局部晚期鼻咽癌同时放、化疗疗效观察

目的：观察同期放、化疗治疗局部晚期鼻咽癌的近期疗效、生存率、局部控制率、远处转移率和毒副反应。方法：60例局部晚期鼻咽癌为综合治疗组，分别在放疗第1，5周及放疗后1周给予DDP30mg／m^2 1天～3天，5-Fu500mg／m^2 1天～5天化疗共4～5个周期，另配对选取60例单纯放疗者为对照组，两组放疗方法相同。结果：综合组与单放组鼻咽肿瘤完全消退率分别为93％和84．2％（P〉0．05），颈部淋巴结完全消退率分别为87．2％和59．8％（P〈0．05），3年生存率分别为75．2％和48．3％（P〈0．05），3年局控率分别为87．2％和70．3％（P〈0．05），3年远处转移率分别为17．2％和38．8％（P〈0．05）。综合组白细胞减少症、胃肠道反应和口腔粘膜反应较单放组多且明显（P〈0．05），但可接受。结论：同期放、化疗与辅助化疗有助于提高局部控制率和生存率，减少远处转移率。     

联合化疗和放射治疗局部晚期鼻咽癌的临床研究

为探讨联合化疗在鼻咽癌治疗中的作用，从１９９０年７月至１９９１年１２月把７６例经病理证实，初治的局部晚期（Ⅲ、Ⅳ期）鼻咽癌，随机分为联合化疗和放射治疗组（综合治疗组）以及单纯放疗组（对照组）各３８例，化疗方案：顺铂、氟脲嘧啶和平阳霉素。治疗３月后，综合治疗组和对照组鼻咽肿瘤完全消退率分别为８９．５％和９７．５％，颈转移灶消退率分别为９３．８％和９０．６％，两组均无显著性差异（Ｐ〉０．０５）。随访３     

顺铂单药方案与PF方案分别联合放疗治疗局部晚期鼻咽癌的临床观察

目的观察顺铂单药方案与顺铂联合氟尿嘧啶（PF）方案分别联合放疗治疗局部晚期鼻咽癌的近期疗效和毒副反应。方法84例确诊为局部晚期的鼻咽癌患者随机分为两组：治疗组42例,用顺铂80mg／m2,静滴,d1-d2;对照组42例,用顺铂20mg/m2和5-氟尿嘧啶500mg／m2,静滴,d1～d5。两组均以3周为1个疗程,可用2-3个疗程。两组均与放疗联合同步应用,放疗方法均相同,鼻咽部剂量为68～74Gy,颈部淋巴结转移剂量为66—70Gy。结果全程放化疗结束时,治疗组和对照组的鼻咽部肿瘤消退率及颈部淋巴结消退率分别为80．9％、83．3％和83．3％、85．7％。3个月后复查显示,治疗组和对照组的鼻咽部肿瘤消退率及颈部淋巴结消退率分别为88．1％、90．5％和88．1％、88．1％。两组鼻咽部肿瘤消退率及颈部淋巴结消退率近似（P〉0．05）。对照组的毒副反应（口腔黏膜反应、白细胞下降）明显高于治疗组,差异有统计学意义（P〈0．05）。结论两种方案同期放化疗治疗局部晚期鼻咽癌的近期疗效近似,但治疗组的毒副反应较轻,值得临床推广应用。     

动脉插管化疗合并放疗治疗晚期和巨块型宫颈癌

目的 评价动脉插管化疗加放疗治疗晚期及巨块型宫颈癌的疗效。方法 将68例巨块型宫颈癌及78例晚期宫颈癌随机分为2个组，各73例。A组采用腹壁下动脉或股动脉插管化疗（顺铂、氟脲嘧啶及丝裂霉素化疗3个周期）加放疗；B组为单纯放疗。2组放疗均为外照射加腔内照射。结果 A组的3年生存率（78．08％；P＜0．05）高，局部复发率（17．81％，P＜0．05）低，A、B2组远处转移率及直肠膀胱并发症发生率无显著性差异。A组中2种插管法的治疗效果无显著性差异。结论 动脉插管化疗合并放疗治疗晚期及巨块型宫颈癌，可提高生存率，降低局部复发率，但不能降低远处转移率。     

