华蟾素联合化疗治疗晚期恶性肿瘤的疗效分析

目的　观察华瞻素联合化疗治疗恶性肿瘤的疗效。方法　选择经细胞学和 /或病理证实的晚期癌症患者 44例 ,随机分为两组。治疗组 2 4例 ,采用华蟾素联合化疗 ;对照组 2 0例 ,应用单纯化疗。结果　治疗组 CR3例、PR11例、CR PR为 5 8.3 % (14/ 2 4)。对照组 CR1例 ,PR6例 ,CR PR为 35 % (7/ 2 0 )。治疗组静脉炎发生率高于对照组 ,但消化道反应 ,骨髓抑制率均低于对照组 ,而且生活质量高于对照组。结论　华蟾素配合化疗治疗恶性肿瘤效果显著 ,安全可靠 ,值得临床使用     

奈达铂或顺铂联合多西他赛治疗晚期非小细胞肺癌的临床观察

目的评价奈达铂(NDP)或顺铂(DDP)联合多西他赛(TXT)治疗晚期非小细胞肺癌的疗效和不良反应。方法 96例初治的晚期非小细胞肺癌随机分为2组,试验组患者采用奈达铂加多西他赛(TN组),TXT 75mg/m2、d1;NDP 80mg/m2,分3d静脉注射,21d为1个周期。对照组患者采用顺铂加多西他赛(TP组),TXT 75mg/m2,DDP 80mg/m2,分3d静滴,21d为1个周期。结果 TN组中,CR 1例,PR 21例,有效率(CR+PR)为45.8%。TP组中,CR 2例,PR 19例,有效率为43.8%,两组间差异无统计学意义(P>0.05)。试验组白细胞与血小板减少与对照组比较,差异无统计学意义(P>0.05)。试验组消化道反应明显小于对照组(P<0.05)。结论奈达铂联合化疗治疗晚期非小细胞肺癌的疗效与顺铂相似,消化道反应小于顺铂组。奈达铂联合多西他赛化疗治疗晚期非小细胞肺癌有效,不良反应轻。     

36例老年晚期非小细胞肺癌吉西他滨联合奥沙利铂化疗

36例老年晚期非小细胞肺癌(鳞癌21例,腺癌15例),采用泽菲1250mg/m2静注,第1、8d,艾恒130mg/m2静注,1d,联合化疗.CR 2例(5.6%),PR 16例(44.4%),总有效率(CR PR)为50.0%.主要毒性反应为轻度骨髓抑制和消化道反应.     

颞浅动脉插管化疗治疗72例晚期口腔颌面部恶性肿瘤的临床观察

目的:观察口腔颌面部晚期恶性肿瘤颞浅动脉插管化疗的近期疗效、影响因素及毒副反应。方法:对72例口腔颌面部晚期恶性肿瘤采用 TDP方案进行插管化疗,THP 20 mg, 静脉推注,d1;DDP 30mg,静脉推注,d2 ~d4;PYM 8 mg,静脉推注,d5~d9。21 d为 1 个周期,满 2 个周期以上进行疗效评价。结果:总有效率(CR+PR) 为 90 .28% ( 65/72 ), 其中 CR 为16 .67%(12/72), PR为 73 .61 % (53/72)。Ⅲ期有效率 93. 75% (30/32),Ⅳ期有效率87 50%(35/40),两组比较差异无统计学意义,P=0. 62。初治的有效率 100 00%(38/38),复治的有效率为79 .41%(27/34),两组比较差异有统计学意义,P=0. 01。化疗 2个周期有效率为 86 .36%(38/44),化疗>2个周期有效率为 96 43%(27/28),两组比较差异无统计学意义,P>0. 32。结论: 颞浅动脉插管化疗对晚期口腔颌面部恶性肿瘤疗效好,安全且不良反应轻。初治与复治是影响疗效的主要因素。     

