骨肉瘤对化疗反应的临床监测

本世纪70年代以来,抗癌药物的广泛应用开创了骨肉瘤治疗的新纪元。特别是术前化疗(即所谓的早期化疗、诱导化疗、新辅助化疗)的理论提出与临床实践更是骨肉瘤治疗中的一个里程碑。     

大剂量醛氢叶酸与氟尿嘧啶治疗晚期胃肠道癌

用醛氢叶酸（ＣＦ）与氟尿嘧啶（５ＦＵ）治疗经病理证实的晚期胃肠道癌１７例，其中胃癌８例，大肠癌９例。ＣＦ每次２００毫克，静滴２小时，５ＦＵ每次１克，于ＣＦ滴至一半时用，静滴１４小时以上，连用５天，２１天重复。结果：总有效率（ＣＲ＋ＰＲ）４７．１％，其中初治８例，有效率为６２．５％，复治９例（曾用过５ＦＵ或ＦＴ－２０７治疗），有效率３３．３％。胃癌与大肠癌有效率分别为５％和４４．４％，１７例中除１例     

骨肉瘤的化疗

本文综述了骨肉瘤化疗的意义、发展、实际价值，介绍了目前常用的主要药物、联合用药、其它辅助治疗及已出现转移灶病人的化疗。     

放疗联合化疗治疗复发直肠癌的临床研究

目的 探讨放疗联合化疗治疗是复发直肠癌的临床效果。方法 对２９例根治术后复发的直肠癌进行了放射治疗，其中１６例同时给予大剂量醛氢叶酸（ＣＦ），氟脲嘧啶（５－ＦＵ）的全身化疗（观察组）１３例单纯放疗（对照组）。结果 观察组中局部症状缓解率较对照组高，两组有效率分别为８１．２５％，４６．１６％，有显著性差异（Ｐ〈０．０５），完全缓解分别为１８．７５％，７．６９％两组放疗引起的局部毒性反应相似，结论，Ｃ     

大剂量醛氢叶酸联合氟尿嘧啶为主的化疗方案治疗头颈与消化道癌56例

目的 探讨治疗头颈与消化道癌实用有效的化疗方案。方法 采用大剂量醛氢叶酸（HD－CF）＋5－氟尿嘧啶（5－Fu)为主的联合化疗方案,持续滴注48h,治疗头颈与消化道癌56例,每例患者平均3．8个周期（2－6周期）。结果 全组患者有效率（CR＋PR）为35．7％,临床受益率达80．4％。不良反应为外周静脉炎、骨髓抑制、口腔溃疡和恶心呕吐等,但多为I－Ⅱ度。结论 大剂量醛氢叶酸＋5－氟尿嘧啶为主的联合化疗方案,持续滴注48h,治疗头颈与消化道癌疗效较满意,经济实用,值得进一步研究。     

大剂量醛氢叶酸,5—FU,顺铂方案治疗晚期头颈癌28例疗效分析

我们采用大剂明醛氢叶酸／５－ＦＵ＋ＤＤＰ方案治疗晚期头颈癌２８例，取得ＣＲ１例，ＰＲ１４例，ＭＲ３例，ＳＤ８例，ＰＤ２例，总有效率５３．６％，中数生存期为１０个月。毒副反应主要有白细胞降低，口腔粘膜溃烂，恶心，呕吐等，但多数在Ⅰ－Ⅱ级，绝大多数病人可以耐受。     

口服大剂量CF加PF方案与PF方案联合放射治疗晚期鼻咽癌疗效比较

目的：对比观察口服大剂量醛氢叶酸,５－ＦＵ,ＤＤＰ（ＰＦＬ）与ＰＦ方案联合治疗晚期及复发转移的鼻咽癌的疗效。方法 １９９６～１９９８年间,１００例局部晚期及复发转移的鼻咽癌,非随机分为ＣＦ组（ＰＦＬ方案）５１例,对照组（ＰＦ方案）４９例。晚期初治采用放化疗综合治疗（Ｃ＋Ｒ）复发转移采用单纯化疗（Ｃ）。结果 ＣＦ组初治２８例,其ＣＲ率,有效率分别为６４．２％,８５．７％,中位生存期２１月（４－３３月     

大剂量醛氢叶酸合并氟脲嘧啶治疗结直肠癌的探讨

大剂量醛氢叶酸合并氟脲嘧啶治疗结直肠癌的探讨唐云强，宁家菁广州市肿瘤医院（广州·５１００６０）近年，实验证明大剂量醛氢叶酸（ＨＤＣＦ）可促进５Ｆｕ的活性代谢物（Ｆｄｕｍｐ）与胸苷酸合成酶Ｔｍｐｓ结合成三联体，从而加强５Ｆｕ的抗瘤作用，国外已广泛使用于...     