三维适形放疗结合奥沙利铂为主的化疗治疗晚期直肠癌

目的 探讨三维适形放疗（3DCRT）结合奥沙利铂为主化疗治疗局部晚期和术后复发直肠癌的临床疗效。方法 66例局部晚期和术后复发直肠癌均在常规放疗44Gy后进入3DCRT，采用3DCRT结合奥沙利铂、氟尿嘧啶、亚叶酸钙同步化疗（综合组）34例，单独应用3DCRT（对照组）32例。综合组同步放化疗结束3～4周后，再巩固化疗2～3个周期。结果 综合组和对照组疼痛缓解率分别为97％和84％（P〉0．05）；有效率（CR＋PR）分别为91％和84％（P〉0．05）；2年局部控制率与局部无进展率之和分别为71％和66％（P〉0．05）；2年生存率分别为65％和38％（P〈0．01）；2年远处转移率分别为35％和63％（P〈0．01）。在毒副反应方面两个组相似（P〉0．05）。结论 三维适形放疗结合奥沙利铂为主化疗治疗局部晚期和术后复发直肠癌可明显减少远处转移率和提高2年生存率，且毒副反应可以耐受。     

奈达铂与顺铂单药周方案同步化疗治疗局部晚期鼻咽癌的疗效观察

目的：观察奈达铂（ NDP）和顺铂（ DDP）单药周方案同步化疗治疗初治局部鼻咽癌的毒副作用及近期疗效。方法初治局部晚期鼻咽癌患者60例,随机分成NDP组和DDP组,各30例。 NDP组化疗方案：0．9％氯化钠500 ml＋NDP 50 mg,静脉滴注,每周1次;DDP组化疗方案：0．9％氯化钠500 ml＋DDP 40 mg,静脉滴注,每周1次。2组均采用全程调强放疗。结果 NDP组和DDP组的呕吐发生率分别为53．3％、83．3％（P＜0．05）;血小板下降发生率分别为80．0％、50．0％（P＜0．05）;NDP组肾毒性发生率显著低于DDP组（P＜0．05）;2组白细胞下降、血红蛋白下降、肝脏毒性、口腔黏膜炎、耳神经毒性指标差异无统计学意义（P＞0．05）。2组有效率分别为93．4％、86．7％（P＞0．05）。结论NDP单药周方案同步化疗治疗局部晚期鼻咽癌的不良反应较DDP轻,患者依从性好,且与顺铂单药周方案同步化疗近期疗效相近。     

顺铂与多西紫杉醇同步放化疗治疗中陵期富颈癌64例疗效观察

目的探讨治疗中晚期宫颈癌同步放化疗的化疗药物选择。方法64例中晚期宫颈癌患者同步放化疗随机分成顺铂组（30例）及多西紫杉醇组（34例），两组在同样放疗的基础上，顺铂组同步给予顺铂40mg／m^2，每周1次，化疗6周；多西紫杉醇组同步给予多西紫杉醇25mg／m^2，每周1次，化疗6周。放疗方法：两组患者均采用^60Co全盆对穿两头照射野DT30Gr后，改为^60Co盆腔四野照射并后装治疗。观察两组的治疗效果和不良反应，并进行比较。结果外照射结束时两组的有效率分别为96．67％及100％，差异无显著性（P〉0．05），两组4年生存率分别为56．67％及73．52％，差异有显著性（P〈0．05），局部复发率分别为10．00％及5．88％，差异有显著性（P〈0．05），远处转移率分别为8．82％及5．88％，差异有显著性（P〈0．05）。顺铂组有较明显的骨髓抑制和消化道反应，而且肾功损害明显，差异有显著性（P〈0．05）。结论多西紫杉醇同步放化疗能明显提高患者的生存率，降低局部复发率及远处转移率，副作用相对较轻。     

