胃癌D2根治术后同期放化疗与化疗的疗效及毒副反应的Meta分析

目的评价胃癌D2根治术后同期放化疗与化疗的疗效及毒副反应。方法计算机检索2013年10月之前纳入Cochrane library图书馆、Embase数据库、Pub Med数据库、Web of Science数据库、Wanfang数据库、CNKI数据库中比较胃癌D2根治术后同期放化疗与化疗的随机对照(RCT)研究。依据数据同质性或异质性确定数据使用固定效应模型或随机效应模型。使用Rev Man 5.2软件进行数据分析,两组之间的差异用OR值和95%CI描述。结果共纳入5个RCT研究,总计979例患者。通过Meta分析得出:胃癌D2根治术后同期放化疗与化疗相比,放化疗显著提高了5年局部无复发生存率(LRRFS)及3年总生存率(OS),但不能提高5年无远处复发生存率(DMRFS)及1年、3年、5年无病生存率(DFS)和1年、5年OS;且拥有和化疗同样的1~2级、3~4级恶心呕吐不良反应及1~2级、3~4级白细胞毒性反应。结论今后研究应依据胃癌的分期、种族、淋巴结转移及淋巴结清扫数目来确定胃癌D2根治术术后同期放化疗与化疗。     

中晚期胃癌根治术后同步放化疗临床观察

243例中晚期胃癌根治术后患者随机分为单纯化疗组(A组)、单纯放疗组(B组)、同步放疗+化疗组(C组),放疗采用钴60和6/15MV直线加速器,部分患者采用常规四野照射,部分患者采用三维适型放疗,经三维治疗计划系统DVH评价,PTV在90%等剂量线以上.A组均采用ECF方案,C组化疗采用LF方案.发现A组1、2、3、5 a总生存率分别为90.1%、70.4%、42.0%、24.7%,B组分别为96.3%、71.3%、38.8%、22.5%,C组分别为95.1%、87.8%、54.9%、40.2%,C组均高于A、B组.认为中晚期胃癌根治术后同步放化疗综合治疗可以提高生存率.     

老年胃癌术后腹腔热灌注化疗的临床疗效

目的研究老年胃癌术后早期腹腔热灌注化疗的可行性、安全性及疗效。方法选择规范胃癌根治术后的老年胃癌患者168例,随机分为腹腔内热灌注化疗组(5-FU+奥沙利铂)和全身化疗组(5-FU+奥沙利铂),比较两组的术后并发症、不良反应、生存率、复发率和转移率。结果两组术后并发症发生率无显著性差异。两组不良反应分度及严重毒副反应比较无显著性差异。两组生存率比较有显著性差异(P0.05)。两组局部复发率、远处转移率比较有显著性差异(P0.05)。结论老年胃癌术后早期腹腔持续温热灌注化疗可减少局部复发率和远处转移率,提高生存率;有利于胃癌术后腹腔内较小的残余癌或游离癌细胞的杀灭。     

晚期胃癌术后腹腔灌注化疗联合全身化疗的临床随访研究

118例晚期胃癌患者分为两组。治疗组术中采用顺铂（DDP）腹腔灌注化疗联合静脉全身化疗,同时辅以免疫治疗和中医中药等。对照组除不用腹腔灌注化疗外,余治疗方法同上。随访2a,治疗组1、2a的生存率较对照组均明显改善;术后2a两组间的KPS评分有显著性差异;Cox回归模型显示,肿瘤分期和化疗方法是影响晚期胃癌术后的重要预测因子。提示腹腔灌注化疗联合非根治性手术及静脉全身化疗的综合治疗能够进一步改善晚期胃癌患者的预后。     

