吉西他滨联合紫杉醇治疗晚期非小细胞肺癌的临床研究

目的探讨紫杉醇联合吉西他滨治疗晚期非小细胞肺癌(NSCLC)的近期疗效和安全性。方法老年晚期非小细胞肺癌92例,随机分为2组:吉西他滨1 000 mg联合紫杉醇120 mg方案(TG组)45例,吉西他滨联合卡铂方案(GC组)47例,每3~4周为l周期,连续用药3周期。结果近期疗效:2组组间总有效率(RR)及疾病控制率(DCR)经比较,差异无统计学意义;TG组中位生存期为8.6个月,3年生存率约6.6%;GC组中位生存期为9个月,3年生存率约6.4%;主要不良反应是Ⅲ~Ⅳ度骨髓抑制、血液学毒性、肝功能损害等,TG组血小板减少、白细胞减少以及贫血(Ⅲ~Ⅳ度)发生率明显少于GC组。结论吉西他滨联合紫杉醇治疗老年晚期NSCLC疗效较好,毒性反应较轻。     

非小细胞肺癌术后应用吉西他滨联合顺铂方案行辅助化疗的疗效观察

目的探讨非小细胞肺癌(NSCLC)术后应用吉西他滨联合顺铂方案行辅助化疗的疗效。方法 95例非小细胞癌患者分为2组,观察组使用吉西他滨联合顺铂,对照组使用长春瑞滨联合顺铂。比较2组患者疗效和不良反应发生情况。结果观察组总有效率为52.08%,高于对照组的40.43%。2组患者不良反应发生例数和症状比较无显著差异(P0.05)。2组患者化疗后白细胞、粒细胞和血小板计数均减少。观察组6个月后复发率为10.42%,对照组复发率为14.89%。结论吉西他滨联合顺铂治疗NSCLC疗效更好,值得推广应用。     

Pilot study of hydrolytically activated paclitaxel prodrug therapy in patients with progressive malignancies

Background: The development of novel strategies based on chemotherapy with prodrugs is still a challenge for physicians developing effective treatment of malignancies in advanced-stage disease. In this study, we tested the hypothesis that this can be achieved by a prodrug of paclitaxel if the C7 hydroxyl group is blocked by condensation with a solketal chloroformate followed by a ring-opening reaction to the dihydroxyl derivative.Objective: The purpose of this study was to obtain information about toxicity, pharmacokinetic characteristics, and outcomes following paclitaxel prodrug therapy in 10 patients suffering from various progressive end-stage malignancies.Methods: Eligible patients had failed standard therapies and presented with progressive disease, were free of acute infections, had a total white blood cell count >2500 cells/mm³ and platelet count of >150,000 cells/mm³, and had not received chemo- or radiotherapy in the preceding 8 weeks. Subjects were treated with paclitaxel prodrug (pro Taxol) (100-1200 mg/m²) under the compassionate-use Investigational New Drug setting, and toxicity was graded according to the National Cancer Institute's Common Toxicity Criteria (version 2.0). Pharmacokinetic characteristics of paclitaxel prodrug and paclitaxel released from the prodrug were determined by high-performance liquid chromatography.Results: Ten patients with different progressive malignancies were enrolled. Pharmacokinetic monitoring of treated patients demonstrated an increase in the serum half-life (∼5-fold, 14.0 hours vs 2.9 hours) and the maximum plasma drug concentration (∼50-fold, 110.0 μM vs 2.7 μM) of the paclitaxel prodrug over active paclitaxel, respectively. Furthermore, paclitaxel prodrug was shown to convert to active paclitaxel. The patients tolerated doses of ≤1200 mg/m², with transient liver toxicity starting at 450 mg/m². Grade 4 neutropenia was observed in 4 patients and required treatment with granulocyte colony-stimulating factor. Among the 10 enrolled patients, we observed 2 with complete remissions, 3 with partial responses, 1 with stable disease, and 4 with progressive disease.Conclusions: In this study, hydrolytically activated therapy with a paclitaxel prodrug resulted in decreased toxicity in patients based on a slow release of active paclitaxel. Encouraging effects on the course of the disease were observed, albeit in a heterogeneous patient population. These findings indicate that paclitaxel prodrug may further improve the success rate of chemotherapy with active paclitaxel.     