56例局部晚期鼻咽癌同期放化疗的临床疗效观察

[目的]观察单纯放疗和同期放化疗两种治疗方法对局部晚期鼻咽癌的临床疗效、毒副反应。[方法]将56例T3-4N3M0鼻咽癌病人随机分为单纯放疗组（对照组）和同期放化组（放化组）各28例。放疗：两组病人均使用常规分割外照射，使鼻咽部剂量达到70～78Gy，颈部剂量达到66～80Gv。化疗：放化组采用顺铂、氟尿嘧啶（5-Fu），1次／周，共用3～6个周期。[结果]对照组28例病人均按计划完成治疗，放化组中有6例病人因严重放化疗反应未能按计划完成。对照组和放化组3年生存率分别为71．42％、75．00％（P〉0．05）；3年远处转移率分别为28．57％、25．00％（P〈0．05）；3年累计复发率分别为14．28％、17．85％（P〉0．05）；3年无瘤生存率分别为67.85％、64．28％（P〈0．05）。[结论]局部晚期鼻咽癌顺利完成同期放化疗的患者，远处转移率及无瘤生存率体现一定的优势。     

TPF方案诱导化疗联合同期放化疗治疗局部晚期鼻咽癌的临床研究

目的观察TPF方案诱导化疗联合同步放化疗治疗局部晚期鼻咽癌的疗效及不良反应。方法2009年1月至2010年1月,60例局部晚期鼻咽癌随机分为诱导化疗加同步放化疗（试验组,30例）和同步放化疗（对照组,30例）。两组放疗方法相同,均采用调强放射治疗（IMRT）。试验组TPF方案（多西他赛75mg／m^2,dl,顺铂75mg／m^2,dl,氟尿嘧啶500mg／m^2,d1-5q3W×2）诱导化疗＋同期放化疗（顺铂每周40mg／m^2加同步IMRT）。对照组同期放化疗（顺铂每周40mg／m^2加同步IM-RT）。结果试验组和对照组近期疗效比较差异无统计学意义（P〉0．05）。2年局部控制率试验组为96．6％,对照组为86．6％（P〉0．05）。2年无远处转移生存率试验组为93．3％（28／30）,对照组为70．0％（21／30）（P〈0．05）。试验组Ⅲ／Ⅳ级白细胞及血小板下降明显高于对照组（P〈0．05）。结论诱导化疗加同步放化疗治疗局部晚期鼻咽癌疗效较好,且不良反应可耐受。     

顺铂,氟脲嘧啶化疗及放疗对局部晚期鼻咽癌的临床观察

目的 探讨顺铂、氟脲嘧啶化疗综合放疗治疗局部晚期鼻咽癌的化疗。方法 ８７例病理证实的Ⅲ、Ⅳａ期备咽癌进行随机分组观察，４５例采用综合治疗（治疗组），４２例采用单纯放疗（对照组）。两组的照射方法和剂量相同。治疗组化疗：顺铂１００ｍｇ／ｍ＾２，第１天静脉注射，氟脲嘧啶７５０ｍｇ／ｍ＾２，第１￣５天静脉注射；于放疗前１周和辨疗４０Ｇｙ时以及放疗结束２￣４周后进行。结果 鼻咽部原发肿瘤消退率：治疗组９５．     

Experience with Impedance Phlebography Compared with Venography

Venography is a particularly reliable method for the diagnosis of deep venous thrombosis but is not suitable as a screening test. Impedance phlebography represents another attempt to discover a simple, non-invasive and reliable method of detecting deep venous thrombosis. It does not, however, meet these criteria.     