同步放化疗与单纯放疗辅助治疗术后高危子宫内膜癌的临床疗效比较

目的对比研究顺铂(DDP)联合5-氟尿嘧啶(5-FU)同步放化疗与单纯放疗辅助治疗术后高危子宫内膜癌的毒性反应和复发率。方法有高危因素的子宫内膜癌患者43例中22例行单纯放射治疗,21例行术后辅助DDP+5-FU(PF)方案同步放化疗治疗,对比两组毒性反应和复发率。结果同步放化疗组与单纯放疗组3级胃肠道反应率分别为61.90%和31.82%,差异显著(P<0.05);2级以上骨髓抑制率分别为66.67%和18.18%,差异显著(P<0.01);2级以上周围神经毒性反应率分别为33.33%和13.64%,无显著差异(P>0.05),总体复发率分别为4.76%和27.27%,差异显著(P<0.05)。结论高危子宫内膜癌患者同步放化疗后3级胃肠道反应率增加,2级以上骨髓抑制率显著增加,周围神经毒性反应率不增加,毒性反应可以耐受,减少2年总体复发率。     

术后全身化疗或腹腔化疗疗效比较——84例胃癌、结直肠癌分析

目的对84例老年胃癌．结直肠癌患者术后全身化疗或腹腔化疗作回顾性比较。方法分四组：A组剖腹探查术后全身化疗16例；B组剖腹探查术后全身化疗加腹腔化疗12例；C组根除术后全身化疗36例：D组根治术后腹腔化疗20例。结果腹腔化疗的毒副反应和对血象的影响较全身化疗小，术后18个月复查、C组发现转移1l／36例，D组3／20例，D组的腹腔扩散和脏器转移少，五年生存率最高45％，A、B组平均生存时间仅625月和630月。结论腹腔化疗的毒副反应小，患者耐受剂量大，对降低术后复发具有积极作用，是老年胃癌、结直肠癌患者根治术后比较理想的化疗方法。     

甲孕酮预防胃癌患者化疗后消化道毒副反应效果观察

20 0 2年 3月至 2 0 0 3年 5月 ,我们采用口服甲孕酮(MPA )预防消化道癌肿患者化疗后消化道反应。现报告如下。临床资料 :本文晚期胃癌患者 6 2例 ,其中男 4 2例 ,女 2 0例 ,年龄 32～ 79岁。胃腺癌 4 3例 ,鳞癌 19例。均经组织病理学证实。临床均有不同程度的返酸、腹胀、恶心、食欲不振等消化道症状。治疗组对照组各 31例 ,两组间具有可比性。方法 :两组化疗方案均为 EDF或 VDF(足叶乙甙或卫萌 ,顺铂 ,氟尿嘧啶 ) ,化疗时均给予水化碱化尿液 ,利尿剂格拉斯琼 3mg化疗前后静脉推注。治疗组化疗前 1天开始口服甲孕酮 (MPA) 5 0 0 mg,2…     

外生型子宫颈癌术前放化疗的疗效分析

目的探讨新辅助化疗对外生型Ⅰb~Ⅱa期宫颈癌的近期疗效。方法回顾性分析30例新辅助化疗配合组织间插植放疗（治疗组）及30例单纯组织间插植放疗（对照组）后再行手术的外生型Ⅰb~Ⅱa期宫颈癌的近期疗效。结果对照组总有效率为76.7%,治疗组为93.4%,P〈0.05。结论外生型Ⅰb~Ⅱa期宫颈癌术前行新辅助化疗配合组织间插植放疗可能是更好的选择。     

复方苦参注射液预防胃癌患者术后化疗不良反应的临床观察

目的观察复方苦参注射液预防胃癌患者术后化疗不良反应的疗效。方法将54例胃癌术后拟行化疗患者随机分为两组,化疗期间治疗组联用复方苦参注射液;对照组不用复方苦参注射液。化疗结束后观察两组不良反应、生活质量及外周血象变化。结果与对照组比较,治疗组生活质量较高,不良反应较小,外周血WBC、Hb、PLT下降幅度较小（P均〈0.05）。结论复方苦参注射液预防胃癌术后化疗不良反应有一定疗效。     

Effects of omeprazole in improving concurrent chemoradiotherapy efficacy in rectal cancer