紫杉醇联合S-1的新辅助化疗方案在局部进展期胃癌中的疗效

目的:评价紫杉醇联合S-1方案的新辅助化疗治疗进展期胃癌的临床疗效及不良反应。方法:回顾性分析2014年7月至2017年7月在上海交通大学附属第六人民医院普外科接受治疗的55例进展期胃癌患者的临床资料。采用Kaplan-Meier法进行生存分析,Cox比例风险模型进行多因素预后分析。结果:新辅助化疗+手术组的R0切除率明显高于常规手术组(P<0.05);新辅助化疗+手术组的不良反应均可经对症处理后缓解,不影响治疗,停药后逐渐恢复。Cox比例风险模型显示:病理反应(P=0.002,RR=0.121,95%CI:0.014~0.453)、影像学疗效(P=0.009,RR=0.212,95%CI:0.076~0.478)和TNM分期(P=0.015,RR=1.712,95%CI:1.021~4.123)是影响新辅助化疗+手术组患者术后复发的独立因素。新辅助化疗+手术组的并发症发生率与常规手术组差异无统计学意义(P>0.05)。结论:紫杉醇联合S-1方案是一个针对进展期胃癌新辅助化疗效果较好而不良反应较小的方案。     

脂质体紫杉醇联合博莱霉素治疗淋巴瘤的观察与护理

[目的]探讨脂质体紫杉醇联合博莱霉素治疗淋巴瘤化疗期间的护理。[方法]回顾性分析2007年8月—2009年4月在我区接受脂质体紫杉醇与博莱霉素联合化疗的14例淋巴瘤病人的临床资料。[结果]14例病人均完成全程化疗,期间1例出现发热反应,3例出现轻度胃肠道反应,3例出现不同程度的脱发,1例出现骨髓抑制。[结论]脂质体紫杉醇联合博莱霉素化疗期间,对病人进行良好的心理护理,并加强药物毒副反应的观察和护理,有助于化疗的顺利完成。     

脂质体紫杉醇联合博菜霉素治疗淋巴瘤的观察与护理

[目的]探讨脂质体紫杉醇联合博莱霉素治疗淋巴瘤化疗期间的护理。[方法]回顾性分析2007年8月-2009年4月在我区接受脂质体紫杉醇与博莱霉素联合化疗的14例淋巴瘤病人的临床资料。[结果]14例病人均完成全程化疗,期间1例出现发热反应,3例出现轻度胃肠道反应,3例出现不同程度的脱发,1例出现骨髓抑制。[结论]脂质体紫杉醇联合博莱霉素化疗期间,对病人进行良好的心理护理,并加强药物毒副反应的观察和护理,有助于化疗的顺利完成。     

最佳支持治疗与吉西他滨或并卡铂治疗老年晚期非小细胞肺癌的临床比较

目的观察比较最佳支持治疗(BSC)、单药吉西他滨(GEM)或并卡铂(CBP)治疗老年晚期非小细胞肺癌的疗效、毒副反应以及患者的生存质量。方法拒绝化疗者入BSC组,接受化疗者随机分为GEM单药化疗组和GEM+CBP联合化疗组。BSC组:最佳支持治疗。GEM组:GEM 1000 mg/m2静脉滴注30 min,第1,8天。GEM+CBP组:GEM1 000 mg/m2静脉滴注30 min,第1,8天;CBP AUB=4静脉滴注第1天。化疗组均21天为1周期,每例至少完成2周期化疗。结果近期疗效:总有效率BSC组0、GEM 30.3%、GEM+CBP组46.7%,组间比较P<0.05。毒副反应:主要表现为骨髓抑制和消化道反应,尽管Ⅲ~Ⅳ度毒副反应的发生率GEM+CBP组明显高于GEM组(P<0.05),但耐受性均较好。生存质量:临床受益率BSC组13.2%、BEM组48.5%、GEM+CBP组50.0%,两化疗组优于BSC组(P<0.05),但两化疗组之间相互比较无显著性差异(P>0.05)。结论对于老年晚期NSCLC,化疗优于对症支持治疗,GEM+CBP联合化疗的疗效优于GEM单药化疗,但联合化疗毒副反应相应增加,临床受益率未显示出优势。临床实践中,注意选择个体化方案治疗。     

