VCMP方案治疗多发性骨髓瘤的临床分析

目的:研究VCMP方案治疗多发性骨髓瘤（multiple myeloma,MM）的临床疗效及安全性。方法:回顾分析汉中市人民医院2007年6月至2012年12月收治的66例多发性骨髓瘤患者的临床资料。所有患者均采用VCMP方案,化疗1~12个疗程不等,疗效判断采用EBMT标准并按WHO标准判断不良反应。结果:完全缓解 27例,部分缓解20例,轻微反应10例,疾病进展5例,4例无变化,总有效率为71.2%。结论:以VCMP为主的化疗方案治疗初诊多发性骨髓瘤安全有效,能够延长患者的无病生存期。各亚型间有效率无明显差别,对于不适合做造血干细胞移植的老年患者亦安全有效,不良反应轻微可耐受。     

Treatment of multiple myeloma: a randomized study of three different regimens

The results of an Italian multicentric trial for treatment of symptomatic Multiple Myeloma (MM) are reported. One hundred and thirty-three previously untreated patients were singled out at random for three different chemotherapy schedules: Melphalan plus Prednisone (M.P.) X 6 monthly cycles; Vincristine plus Melphalan plus Cyclophosphamide plus Prednisone (VMCP) X 6 monthly cycles; Peptichemio, Cyclophosphamide, BCNU. Drugs in this latter schedule were administered sequentially, for a period of six months. Criteria for response, progression and relapse were those of the Southwestern Oncology Group. Fifteen patients in MP chemotherapy (35%) and 20 patients in VCMP chemotherapy (46%) achieved an objective response (decrease of at least 50% in the synthesis index of Monoclonal Component (M.C.], while only 3 out of the other 21 patients assigned to the third schedule responded to treatment. No significant differences were noted in the survival curves in either of the three treatment groups. The 38 responding patients did not receive maintenance therapy; no significant difference was found in remission duration between patients in MP and VCMP arms, with a median duration of 16 months for the whole group. No statistical difference was observed between survival and remission curves of patients with a 'response' (M. spike reduction greater than 75%) and those with 'improvement' (M. spike reduction between 75 and 50%). The authors conclude that the inclusion of Vintristine in a combination chemotherapy does not produce clear survival benefits; a longer induction period (12 cycles) could allow a better differentiation between MP and VMCP regimens.     

Current results of a multicenter trial in multiple myeloma

257 untreated myeloma patients (stage II and III) were studied in a multicenter trial. The patients were randomized and received MP or VCMP therapy. No differences in remission rate could be found in both therapy arms. After successful remission induction those patients without maintenance therapy relapsed significantly earlier than those patients receiving maintenance therapy. In pilot studies an etoposide therapy was found ineffective and a multidrug therapy (VBAMDex) could induce high remission rates in high risk and pretreated patients.     

Induction chemotherapy in the treatment of patients with carcinoma of the esophagus

A prospective randomized phase III trial was carried out at Songklanagarind Hospital from August 1988 to December 1990. The objectives of the study were to evaluate the effect of chemotherapy regimen in squamous cell carcinoma of the esophagus and to determine whether induction chemotherapy improves symptom-free period and survival in these patients compared to surgical treatment alone. Twenty-four patients were randomized to receive 2 cycles of chemotherapy, cis-platinum 100 mg/m² intravenously on day 1, bleomycin 10 mg/m² loading dose on day 3, followed by 10 mg/m²/day continuous intravenous infusion on days 4 through 7, and vinblastine 3 mg/m² given intravenously on days 1, 8, 15, 22. The cycle was repeated on day 29. Fifteen patients completed 2 courses of chemotherapy and among these, 2 patients had a complete clinical response (13%), 6 (40%) had a partial response, and 7 patients (47%) had no response. Four patients died during chemotherapy treatment. Grade 3 hematologic toxicity (ECOG criteria) was observed in 47% (7/15) of patients. Twenty-two patients were randomized to conventional treatment (surgery alone). Median survival time was 17 months in both groups. However, early survival appeared to be better in the control group. Kaplan-Meier survivals at 6 months were 69% and 89% and at 3 years were 31% and 36% for the induction chemotherapy group and control group, respectively. The survival time differences were not statistically significant (P = 0.186). These findings demonstrate that although this chemotherapy regimen had some effect on squamous cell carcinoma of esophagus, it did not improve survival. On the contrary, survival seems to be better in the control group. The 6-month survival discrepancy between both groups might be due to the poor nutritional status of our patients, who may better tolerate smaller dosages of chemotherapy. © 1994 Wiley-Liss, Inc.     