AIM To explore the effects of omeprazole on chemoradiotherapy efficacy and tumor recurrence in rectal cancer. METHODS The medical data of 125 rectal cancer patients who received the same neoadjuvant chemoradiotherapy(CRT) followed by surgery were retrospectively collected. Patients who received omeprazole(OME) orally at a dose of 20 mg at least once daily for six days and/or intravenously at 40 mg a day were recognized as eligible OME users(EOU). Otherwise, patients were regarded as non-eligible OME users(non-EOU).Moreover, a preferred OME dose cut-off of 200 mg on tumor recurrence was obtained by receiver operating characteristic(ROC) curves. Patients were divided into two groups: the effective OME group(EOG, OME ≥ 200 mg) and the non-effective OME group(non-EOG, OME 200 mg). RESULTS The good response rate of CRT efficacy(50.8%) in EOU was significantly increased compared with nonEOU(30.6%)(P = 0.02). The recurrence rate in the EOG was 10.3%, which was significantly lower compared with 31.3% in non-EOG(P = 0.025). The good response rate of CRT efficacy in EOG was 55.2%, which was obviously higher compared with 36.5% in non-EOG, with a significant difference(P = 0.072). Multivariate Cox analysis demonstrated that OME(nonEOG and EOG) was an independent and significant impact factor for DFS(P = 0.048, HR = 0.30, 95%CI: 0.09-0.99).CONCLUSION When applied as an adjuvant drug in cancer treatment for relieving common side effects of chemotherapy, omeprazole has a synergetic effect in improving CRT efficacy and decreasing rectal cancer recurrence.     

Cisplatin and gemcitabine induction chemotherapy followed by concurrent chemoradiotherapy or surgery for locally advanced non-small cell lung cancer

BACKGROUND: We report a study of induction chemotherapy followed by concurrent chemoradiotherapy for stage IIIA/IIIB non-small cell lung cancer. METHODS: Patients received two cycles of induction chemotherapy with cisplatin 100 mg/m(2) on day 1 and gemcitabine 1000 mg/m(2) on days 1, 8, and 15 of a 28-day cycle. If the disease was resectable [corrected] surgery was followed with two further cycles. If unresectable, patients received cisplatin 100 mg/m(2) day 1, 29 with 5-fluorouracil 1000 mg/m(2) per 24 h continuous infusion for 96 h on days 2-5 and days 30-33 of the radiotherapy administration. Radiation therapy consisted of 63 Gy, 35 fractions, 7 weeks. RESULTS: Of 48 patients, 40% had a partial response to induction chemotherapy. Four of eleven patients with stage IIIA tumours had resectable disease. The remaining seven patients plus 37 with stage IIIB disease had chemoradiotherapy. Response at the completion of all therapy was 62% (IIIA 73%, IIIB 59%). For all patients the median survival was 15.3 months: 1 year and 3 years, 58% and 25%, respectively. Those with IIIB disease responding to induction chemotherapy had significantly superior survival to those that did not respond (37 months vs 11 months; P = 0.005). This remained significant from a landmark at 8 weeks after the start of treatment (P = 0.01). CONCLUSION: These results are equivalent to other studies using induction chemotherapy prior to concurrent chemoradiotherapy. Response to induction chemotherapy may have major prognostic significance.     

老年直肠癌患者术后同步放化疗症候群与生活质量的相关性研究

目的 探索老年直肠癌术后同步放化疗患者的生活质量改变及其与临床症候群之间的相关性。方法 选取2019年1月—2020年6月空军军医大学唐都医院明确诊断为直肠癌拟行直肠癌根治术+术后同步放化疗的61例老年患者为研究对象。采用生活质量测定一般量表（The Functional Assessment of Cancer Therapy-General,FACT-G）,评定患者的生活质量;采用汉化版记忆症状评估量表（Memorial Symptom Assessment Scale,MSAS）和常见不良事件评价标准,分别评估患者的症状及术后不良反应情况。结果 患者的生活质量评分总得分为（56.51±12.61）分,从高到底依次为生理状况、社会/家庭状况、情感状况和功能状况评分。直肠癌术后同步放化疗患者中,有50.8%、36.1%、42.6%及82%分别出现消化道、血液学、皮肤及泌尿系统不良反应。直肠癌术后同步放化疗患者MSAS评分总分为（32.15±14.56）分,其他分数从高到低分别为总困扰指数、生理症状和心理症状评分。患者的FACT-G量表总分与MSAS量表总分（r=-0.71,P<...     