大剂量IFO治疗骨及软组织肉瘤的泌尿系统毒性分析

目的探讨IFO在骨及软组织肉瘤化疗中的副作用。方法应用含有IFO的化疗方案化疗骨及软组织肉瘤38例,共88个疗程。IFO化疗剂量2g/m2,连续5天,共76个疗程;减量组IFO1.2g/m2,连用3～5天,共12个疗程。化疗毒副作用依据WHO化疗药物急性及亚急性不良反应分度标准判断。结果因高龄、肾功能异常致初次化疗减量者4例,因严重骨髓抑制至第2个疗程减量者2例。出现Ⅳ度以上白细胞减少者化疗15个疗程(17.0%)。出现Ⅱ度以上恶心、呕吐者化疗54个疗程(61.3%)。出现Ⅱ度以上血尿、出血性膀胱炎者化疗8个疗程(9.0%),出现肉眼血尿者化疗2个疗程(2.3%),其中1例于化疗后1周出现,且为Ⅲ度血尿,其余均于化疗中后期出现。结论在充分补液及应用美斯纳解毒时,应用大剂量IFO治疗骨软组织肉瘤疗效较好,无严重毒副作用。     

FOLFOX方案一线治疗转移性或复发性晚期大肠癌的疗效分析

目的：评价草酸铂、氟尿嘧啶联合醛氢叶酸（FOLFOX方案）一线治疗转移性或复发性晚期大肠癌的临床疗效及不良反应。方法：对于未接受过姑息性化疗的转移性或复发性大肠癌患者给予草酸铂100mg／m^2于第l天静脉滴注2h、醛氢叶酸400mg／m^静脉滴注2h，氟尿嘧啶400mg／m^静脉推注．随后氟尿嘧啶2600～3000mg／m^持续静脉灌注46h。结果：105例患者中97例患者可以评价疗效，总有效率为35．1％，CR率为9．3％，PR率为25．8％；33．0％的患者为SD，另有31．9％的患者PD。中位疾病进展时间（TTP）为7．7个月，中位总生存时间（OS）为20．5个月。1年及2年的总生存率分别为68．0％和32．0％。按照NCI—CTC不良反应分级，Ⅲ．Ⅳ级不良反应发生率分别为：白细胞降低12．3％，贫血11.3％；呕吐4．1％，腹泻7．2％。Ⅲ度外周神经毒性发生率为5．1％。曾接受过根治性手术治疗的患者的生存优于未接受过手术或仅接受过姑息性手术治疗的患者的生存（P=0．0658）；化疗前患者的CEA、ALP及LDH水平对患者的预后无明显影响（P〉0．05）。结论：FOLFOX方案一线治疗转移性或复发性晚期大肠癌是一个有效的方案．并且不良反应可耐受。     

Consensus Guideline for Use of Glucarpidase in Patients with High‐Dose Methotrexate Induced Acute Kidney Injury and Delayed Methotrexate Clearance

Acute kidney injury due to high‐dose methotrexate (HDMTX) is a serious, life‐threatening toxicity that can occur in pediatric and adult patients. Glucarpidase is a treatment approved by the Food and Drug Administration for high methotrexate concentrations in the context of kidney dysfunction, but the guidelines for when to use it are unclear. An expert panel was convened to provide specific, expert consensus guidelines for the use of glucarpidase in patients who develop HDMTX‐induced nephrotoxicity and delayed methotrexate excretion. The guideline provides recommendations to identify the population of patients who would benefit from glucarpidase rescue by more precisely defining the absolute methotrexate concentrations associated with risk for severe or life‐threatening toxicity at several time points after the start of an HDMTX infusion. For an HDMTX infusion ≤24 hours, if the 36‐hour concentration is above 30 µM, 42‐hour concentration is above 10 µM, or 48‐hour concentration is above 5 µM and the serum creatinine is significantly elevated relative to the baseline measurement (indicative of HDMTX‐induced acute kidney injury), glucarpidase may be indicated. After a 36‐ to 42‐hour HDMTX infusion, glucarpidase may be indicated when the 48‐hour methotrexate concentration is above 5 µM. Administration of glucarpidase should optimally occur within 48–60 hours from the start of the HDMTX infusion, because life‐threatening toxicities may not be preventable beyond this time point.