吉西他滨联合卡培他滨在转移性胰腺癌一线化疗中的疗效及安全性分析

目的分析研究吉西他滨联合卡培他滨在转移性胰腺癌一线化疗中的疗效及安全性。方法 23例初治转移性胰腺癌一线化疗接受吉西他滨联合卡培他滨:吉西他滨1000 mg/m2,静脉滴注30 min,第1、8天;卡培他滨650 mg/m2,2次/天,口服,第1~14天;每3周1个疗程,评价它的总生存、无进展生存、客观缓解率、临床获益率、临床获益反应、糖类抗原19-9(CA19-9)缓解率和不良反应等。结果 23例转移性胰腺癌患者中,4例出现部分缓解,6例获得疾病稳定,13例出现按肿瘤进展,总客观缓解率为17.4%,平均缓解持续时间为6.8个月,临床获益为43.5%,临床获益反应率为52.2%,CA19-9缓解率为65.2%,中位无进展生存为6.1个月,1年无进展生存率14.2%;中位生存时间为7.3个月,1年生存率为25.1%。绝大部分治疗相关不良反应是1至2级,最常见的3/4毒性反应为中性粒细胞减少。结论研究证实吉西他滨与卡培他滨联合方案可成为转移性胰腺癌一线化疗方案之一;同时,临床获益反应在疗效相近的化疗方案的选择上有着重要的指导作用。     

新辅助动脉灌注紫杉醇和奈达铂治疗宫颈癌临床观察

目的观察紫杉醇(PTX)联合奈达铂(NDP)方案作为新辅助化疗在宫颈癌术前治疗中的抗肿瘤作用及毒性。方法 102例宫颈癌患者随机分为NDP组(n=45)和PDD组(n=57),NDP组,经动脉导管灌注PTX 135 mg/m2、NDP 80 mg/m2,PDD组,经动脉导管灌注PTX 135 mg/m2、顺铂(PDD)80 mg/m2,均以21天为一个周期,连用2个周期后分析比较两组的疗效和不良反应。结果 NDP组总有效率为91.1%,PDD组总有效率为87.7%,两组总有效率差别无统计学意义(P0.05)。NDP组呕吐发生率为35.6%,PDD组呕吐发生率为84.2%,两组呕吐率差别有统计学意义(P0.05)。结论新辅助动脉灌注PTX联合NDP方案治疗宫颈癌的疗效与PTX联合PDD方案相当,但耐受性好。     

膀胱移行细胞癌患者尿Survivin及透明质酸含量检测意义

目的:探讨尿survivin含量及尿液透明质酸含量检测在膀胱癌诊断及预后中的价值。方法:本实验观察对象为膀胱癌患者87例、其他疾病患者40例及30例健康成人。收集各组尿液,采用ELISA法行survivin、透明质酸含量检测。结果:膀胱癌组survivin含量为(2.51±1.91)μg/L,其他疾病组为(0.55±0.22)μg/L,正常对照组(0.40±0.17)μg/L。膀胱癌组尿液透明质酸含量为(3.12±0.69)mmol/L,其他疾病组为(1.41±0.46)mmol/L,正常对照组为(1.24±0.35)mmol/L。结论:联合检测尿survivin含量和透明质酸含量可作为膀胱癌无创诊断及预后判断辅助方法。     

腹腔热灌注化疗治疗晚期胃癌并恶性腹腔积液疗效观察

目的探讨体外循环恒温持续腹腔热灌注化疗治疗晚期胃癌并恶性腹腔积液的临床疗效。方法22例晚期胃癌并恶性腹腔积液患者,行体外循环恒温持续腹腔热灌注化疗,水温控制在42～43℃,灌注液为生理盐水3000mL,灌注药物为氟尿嘧啶＋顺铂,灌注时间90min,隔日1次,共治疗3次。结果22例患者均顺利完成腹腔热灌注化疗,其中完全缓解19例（86．36％）,部分缓解3例（13．64％）,有效率100％,临床获益率100％;主要不良反应为消化道不良反应和骨髓抑制。结论采用体外循环恒温腹腔热灌注化疗治疗晚期胃癌并恶性腹腔积液疗效确切,不良反应可耐受。     

进展期食管癌患者接受紫杉醇联合顺铂新辅助化疗后的肿瘤标志物及癌基因评价

目的 研究紫杉醇联合顺铂新辅助化疗对进展期食管癌患者肿瘤标志物分泌及癌基因表达的影响.方法 前瞻性选择2017年3月至2020年1月期间重庆市巴南区人民医院收治的50例进展期食管癌患者,随机数字表法分为紫杉醇联合顺铂新辅助化疗+根治性手术的观察组、直接接受根治性手术的对照组,每组各25例.确诊时及手术前,测定2组患者血...     