Compliance with guidelines and correlation with outcome in patients with advanced germ-cell tumours

PurposeTo evaluate prior compliance with guidelines in patients treated with salvage chemotherapy for advanced germ-cell tumours (GCT).Patients and methodsData concerning the initial management of patients requiring salvage chemotherapy for GCT at Institut Gustave Roussy between 2000 and 2010 were obtained and correlated with recommendations for treatment. Criteria of non-compliance were defined based on guidelines. Compliance with guidelines, predictive factors for non-compliance and the impact on outcome were analysed.ResultsAmong 82 patients treated in the salvage setting, guidelines to initial treatment were followed in only 41 cases (50%). The most common non-compliance criteria were non-adherence to the planned dose (16%), an inappropriate interval between first-line chemotherapy cycles (16%), the lack of post-chemotherapy surgery (16%) and a long interval to post-chemotherapy surgery (48%). Compliance with standard care was better in cancer centres than in other hospitals (private or public) (Odd Ratio (OR): 6.9, P = 0.001). A poor-risk status according to the International Germ Cell Cancer Collaborative Group (IGCCCG) was also predictive of compliance in univariate but not in multivariate analysis. No significant difference in outcome after salvage chemotherapy was observed. Patients relapsing after non-compliant first-line therapy tended to be more easily salvaged, which is consistent with the fact that their initial treatment was inadequate. Some of these relapses were therefore probably not due to true biologically refractory disease.ConclusionGuidelines for first-line treatment are adhered to in only half the patients requiring salvage chemotherapy. As the only predictive factor for non-compliance was the treating centre, centralisation of patients with GCT in well-trained hospitals should be recommended.     

Treatment with methylnaltrexone is associated with increased survival in patients with advanced cancer

BackgroundMethylnaltrexone (MNTX), a peripherally acting μ-opioid receptor (MOR) antagonist, is FDA-approved for treatment of opioid-induced constipation (OIC). Preclinical data suggest that MOR activation can play a role in cancer progression and can be a target for anticancer therapy.Patients and methodsPooled data from advanced end-stage cancer patients with OIC, despite laxatives, treated in two randomized (phase III and IV), placebo-controlled trials with MNTX were analyzed for overall survival (OS) in an unplanned post hoc analysis. MNTX or placebo was given subcutaneously during the double-blinded phase, which was followed by the open-label phase, allowing MNTX treatment irrespective of initial randomization.ResultsIn two randomized, controlled trials, 229 cancer patients were randomized to MNTX (117, 51%) or placebo (112, 49%). Distribution of patients' characteristics and major tumor types did not significantly differ between arms. Treatment with MNTX compared with placebo [76 days, 95% confidence interval (CI) 43–109 versus 56 days, 95% CI 43–69; P = 0.033] and response (laxation) to treatment compared with no response (118 days, 95% CI 59–177 versus 55 days, 95% CI 40–70; P < 0.001) had a longer median OS, despite 56 (50%) of 112 patients ultimately crossing over from placebo to MNTX. Multivariable analysis demonstrated that response to therapy [hazard ratio (HR) 0.47, 95% CI 0.29–0.76; P = 0.002) and albumin ≥3.5 (HR 0.46, 95% CI 0.30–0.69; P < 0.001) were independent prognostic factors for increased OS. Of interest, there was no difference in OS between MNTX and placebo in 134 patients with advanced illness other than cancer treated in these randomized studies (P = 0.88).ConclusionThis unplanned post hoc analysis of two randomized trials demonstrates that treatment with MNTX and, even more so, response to MNTX are associated with increased OS, which supports the preclinical hypothesis that MOR can play a role in cancer progression. Targeting MOR with MNTX warrants further investigation in cancer therapy.Clinical trials numberNCT00401362, NCT00672477.     

Costs associated with complications are lower with capecitabine than with 5‐fluorouracil in patients with colorectal cancer

BACKGROUND:

Capecitabine, an oral alternative to 5‐fluorouracil (5‐FU) in patients with colorectal cancer (CRC), has equal clinical efficacy and a favorable safety profile; however, its use may be limited because of unit cost concerns. In this study, the authors measured the cost of chemotherapy‐related complications during treatment with capecitabine‐ and 5‐FU–based regimens.