托瑞米芬联合NP方案治疗56例晚期非小细胞肺癌

[目的]观察托瑞米芬(TOR)联合NP方案(长春瑞滨加顺铂)治疗晚期非小细胞肺癌(NSCLC)的近期疗效,探讨提高晚期NSCLC化疗效果的新方法。[方法]56例晚期NSCLC患者随机分为两组,试验组28例:化疗加托瑞米芬治疗,托瑞米芬240mg每天2次口服,d1￣7,连用7d,化疗方案:长春瑞滨25mg/m2d1,d8,顺铂70mg/m2￣90mg/m2d1￣3或d1￣5;对照组仅做化疗,不加TOR治疗,化疗方案同试验组。[结果]试验组PR15例,NC7例,PD6例,有效率为53.6%(15/28);对照组PR9例,NC8例,PD11例,有效率为32.1%(9/28),试验组近期疗效高于对照组,但统计学处理无显著性差异(χ2=1.82,P>0.05)。中位肿瘤进展时间试验组132d,对照组66d。毒副作用主要为骨髓抑制和消化道反应,均可耐受。[结论]托瑞米芬与NP方案联合治疗晚期NSCLC值得临床进一步深入研究。     

康莱特注射液联合化疗治疗胃癌的疗效观察

为进一步研究康莱特与化疗联合应用治疗胃癌的疗效 ,对入选的 114例均已经过手术治疗且经病理学确诊的患者 ,随机分组为实验组 5 7例 ,即化疗联合康莱特的应用 ;对照组 5 7例 ,单纯应用化疗。化疗方案为FAM。参照WHO制定的实体瘤疗效标准 ,试验组CR为 5 0 88% ,PR为 3 5 88% ;对照组CR为 3 6 84% ,PR为 3 1 5 8%。总的有效率实验组 87% ;对照组 69% ,两组比较差异有显著性 (P <0 0 5 )。     

5氟尿嘧啶持续静脉滴注与小剂量顺铂联用治疗晚期胃癌53例

[目的]观察持续静脉滴注5氟尿嘧啶 (5 Fu)与小剂量顺铂 (DDP)联合应用治疗晚期胃癌的近期疗效及毒性。[方法]治疗组53例患者接受5 Fu350mg/m2·d ,持续滴注28～30天 ,DDP5mg/m2·d ,每周应用5天 ,连续应用4周的联合化疗方案化疗2个周期 ,对照组53例采用FAM/FMP(5 Fu+MMC +ADM/DDP)方案 ,治疗两个周期 ,常规剂量给药。[结果]治疗组完全缓解 (CR)0例 ,部分缓解 (PR)32例 ,近期总有效率 (CR +PR)60.37 % ,对照组CR0例 ,PR21例 ,总有效率39.62% ,两组差异具有显著性 ,常见毒副反应如骨髓抑制及恶心、呕吐的发生率对照组明显高于治疗组。[结论]FP方案治疗晚期胃癌 ,近期疗效肯定 ,毒副反应低     

低剂量氟尿嘧啶持续输注联合奥沙利铂治疗老年晚期胃肠道恶性肿瘤

[目的]观察低剂量氟尿嘧啶(5-Fu)持续输注联合奥沙利铂(L-OHP)方案治疗老年性晚期胃肠道恶性肿瘤的近期疗效及毒副反应等。[方法]32例晚期胃肠道恶性肿瘤患者给予5-Fu225mg/(m2·d)微量泵持续静脉滴注3周,L-OHP60mg/m2d1、8、15,静脉滴注,28d为1个周期,2个周期后评定疗效。[结果]CR1例,PR14例,NC13例,PD4例,32例病例的总有效率为46.88%(15/32),其中转移性肝癌患者有效率为64.71%(11/17)。化疗后ECOG评分比化疗前有显著性改善(P<0.05)。化疗后毒副反应病人均能耐受。[结论]低剂量氟尿嘧啶持续静脉输注联合奥沙利铂方案治疗老年性晚期胃肠道恶性肿瘤是一个有效、低毒,且能显著改善生活质量的化疗方案。     