DDP与5-FU联合个体化化疗治疗口腔鳞癌的护理体会

目的探讨DDP+5鄄FU联合个体化化疗治疗口腔鳞癌的护理经验。方法对36例口腔鳞癌术后患者采用DDP与5鄄FU联合缓慢持续静脉滴注,观察不良反应及采取相应的护理。结果36例患者化疗过程中,经过观察及对症护理,均能顺利完成化疗。结论联合化疗是口腔鳞癌综合治疗的有机部分,而化疗中密切观察病情及精心的护理是使化疗顺利完成的重要措施。     

~(99)Tc~m-MIBI显像预测小细胞肺癌化疗疗效的临床研究

目的 探讨~(99)Tc~m-MIBI显像预测小细胞肺癌化疗疗效的价值.方法 53例小细胞肺癌患者根据胸部CT结果分为化疗有效组(完全缓解+部分缓解)39例和无效组(病情稳定+疾病进展)14例,于化疗前行~(99)Tc~mMIBI肺显像,静脉注射~(99)Tc~m-MIBI 740 MBq后10～30 min及2～3 h分别行早期及延迟显像,分别获得早期相肿瘤与正常肺组织摄取比值(ER)和延迟相肿瘤/正常肺摄取比值(DR),计算滞留指数(RI).采用t检验及秩和检验分析化疗有效组与化疗无效组ER、DR和RI之间的差别.结果 ~(99)Tc~m-MIBI显像结果中,化疗有效组的ER、DR分别为2.33±0.21、2.44±0.19,均显著高于化疗无效组的2.02±0.31、1.86±0.30,差异有统计学意义(t=-3.401、-6.724,P均<0.05).化疗有效组的RI中位值为5.31%,高于化疗无效组的-9.26%,差异有统计学意义(Z=-3.612,P<0.05).结论 ~(99)Tc~m-MIBI显像在预测小细胞肺癌化疗疗效方面具有重要的临床价值.     

尼妥珠单抗联合吉西他滨加顺铂方案治疗晚期胰腺癌临床疗效观察

目的观察尼妥珠单抗(nimotuzumab)联合吉西他滨(gemcitabine,GEM)加顺铂(cisplatin,CDDP)(GP)方案治疗晚期胰腺癌(APC)的近期疗效及不良反应。方法 2007年5月～2010年8月,共有16例住院的APC患者采用尼妥珠单抗联合GP方案治疗,具体方案如下:尼妥珠单抗200 mg,每周1次,连用8周,此后同样剂量每2周静脉输注,直至疾病进展;化疗方案采用GEM 800～1 000 mg/m2,按固定剂量率法(FDR)静脉输注,第1、8天,CDDP 30 mg/m2静脉注射,第2～4天,每21天重复1次。结果 16例患者中部分缓解(PR)8例,稳定(SD)5例,和进展(PD)3例。有效率50%,疾病控制率81%。常见的不良反应为恶心、呕吐,白细胞及血小板减少,未见Ⅳ级不良反应。结论妥珠单抗联合GP方案治疗APC安全有效,值得进一步扩大样本研究。     

紫杉醇加洛铂联合化疗治疗卵巢癌的护理

目的探讨卵巢癌患者应用紫杉醇加洛铂联合化疗的最佳护理方法。方法对12例卵巢癌患者采用紫杉醇加洛铂进行治疗,化疗期间实施相应的护理措施包括加强心理护理、化疗用药护理、骨髓抑制护理及饮食护理等,观察其护理效果并总结其要点。结果12例卵巢癌患者除1例发生过敏性休克经抢救脱险停止化疗外,其余均顺利完成化疗计划,心理表现也正常。结论紫杉醇加洛铂联合化疗治疗卵巢癌患者,通过严格执行化疗计划,严密的病情观察,强化化疗护理,可以有效地预防和减轻毒性反应,保证化疗的顺利完成,取得了满意的治疗效果。     