The superiority of combination chemotherapy over single agent chemotherapy in small cell lung carcinoma.

From June 1974 to October 1976, 288 patients with small cell undifferentiated lung carcinoma were entered into a randomized, controlled study comparing the two noncycle-active induction regimens of cyclophosphamide vs. the combination of cyclophosphamide, doxorubicin and imidazole carboximide (DTIC). Patients were stratified by extent of disease, previous radiotherapy and performance status. Responding patients and those who did not progress were then randomized to receive their initial regimen alone, or their initial regimen with added cycle-active therapy (vincristine, hydroxyurea and methotrexate). While only 4/34 (12%) evaluable patients treated with cyclophosphamide achieved a response (greater than 50% regression), a final total of 119/217 (57%) evaluable patients on the three drugs have responded (p = 0.005). The survival curve for all the combination-treated patients was significantly better than for those treated with cyclophosphamide alone (p = 0.012). There was no demonstrable statistical superiority in length of remission or survival for patients on the combination who received in addition cycle-active consolidation therapy. In the combination chemotherapy group, survival duration was longer for patients with limited disease than extensive disease (p = 0.035). There was a strong correlation between quality of remission produced by the combination and survival.     

Neoadjuvant chemotherapy with cisplatin and methotrexate in patients with muscle-invasive bladder tumours

This prospective, randomized study based on two associated trials was designed to evaluate the effect of neoadjuvant chemotherapy with cisplatin and methotrexate with folinic acid rescue or no chemotherapy prior to local treatment in patients with T2-T4b, NX-3, MO transitional cell carcinoma of the bladder. In the first trial, local treatment consisted of cystectomy (DAVECA 8901) and in the other trial the treatment was radiotherapy (DAVECA 8902); 153 eligible patients were randomized. The majority of the patients (89%) completed the protocol. The overall time to progression for all 153 patients was 12.9 months. Median time to progression was 14.2 months with chemotherapy and 11.4 months without chemotherapy. The actuarial 5-year overall survival rate for all 153 patients was 29%, and 29% for both treatment groups. Multivariate analyses showed that T-stage, tumour size and serum creatinine were independent prognostic factors for survival. The cystectomy trial included 33 patients. Median survival was 78.9 months, 82.5 months with chemotherapy and 45.8 months without chemotherapy (p=0.76). The radiotherapy trial included 120 patients. The median survival was 17.6 months. Median survival was 19.2 months in the group receiving chemotherapy and 16.3 in the group not receiving chemotherapy. The 5-year survival rate was 19% in the group receiving chemotherapy and 24% in the groups not receiving chemotherapy (p=0.98). Late toxicity grade 3 or 4 of the bladder was recorded in 25% of the patients (actuarial rate). Neoadjuvant chemotherapy with cisplatin and methotrexate did not significantly improve disease-free or overall survival in 153 randomized patients with invasive bladder cancer.     