METHODS:

Patients with CRC who received at least 1 administration of capecitabine or 5‐FU during 2004 and 2005 were identified from the Thomson MarketScan research databases. Monthly frequency and cost for 23 complications were recorded. Logistic regression was used to predict complication probability. General linear models were used to predict monthly complication cost and total monthly expenditure.

RESULTS:

In total, 4973 patients with CRC met the inclusion criteria for this analysis. Although the most frequently observed complications were the same between capecitabine and 5‐FU (nausea and vomiting, infection, anemia, neutropenia, diarrhea), each was observed with greater frequency in 5‐FU–based regimens. The mean predicted monthly complication cost was significantly higher (by 136%) with 5‐FU monotherapy than with capecitabine monotherapy (difference, $601; 95% confidence interval [95% CI], $469‐$737). In addition, the mean predicted monthly complication cost for 5‐FU+oxaliplatin was higher than the cost with capecitabine plus oxaliplatin (difference, $1165; 95% CI, $892‐$1595). When acquisition, administration, and complication costs were taken into consideration, there were no significant differences in the total cost between capecitabine regimens and 5‐FU regimens.

CONCLUSIONS:

Capecitabine compared well with 5‐FU–based therapy in patients with CRC and was associated with lower complication rates and associated costs. Cancer 2009. © 2009 American Cancer Society.     

Living with secondary breast cancer: coping with an uncertain future with unmet needs

JOHNSTON S.R.D. (2010) European Journal of Cancer Care 19 , 561–563 Living with secondary breast cancer: coping with an uncertain future with unmet needs     

奥沙利铂联合羟基喜树碱治疗晚期胃癌临床分析

背景与目的体外及体内的临床研究显示,奥沙利铂(L-OHP)对多种肿瘤有显著抑制作用并与绝大多数抗癌药物具有相加或协同细胞毒作用.本文旨在观察L-OHP联合羟基喜树碱(HCPT)治疗晚期胃癌的近期疗效和患者耐受性,并与传统的化疗方案进行对比.方法采用非随机的分组方法将43例晚期胃癌患者分为L-OHP+HCPT方案组(治疗组)与Vp-16+CF+5-FU(ELF)方案组(对照组),其中男性28例,女性15例,中位年龄59岁,KPS评分≥60,观察两组的近期疗效和患者耐受性.结果治疗组24例有效率58.3%(14/24),对照组19例有效率42.1%(8/19).治疗组有效率高于对照组,两组差异有显著性(P<0.05).两组不良反应主要是骨髓抑制、恶心、呕吐、口腔炎、周围神经炎、静脉炎、脱发等,均在Ⅰ、Ⅱ度范围内.结论L-OHP联合HCPT方案治疗晚期胃癌疗效较好,不良反应可以耐受.     

Varicella-Zoster Virus Prophylaxis with Low-Dose Acyclovir in Patients with Multiple Myeloma Treated with Bortezomib

BackgroundVaricella-zoster virus (VZV) reactivation is a common complication in patients with multiple myeloma (MM) treated with bortezomib, with an incidence rate of 10%-60%. The aim of our study was to analyze the effect of acyclovir prophylaxis in this patient population.Patients and MethodsWe studied 98 consecutive patients with relapsed MM treated with bortezomib. Bortezomib 1.3 mg/m² was given on days 1, 4, 8, and 11 of a 21-day cycle. At first, patients did not receive any VZV prophylaxis, but because of the high incidence of VZV reactivation, VZV prophylaxis with acyclovir was implemented subsequently.ResultsA total of 11 patients treated with bortezomib did not have any VZV prophylaxis, and 4 of these 11 patients (36%) developed VZV reactivation in the form of herpes zoster. No VZV reactivations were observed in the 32 patients who received acyclovir 400 mg 3 times daily or the 55 patients who received acyclovir in a dose reduced to 400 mg once daily during bortezomib treatment.ConclusionVaricellazoster virus reactivation is a common and serious adverse effect of bortezomib treatment. Acyclovir 400 mg once daily is sufficient to protect from VZV reactivation in patients with MM treated with bortezomib.