% CI, 1.06–5.48; P = .035). The presence of omental chemotherapy effect was the only statistically significant predictor of disease specific survival (HR, .21; 95% CI, .068–.639; P = .006). The estimated median survival for the group with positive omental chemotherapy effect was 84.45 months (95% CI, 69.63–99.28). The corresponding statistic in patients with no observed response to chemotherapy was 31.15 months (95% CI, 21.84–40.47). Conclusions Upper abdominal disease location and its response to chemotherapy were independent prognostic factors for progression-free survival. Aggressive upper abdominal debulking procedures are recommended to improve oncologic outcomes.