局部晚期鼻咽癌不同化疗方案配合IMRT多中心前瞻性随机对照研究

目的 评价局部晚期鼻咽癌奈达铂联合多西他赛诱导化疗+奈达铂同期IMRT与顺铂的疗效及不良反应。方法 2011—2012年间5个治疗中心共 223例经病理确诊的初治局部晚期鼻咽癌患者被随机分为两组,试验组 113例采用多西他赛(65 mg/m²第1天)+奈达铂(80 mg/m²第1天)诱导化疗2周期,奈达铂(40 mg/m²第1天)每周方案同期IMRT;对照组 110例采用相同方案诱导化疗2周期,IMRT顺铂(40 mg/m²第1天)每周方案同期IMRT。Kaplan-Meier计算生存率并Logrank检验两组差异,不良反应行z检验。结果 随访率为99.1%。治疗结束后3个月两组有效率均为100%,试验和对照组 2年LRFS、RRFS、DMFS、OS分别为94.0%和93.4%、94.2%和94.1%、88.2%和86.7%、90.3%和87.3%(P=0.757、0.478、0.509、0.413);试验组白细胞、中性粒细胞、血小板减少发生率及严重程度较对照组高(P=0.027、0.028、0.035),血红蛋白减少发生率及严重程度低于对照组(P=0.000);试验组恶心、呕吐发生率及程度低于对照组(P=0.023),两组口腔黏膜炎、口干发生率相近(P=0.483、0.781)。结论 局部晚期鼻咽癌奈达铂联合多西他赛诱导化疗+奈达铂同期IMRT的近期疗效与顺铂的相似,胃肠道反应轻患者可耐受,但其骨髓抑制较重使用时应密切监测。     

Clinical benefits of hepatocellular carcinoma surveillance: a single-center, hospital-based study

Although there is no definitive evidence that hepatocellular carcinoma (HCC) screening in high-risk groups improves survival, many physicians screen high-risk populations with various tools such as alpha-fetoprotein (AFP) and ultrasonography (USG). The aim of this study was to clarify clinical differences between HCC patients diagnosed by surveillance and those with incidentally detected HCC. Two hundred and seventy-one Japanese patients with HCC diagnosed between January 1991 and December 2001 were recruited. They were categorized into two groups: 178 patients (group 1) had subclinical HCC diagnosed by surveillance and 93 patients (group 2) presented with incidentally detected HCC. The tumor size was significantly smaller in group 1 compared to that of group 2 (2.8 vs. 5.6 cm; P<0.0001). A significantly higher proportion of patients in group 2 had multiple HCC and portal vein infiltration when compared to group 1. Eighty-six (48.3%) group 1 patients and 16 (17.2%) group 2 patients underwent local ablation treatment, which is a curative treatment available for small HCCs (P<0.0001). The cumulative actuarial survival rate was significantly higher in group 1 than in group 2 (P=0.0091). Early detection of HCC by surveillance may contribute to a greater chance of receiving effective treatment and prolonged survival, although a further prospective, randomized study is needed.     

细胞因子诱导的杀伤细胞联合化疗治疗晚期结肠癌的随机对照研究

目的探讨细胞因子诱导的杀伤（cytokine induced killer,CIK）细胞联合FOLFOX4方案化疗治疗晚期结肠癌的临床疗效。方法将85例晚期结肠癌患者进行随机分组：治疗组43例,给予FOLFOX4方案化疗＋CIK细胞治疗;对照组42例,给予FOLFOX4方案化疗。比较两组患者的免疫功能、生活质量、近期疗效、远期生存率及不良反应。结果经过治疗后,治疗组CD3^＋、CD4^＋、CD4^＋/CD8^＋比值及CD16^＋CD56^＋显著上升,CD8^＋细胞显著下降,与治疗前相比差异有统计学意义（P〈0.05）;对照组CD3^＋、CD4^＋、CD8^＋、CD4^＋/CD8^＋及CD16^＋CD56^＋与治疗前相比差异无统计学意义（P〉0.05）。治疗组QOL评分改善83.7%,明显高于对照组的33.3%（P〈0.001）。治疗组客观有效率为67.4%,对照组为61.9%,两组比较差异无统计学意义（P=0.593）。治疗组和对照组的1年、2年生存率分别为93.0%vs 83.3%,81.4%vs 69.0%,两组比较差异无统计学意义（P=0.166,P=0.187）。治疗组和对照组的不良反应无显著差异（P〉0.05）。结论 CIK细胞联合化疗可以提高晚期结肠癌患者的免疫功能,改善生活质量。     