Mismatched clinicopathological response after concurrent chemoradiotherapy for thoracic esophageal cancer

We have been treating patients with operable thoracic esophageal cancer according to our own protocol. It includes the initial concurrent chemoradiotherapy (CRT) followed by continuous CRT or surgery. Patients with good response to initial chemoradiotherapy were allowed to continue chemoradiotherapy, whereas the others were treated with surgery. However, there were two cases which showed discrepancies in the clinicopathological response. Both patients received initial chemoradiotherapy, including two courses of cisplatin (100-120 mg), 5-fluorouracil (750-1000 mg for 4 days) and radiation (44-50 Gy). On completion of the initial chemoradiotherapy, all diagnostic imaging modalities including barium swallow, esophagoscopy, endoscopic ultrasonography and thoracic computed tomography strongly implicated residual tumor with a reduction rate of 40-50%. The patients underwent radical esophagectomy 15-20 days after initial chemoradiotherapy. Pathological specimens only revealed thickening of the esophageal wall due to inflammatory change without residual carcinoma. These facts suggest the current limitations of diagnostic images in evaluating the response to chemoradiotherapy.     

胃癌腹腔化疗毒副反应的观察和处理

目的 评价胃癌腹腔化疗的毒副反应，并探讨其处理方法。方法 将156例胃癌病人进行随机分组。分为术中即时低渗温热腹腔化疗联合术后早期腹腔化疗组（治疗组），单纯术中即时低渗温热腹腔化疗组（对照组1），未行腹腔化疗组（对照组2），共三组，观察化疗的安全性和毒副反应。结果 治疗组化学性腹膜炎、消化道反应、骨髓抑制和肝功能异常的发生率明显高于两个对照组。结论 应用术中即时，低渗温热腹腔化疗联合术后早期腹腔化疗时化学性腹膜炎的防治不容忽视。     

Salvage surgery after definitive chemoradiotherapy for esophageal cancer

Background Definitive chemoradiotherapy has been performed as a first-line treatment for esophageal cancer, whereas salvage surgery might be the only reliable treatment for patients with recurrence after definitive chemoradiotherapy.Methods We reviewed 38 patients with squamous cell carcinoma who underwent esophagectomy and 6 patients who underwent lymphadenectomy after definitive chemoradiotherapy (≥50 Gy).Results The median survival time and 5-year survival rate after salvage esophagectomy were 16 months and 27%, respectively. Three of the 7 patients who had cervical esophageal cancer underwent cervical esophagectomy with laryngeal preservation. Two patients (5.2%) who underwent salvage esophagectomy with three-field lymphadenectomy before 1997 died of postoperative complications, but no patient died of complications thereafter. Although the overall survival after salvage esophagectomy was correlated with residual tumor (R) (P = 0.0097), the median survival time of 7 patients with residual tumors (R₂) was 7 months. Overall postoperative survival was closely correlated with the response to chemoradiotherapy (P < 0.0001) but was not associated with histologic effects on resected specimens. Survival was significantly correlated with the depth of viable tumor invasion (pT) (P = 0.0013) and with lymph node metastasis (pN) (P < 0.0001). Long-term survival was achieved in 5 of the 6 patients who underwent salvage lymphadenectomy.Conclusions Salvage surgery should be considered for patients with recurrence after definitive chemoradiotherapy. Salvage lymphadenectomy may be useful for recurrence confined to the lymph nodes whereas postoperative complications of salvage esophagectomy should be warranted.     

Endoscopic ultrasound classification of esophageal cancer after chemotherapy or chemoradiotherapy

Because of its ability to provide high resolution images of the esophageal wall and surrounding structures, Endoscopic Ultrasound (EUS) is thought to be well suited for prediction of T classification (depth of tumor invasion) and N classification (lymph node status) in patients with newly diagnosed esophageal cancer. EUS is also frequently used for interim classification after neoadjuvant therapy (chemotherapy or chemoradiotherapy). This editorial will focus on the potential goals of EUS in interim classification, its performance in this setting, and the relevance of interim staging.