重组改构人肿瘤坏死因子治疗恶性肿瘤的随机对照研究

目的:观察重组改构人肿瘤坏死因子(Recombinant mutant human tumor necrosis factor,rmhTNF)治疗晚期恶性肿瘤的有效性和安全性。方法:92例患者随机纳入试验组和对照组。试验组在化疗的同时,rmhTNF 400万u/m2,肌注,第1～7天和第11～17天;对照组仅给联合化疗;两组均每21天重复,连用二个周期。结果:①试验组和对照组的有效率分别为11.11％和2.78％,两组疗效无显著性差异(P>0.05);②试验组和对照组治疗前后KPS评分及其差值无显著性差异(P>0.05);③rmhTNF的主要不良反应为一过性轻度注射局部疼痛63.0％、骨骼肌痛38.9％、发热24.1％、感冒样症状22.0％和局部红肿硬结13.0％。结论:受病例数等因素影响rmhTNF联合化疗药物治疗晚期肺癌、头颈癌、胃肠道癌、肾癌及恶性黑色素瘤的疗效不优于单纯化疗。rmhTNF联合化疗的耐受性和安全性良好,为进一步扩大病例临床研究提供了可靠的保证。     

紫杉醇联合FUDR治疗晚期胃癌的临床观察

为了观察紫杉醇(PTX)联合脱氧氟尿苷(FUDR)/亚叶酸钙(CF)方案治疗晚期胃癌近期疗效及其不良反应,将58例晚期胃癌患者,采用PTX135mg/m2,静脉滴入3h,d1,CF100mg/m2,静脉滴入2h,d1～d5,FUDR425mg/m2,静脉滴入2h,d1,再续滴入FUDR350mg/(m2.d),微量化疗泵24h持续滴入(civ)d1～d5,21d为1个周期,至少完成2个周期。58例晚期胃癌患者,CR3例(5.2%),PR30例(51.7%),SD13例(22.4%),PD12例(20.7%),总有效率(CR PR)达56.9%。主要不良反应为骨髓抑制、脱发和肌肉酸痛,无化疗相关死亡。初步研究结果提示,PTX联合FUDR/CF方案一线治疗晚期胃癌具有较好的疗效和安全性。     

Interstitial high dose-rate brachytherapy: principle, practice and first clinical experiences with a new remote-controlled afterloading system using Ir-192

In our newly developed remote-controlled afterloading system, a single Ir-192-source is moved within hollow stainless steel needles, which are arranged strictly parallel and are uniformly spaced. Dose calculation is performed by an especially designed computer program using geometrical bodies (ellipsoid, cylinder and plane parallel body) as idealized tumor shapes. Reference points for calculation are defined on the surface of the chosen geometrical body. Theoretical base, principles of dosage, handling and first clinical experiences after treatment of 28 patients are presented.     

乳腺癌的新辅助全身治疗

 乳腺癌新辅助全身治疗,是指对某些乳腺癌患者在术前给予其全身性的治疗。术前综合运用化疗、内分泌治疗和靶向治疗可起到降期和提高保乳手术率的独特作用。新辅助化疗已经成为局部晚期乳腺癌的标准治疗方式之一。新辅助条件下,对于特定患者使用芳香化酶抑制剂和曲妥珠单抗治疗的研究也取得了长足进步。     

Neoadjuvant therapy in pancreatic cancer

Pancreatic cancer is the fourth leading cause of cancer deaths in the United States. Surgical resection offers the only hope of cure, though the addition of chemoradiation in the adjuvant setting has been shown to improve survival over surgery alone. Many patients are unable to receive adjuvant therapy due to prolonged postoperative recovery. For this reason, administration of chemoradiation preoperatively (neoadjuvant) has been proposed as an alternative to postoperative treatment. In patients with resectable disease, neoadjuvant therapy results in similar survivals compared to postoperative therapy, with a greater proportion of patients able to complete treatment. For selected patients with borderline or unresectable disease, neoadjuvant therapy offers the potential for tumor downstaging and increasing the likelihood of a margin-negative resection. This article reviews the use of neoadjuvant therapy in the treatment of pancreatic cancer.     

Successful treatment of metastatic androgen-independent prostate carcinoma in a transsexual patient

The occurrence of prostate carcinoma in transsexual patients has rarely been reported. These cases present a unique challenge in that such patients are effectively receiving androgen deprivation therapy. By definition, their disease is androgen-independent prostate cancer, and the role of local therapy is undefined. We report on a male-to-female transsexual patient with metastatic prostate cancer treated successfully with combination chemotherapy after previous standard therapy failed.     