DICE方案与CHOP方案治疗中高度恶性非霍奇金淋巴瘤的随机对照研究

背景与目的：长期以来，CHOP方案被认为是治疗中、高度恶性非霍奇金淋巴瘤（non—Hodgkin，slym—phoma，NHL）的基本方案，近年有文献报道DICE方案可以提高中、高度恶性NHL的疗效。本研究中我们比较DICE方案与CHOP方案治疗中、高度恶性NHL的疗效与安全性，为中、高度恶性NHL的规范治疗提供依据。方法：选择经病理学或组织学证实的中、高度恶性NHL的患者74例，按信封法随机分为DICE组与CHOP组两组，分别采用上述两种方案治疗。结果：DICE组CR15例（40．5％），PR14例（37．8％），缓解率RR（CR＋PR）为78．3％（29／37）；CHOP组CR11例（29．7％），PR10例（27．0％），RR为56．7％（21／37）；两组比较有显著性差异（P〈0．05）。DICE组的1、3、5年生存率分别为89．2％、76．0％和46．7％，CHOP组分别为81．2％、52．6％和36．4％。两组比较有显著性差异（P〈0．05）。两组出现的主要不良反应为Ⅲ／Ⅳ度粒细胞和血小板减少及恶心等，两组比较无显著性差异（P〉0．05）。结论：与CHOP方案相比，DICE方案疗效较好，不良反应可以耐受，但是否可作为治疗中、高度恶性NHL的首选方案之一，值得进一步研究。     

薏苡仁提取物联合经导管肝动脉化疗栓塞术治疗转移性肝癌的临床研究

 目的　研究薏苡仁提取物联合经导管肝动脉化疗栓塞术（TACE）对转移性肝癌的疗效以及治疗前后血清血管内皮生长因子 （VEGF）的变化。方法　转移性肝癌患者62例随机分为两组,每组各31 例。研究组：采用薏苡仁提取物+TACE术。对照组：单纯TACE术。薏苡仁提取物注射液缓慢静脉注射200 ml,1次/d,连用21 d,1个月为1个周期,至少连用2个周期。每位患者至少行TACE术2 次,并检测TACE术前1 周及术后3 周血清VEGF水平。结果　研究组有效率为61.3 ％（19／31）,对照组为45.2 ％（14／31）,两组差异无统计学意义（P＞0. 05）;研究组疾病控制率（DCR）为80.6 %（25／31）,对照组为54.8 ％（17／31）,两组差异有统计学意义（P＜0.05）;研究组1 年生存率为67.7 ％（21／31）,对照组为38.7 %（12／31）,两组差异有统计学意义（P＜0.05）;研究组中位无进展生存期（PFS）为7.0 个月,对照组为5.1 个月,两组间差异有统计学意义（P＜0.05）。血清VEGF研究组下降显著（P＜0.05）;对照组治疗前后血清VEGF水平差异无统计学意义（P＞0.05）;研究组治疗后血清VEGF水平较对照组治疗后水平明显低下,差异有统计学意义（P＜0.05）;两组不良反应均为Ⅰ～Ⅲ级,研究组乏力、食欲下降及右上腹疼痛症状较对照组轻,差异有统计学意义。结论　薏苡仁提取物联合TACE术治疗转移性肝癌能提高疾病控制率,并降低血清VEGF水平,延长无进展生存期及1年生存率,改善临床症状。     

单药口服替吉奥与单药吉西他滨对中晚期胰腺癌的综合疗效比较

目的 探究单药口服替吉奥与单药吉西他滨对中晚期胰腺癌的综合疗效.方法 选取中晚期胰腺癌患者92例为研究对象,针对患者的临床资料进行了回顾性的比较研究.结果 (1)替吉奥组46例患者中,完全缓解4例,部分缓解10例,稳定16例,进展16例,有效率为30.4%;吉西他滨组46例患者中,完全缓解4例,部分缓解9例,稳定15例,进展18例,有效率为28.3%.2组临床治疗有效率组间比较,差异均无统计学意义;(2)替吉奥组46例患者6个月生存患者22例,1年的生存患者16例,2年生存患者4例;吉西他滨组46例患者6个月生存患者23例,1年的生存患者15例,2年生存患者3例.2组不同时点的生存率水平相当,组间差异无统计学意义;(3)2组患者化疗前后CEA和CA-199水平差异不大,且组间差异无统计学意义;(4)2组不良反应发生率无显著差异.结论 单药口服替吉奥与单药吉西他滨对中晚期胰腺癌的综合疗效相当,近远期综合治疗效果差异不明显.     