Implications for Practice

Glucarpidase is a rarely used medication that is less effective when given after more than 60 hours of exposure to high‐dose methotrexate, so predicting early which patients will need it is imperative. There are no currently available consensus guidelines for the use of this medication. The indication on the label does not give specific methotrexate concentrations above which it should be used. An international group of experts was convened to develop a consensus guideline that was specific and evidence‐based to identify the population of patients who would benefit from glucarpidase.     

Adjuvant Treatment for Gastric Cancer: Chemotherapy Versus Radiation

Gastric cancer is among the leading causes of cancer death worldwide. Surgery is the only curative modality, but mortality remains high because a significant number of patients have recurrence after complete surgical resection. Chemotherapy, radiation, and chemoradiotherapy have all been studied in an attempt to reduce the risk for relapse and improve survival. There is no globally accepted standard of care for resectable gastric cancer, and treatment strategies vary across the world. Postoperative chemoradiation with 5‐fluorouracil/leucovorin is most commonly practiced in the United States; however, recent clinical trials from Asia have shown benefit of adjuvant chemotherapy alone and have questioned the role of radiation. In this review, we examine the current literature on adjuvant treatment of gastric cancer and discuss the roles of radiation and chemotherapy, particularly in light of these new data and their applicability to the Western population. We highlight some of the ongoing and planned clinical trials in resectable gastric cancer and identify future directions as well as areas where further research is needed.     

Primary Chemotherapy and Delayed Surgery (Neoadjuvant Chemotherapy) for Telangiectatic Osteogenic Sarcoma of the Extremities

Summary

Twelve patients with telangiectatic osteogenic sarcoma (TOS) of the extremities were treated with neoadjuvant chemotherapy, according to two different protocols.

Preoperatively the patients received high-dose methotrexate(HD-MTX)/cisplatinum(CPD) or HD-MTX/CPD/adriamycin(ADM). CPD was delivered intra-arteriously, the other drugs intravenously. Limb salvage surgery was performed in eight instances and four patients underwent amputation. Post operative chemotherapy was tailored according to the grade of necrosis determined by preoperative treatment on the primary tumor. In ten cases (83%) the grade of necrosis resulted higher than 95%.

The mean length of follow-up was 3.5 years with a range of 18 to 72 months. Ten patients (83%) reimained continuously disease-free, while two patients developed lung metastases and died of uncontrolled disease. No local recurrences were observed.

These results are better than those observed in 167 contemporary cases of conventional osteosarcoma treated with the same protocols. This study confirms that TOS is not always a lethal tumor as suggested by prior reports. Employing neoadjuvant chemotherapy a high percentage of patients with TOS can be cured and in most of them, limb sparing surgery is possible and safe.     

Primary cardiac sarcomas: A retrospective study of the French Sarcoma Group

IntroductionPrimary cardiac sarcomas (PCS) are rare tumours of dismal prognosis.MethodsData of 124 patients with PCS referred to institutions of the French Sarcoma Group (FSG) from 1977 and 2010 were reviewed.ResultsMedian age was 48.8 years. PCS were poorly-differentiated sarcomas (N = 45, 36.3%), angiosarcomas (N = 40, 32.3%), leiomyosarcomas (N = 16, 12.9%) and others (N = 23, 18.6%). At diagnosis, 100 patients (80.6%) were localised and 24 (19.4%) metastatic. Tumours were located in the right (N = 47, 38.8%), left atrial cavities (N = 45, 37.2%) or encompassed several locations in nine cases (7.4%). Surgery was performed in 81 cases (65.3%). Heart transplant was performed in five patients. Radiotherapy adjuvant (N = 18, 14.5%) or alone (N = 6, 4.8%) was performed in non-metastatic patients only (N = 24, 19.4%). With a median follow-up of 51.2 months, median overall survival (OS) was 17.2 months for the entire cohort, 38.8 months after complete resection versus 18.2 after incomplete resection and 11.2 months in non-resected patients. Radiotherapy was associated with improved progression-free survival (PFS) on multivariate analysis. Chemotherapy was significantly associated with better OS only in non-operated patients but not in operated patients. In non-metastatic patients, surgery (hazard ratio [HR] = 0.42, p < 0.001), male gender (HR = 0.56, p = .032) was associated with better OS and surgery (HR = 0.61; p = .076), radiotherapy (HR = 0.43; p = .004) and chemotherapy (HR = 0.30, p = .003) improved PFS.ConclusionOnly surgical resection is associated with a perspective of prolonged survival. Chemotherapy is associated with a better outcome in non-resected patients.