Role of radiation therapy in the treatment of melanoma

Melanoma has been widely described as radioresistant but this should not be construed as meaning that melanoma is radioincurable. Many melanoma cell lines are as radiosensitive as other tumors commonly treated successfully with radiotherapy (RT). The use of RT requires careful planning resulting in the administration of a tumoricidal dose to the tumor cells with adequate sparing of normal tissues. RT has been used for primary therapy, postresection adjuvant therapy and palliation of symptomatic melanoma. Curative RT has been given for uveal melanoma yielding patient survival equivalent to enucleation. RT has been administered to patients with unresectable disease yielding relatively favorable results. As an adjuvant therapy postoperatively, RT has been used selectively to improve local disease control. Finally, RT is used successfully as a palliative maneuver for symptoms related to distant metastatic melanoma in patients with incurable disease.     

A randomized phase III study of neoadjuvant hormonal therapy in patients with localized prostate cancer

The primary objective of this randomized trial is to evaluate the benefit of the addition of neoadjuvant hormonal therapy to escalated-dose external-beam radiation therapy in the treatment of patients with intermediate-risk carcinoma of the prostate. A secondary objective of this study is to determine prognostic factors for radiation response. All patients will have tissue oxygenation measured and biopsies taken before treatment at the time of fiducial marker insertion for radiation treatment planning and daily monitoring. In addition, patients randomized to the neoadjuvant bicalutamide arm will be asked to consider having these studies repeated before initiation of radiation therapy (after 3 months of hormonal therapy).     

Comparison of optimized single and multifield irradiation plans of antiproton, proton and carbon ion beams

Background and purpose

Antiprotons have been suggested as a possibly superior modality for radiotherapy, due to the energy released when antiprotons annihilate, which enhances the Bragg peak and introduces a high-LET component to the dose. However, concerns are expressed about the inferior lateral dose distribution caused by the annihilation products.

Methods

We use the Monte Carlo code FLUKA to generate depth-dose kernels for protons, antiprotons, and carbon ions. Using these we then build virtual treatment plans optimized according to ICRU recommendations for the different beam modalities, which then are recalculated with FLUKA. Dose-volume histograms generated from these plans can be used to compare the different irradiations.

Results

The enhancement in physical and possibly biological dose from annihilating antiprotons can significantly lower the dose in the entrance channel; but only at the expense of a diffuse low dose background from long-range secondary particles. Lateral dose distributions are improved using active beam delivery methods, instead of flat fields.

Conclusions

Dose-volume histograms for different treatment scenarios show that antiprotons have the potential to reduce the volume of normal tissue receiving medium to high dose, however, in the low dose region antiprotons are inferior to both protons and carbon ions. This limits the potential usage to situations where dose to normal tissue must be reduced as much as possible.     

Radiation therapy (RT) after prostatectomy: The case for salvage therapy as opposed to adjuvant therapy

Patients with pathologic stage T3 or T4 prostate cancer who have undetectable PSA levels following radical retropubic prostatectomy (RRP) have a substantial risk of recurrence. Radiotherapy (RT) can be administered immediately following the RRP (immediate adjuvant RT) or may be postponed until the PSA level has risen to a level that is indicative of residual or recurrent prostate cancer (salvage RT). Immediate adjuvant RT can significantly reduce the risk of relapse, but does not appear to increase the rate of survival. Approximately two-thirds of patients with rising PSA levels after RRP can be salvaged with RT alone. This result was achieved in patients treated with an adequate dose of radiation before the PSA rose to > 1.1 ng/ml. While no one can be certain which approach (adjuvant or salvage RT) is better, future studies should examine this issue. Whether immediate postoperative adjuvant RT is of value to patients is the subject of two randomized prospective studies. The benefit of adjuvant RT is a matter of controversy. Salvage RT treats only those patients with proven residual prostate cancer. The salvage RT approach has several advantages. This approach spares approximately 40% of patients who have had an RRP for T3 or T4 prostate cancer and eliminates the risks and costs associated with adjuvant RT. Additionally, it appears that the results of immediate adjuvant RT are similar to those achieved with early salvage RT.