Chemoradiation with and without surgery in patients with locally advanced squamous cell carcinoma of the esophagus.

PURPOSE: Combined chemoradiotherapy with and without surgery are widely accepted alternatives for the curative treatment of patients with locally advanced esophageal cancer. The value of adding surgery to chemotherapy and radiotherapy is unknown. PATIENTS AND METHODS: Patients with locally advanced squamous cell carcinoma (SCC) of the esophagus were randomly allocated to either induction chemotherapy followed by chemoradiotherapy (40 Gy) followed by surgery (arm A), or the same induction chemotherapy followed by chemoradiotherapy (at least 65 Gy) without surgery (arm B). Primary outcome was overall survival time. RESULTS: The median observation time was 6 years. The analysis of 172 eligible, randomized patients (86 patients per arm) showed overall survival to be equivalent between the two treatment groups (log-rank test for equivalence, P < .05). Local progression-free survival was better in the surgery group (2-year progression-free survival, 64.3%; 95% CI, 52.1% to 76.5%) than in the chemoradiotherapy group (2-year progression-free survival, 40.7%; 95% CI, 28.9% to 52.5%; hazard ratio [HR] for arm B v arm A, 2.1; 95% CI, 1.3 to 3.5; P = .003). Treatment-related mortality was significantly increased in the surgery group than in the chemoradiotherapy group (12.8% v 3.5%, respectively; P = .03). Cox regression analysis revealed clinical tumor response to induction chemotherapy to be the single independent prognostic factor for overall survival (HR, 0.30; 95% CI, 0.19 to 0.47; P < .0001). CONCLUSION: Adding surgery to chemoradiotherapy improves local tumor control but does not increase survival of patients with locally advanced esophageal SCC. Tumor response to induction chemotherapy identifies a favorable prognostic group within these high-risk patients, regardless of the treatment group.     

A randomized trial of adjuvant chemotherapy in head and neck cancer

Ninety-five patients with squamous cell carcinoma of the head and neck were entered into a randomized study testing a two-week course of induction chemotherapy with methotrexate and leucovorin given prior to regional therapy. In addition, following regional therapy, patients randomized to chemotherapy were to receive similar methotrexate courses every three months for one year. Poor tolerance to this regimen after radiation and surgery led to a change in the chemotherapy following regional therapy to a combination of Adriamycin (Adria Laboratories, Columbus, Ohio) and cisplatin every three weeks for four cycles after the first 35 patients had been entered. Nine cases were ineligible and four lacked any follow-up data, leaving 82 analyzable cases. Using Cox regression analysis, no differences in the percentage of patients achieving disease control, the relapse-free survival, or the overall survival were identified between any treatment group. As has been described in many pilot studies of induction chemotherapy of head and neck cancer, chemotherapy responders had a more favorable disease-free survival than chemotherapy nonresponders in the total group of patients receiving adjuvant chemotherapy. However, correcting for imbalances in the expected three year disease-free survival of these patients, based on their disease site and stage, erased this difference, indicating tumor response to this regimen of chemotherapy is not an independent factor affecting disease outcome. The division of patients into arbitrary prognostic categories based on the expected outcome for each specific tumor site and stage proved to be a useful method for balancing treatment groups, given the multiple site-stage combinations within the upper aerodigestive tract. The defined prognostic categories were the single most sensitive predictors of relapse-free and overall survival.     