腹腔热灌注化疗联合系统化疗治疗恶性腹水的疗效和安全性

目的：评价腹腔热灌注化疗（Hyperthermic intraperitoneal chemotherapy,HIPEC）联合系统化疗在实体肿瘤恶性腹水（malignant ascites,MA）中的临床疗效及安全性。方法：回顾性分析88例于2020年07月至2022年12月期间在复旦大学附属中山医院肿瘤内科接受HIEPC联合系统化疗的MA患者临床资料,χ2检验分析MA近期疗效与患者临床病理特征的关系,用Kaplan-Meier法计算不同亚组的腹水控制时间,t检验分析计量资料数据。结果：HIPEC联合系统化疗对MA的总体控制率为72.73%（64/88）,总体中位控制时间为4.27个月。不同原发肿瘤来源的MA近期疗效存在差异,其中胃癌MA的控制率较非胃癌患者高（82.69% vs 58.33%,P=0.023）,但胃癌与非胃癌患者在腹水控制时间上差异不显著（4.77个月 vs 2.88个月,P=0.354）。相较于5-氟尿嘧啶（5-Fluorouracil,5-FU）和顺铂（cisplatin,DDP）等非紫杉醇（non-paclitaxel,Non-PTX）类药物,紫杉醇（Paclitaxel,PTX）可明显延长患者的腹水控制时间（4.70个月 vs 2.45个月,P=0.024）,而性别、年龄、东部肿瘤协作组/体力状态（Eastern Cooperative Oncology Group/Performance status,ECOG/PS）、腹水理化性质、血清白蛋白水平、全身治疗方案、灌注次数等临床病理特征在疗效分析中无显著差异。48.86%（43/88）的患者在HIPEC治疗后出现短暂而轻微的腹胀、腹痛,可自行缓解,另有4.55%（4/88）的患者因HIPEC不良反应而中断系统抗肿瘤治疗（消化道穿孔和消化道出血各1例、肠梗阻2例）。结论：HIPEC联合系统化疗为MA安全且有效的治疗手段,对胃癌MA的近期疗效更佳;选用PTX作为HIPEC的灌注药物,可延长MA的控制时间,为优化HIPEC在MA中的应用提供一定的理论依据。     

Glucose-induced thermogenesis in patients with small cell lung carcinoma. Before and after inhibition of tumour growth by chemotherapy

Summary. Seven weight-losing patients with histologically verified small cell lung carcinoma were given an oral glucose load of 75 g before and at least 3 weeks after the end of chemotherapy to examine the effect of glucose on whole body and skeletal muscle thermogenesis before and after reduction of tumour. Whole body energy expenditure was measured by the open circuit ventilated hood system. Forearm blood flow was measured by venous-occlusion strain-gauge plethysmography. The uptake of oxygen in skeletal muscle was calculated as the product of the forearm blood flow and the difference in a-v oxygen concentration. Whole body resting energy expenditure (REE) did not increase, it was 4.4±0.3kJmin^-1(mean±SE) before chemotherapy and 4.4±0.2 kJ min^-1 after chemotherapy. The glucose-induced thermogenesis in the 180 min following the glucose load was 93.6±9.9 kJ 180 min^-1 before chemotherapy. This is significantly increased compared to that found in a healthy control group (74.7±4.8 kJ 180 min^-1, P < 0.02). The glucose-induced thermogenesis was significantly reduced to 47.7±10.2 kJ 180 min^-1 (P < 0.05) after chemotherapy. The oxygen uptake in resting skeletal muscles was 6.9±0.3 μmol 100 g^-1 min^-1 before chemotherapy and 7.0±0.7 μmOI 100 g^-1 min^-1 after chemotherapy. This did not increase during the first 90 min following the glucose load in either investigations. In the period 90–180 min following the glucose load, the oxygen uptake was significantly increased before chemotherapy as compared to after chemotherapy, which suggests that the reduced whole body thermogenesis after chemotherapy in part was due to reduced skeletal muscle thermogenesis.     

A randomized clinical trial of combination chemotherapy with and without low-molecular-weight heparin in small cell lung cancer

BACKGROUND: Small cell lung cancer (SCLC) is a chemotherapy-responsive tumor type but most patients ultimately experience disease progression. SCLC is associated with alterations in the coagulation system. The present randomized clinical trial (RCT) was designed to determine whether addition of low-molecular-weight heparin (LMWH) to combination chemotherapy (CT) would improve SCLC outcome compared with CT alone. METHODS: Combination CT consisted of cyclophosphamide, epirubicine and vincristine (CEV) given at 3-weekly intervals for six cycles. Eighty-four patients were randomized to receive either CT alone (n = 42) or CT plus LMWH (n = 42). LMWH consisted of dalteparin given at a dose of 5000 U once daily during the 18 weeks of CT. Results Overall tumor response rates were 42.5% with CT alone and 69.2% with CT plus LMWH (P = 0.07). Median progression-free survival was 6.0 months with CT alone and 10.0 months with CT plus LMWH (P = 0.01). Median overall survival was 8.0 months with CT alone and 13.0 months with CT plus LMWH (P = 0.01). Similar improvement in survival with LMWH treatment occurred in patients with both limited and extensive disease stages. The risk of death in the CT + LMWH group relative to that in the CT group was 0.56 (95% confidence interval 0.30, 0.86) (P = 0.012 by log rank test). Toxicity from the experimental treatment was minimal and there were no treatment-related deaths. CONCLUSIONS: These results support the concept that anticoagulants, and particularly LMWH, may improve clinical outcomes in SCLC. Further clinical trials of this relatively non-toxic treatment approach are indicated.