全脑放疗联合替莫唑胺同期化疗在脑转移瘤治疗中的疗效观察

目的 探讨联合使用全脑放疗和替莫唑胺治疗脑转移瘤的疗效.方法 将160例脑转移瘤患者随机分为对照组和观察组,每组各80例.对照组使用全脑放疗进行治疗.使用6mV-X线全脑放射治疗,全脑两侧对穿野等中心放射治疗,DT 30 Gy/10次,5次/周.观察组在全脑放射治疗的基础上使用替莫唑胺75 mg/m2/d进行治疗,连续口服14 d进行.观察2组患者治疗后的近远期疗效以及治疗过程中出现的副作用.结果 观察组总有效率为87.50%,显著高于对照组中的53.75%.对照组和观察组在3个月的生存期上没有统计学差异(P>0.05);在6个月生存率和1年生存率上,观察组显著高于对照组(P<0.05).中位生存期的比较上,观察组显著优于对照组(11.8 v.s.6.4,P<0.05).2组患者治疗过程中均没有出现无法耐受的严重副作用(Ⅳ级);在白细胞、血红蛋白和血小板等骨髓抑制的指标中,观察组出现副作用的发生率显著高于对照组,但是经过对症治疗后,患者均可以耐受;在恶心呕吐和头疼的副作用发生率和等级分布上,2组患者没有统计学差异(P>0.05).结论 全脑放疗联合使用替莫唑胺治疗脑转移瘤,可以显著提高患者总的缓解率,并能够显著延长患者的生存期和提高生存率,且副作用均可耐受,值得临床推荐使用.     

GP方案与吉西他滨单药治疗老年人晚期非小细胞肺癌的疗效比较

 目的　比较GP方案与吉西他滨（GEM）单药治疗老年人晚期非小细胞肺癌（NSCLC）的近期疗效、生存状况及不良反应。方法　85例老年Ⅲ～Ⅳ期NSCLC患者按照起始治疗方案的不同分为GP组（43例）及GEM组（42例）。GP组接受GEM 1.0 g／m2第1、8天＋顺铂（DDP）75 mg/m2第2天至第4天治疗, GEM组接受GEM 1.25 g／m2第1、8天化疗。两组均治疗3周为1个周期，至少2个周期后按实体瘤疗效评价标准（RECIST）评价近期疗效及生存状况，评价不良反应。结果　GP组和GEM组治疗有效率分别为48.84 %（21／43）和35.71 %（15／42），差异无统计学意义（χ2＝1.708，P＝0.424）。GP组1年生存率39.53 %（17／43），2年生存率9.30 %（4／43），中位生存时间（MST）为11个月；GEM组1年生存率26.19 %（11／42），2年生存率7.14 %（3／42），MST为9个月， 两组中位生存时间比较差异无统计学意义（t＝1.377，P＝0.172）。GP组恶心、呕吐发生率（34.88 %）较GEM组（7.14 %）高，差异有统计学意义（χ2＝9.796，P＝0.002），其他不良反应两组接近，患者可耐受。结论　对于老年晚期NSCLC患者，GP方案和GEM单药化疗疗效相当，不良反应接近，GEM单药的胃肠道反应更轻。     

A randomized trial of induction chemotherapy plus concurrent chemoradiotherapy versus induction chemotherapy plus radiotherapy for locoregionally advanced nasopharyngeal carcinoma

The aim of this randomized study was to compare the efficacy of induction chemotherapy plus concurrent chemoradiotherapy (IC+CCRT) versus induction chemotherapy plus radiotherapy (IC+RT) for patients with locoregionally advanced nasopharyngeal carcinoma. From August 2002 to April 2005, 408 patients were randomly divided into two groups: an IC+CCRT group and an IC+RT group. Patients in both groups received the same induction chemotherapy: two cycles of floxuridine (FuDR)+carboplatin (FuDR, 750mg/m(2), d1-5; carboplatin, area under the curve [AUC]=6). The patients received radiotherapy 1week after they finished the induction chemotherapy. The patients in the IC+CCRT group also received carboplatin (AUC=6) on days 7, 28, and 49 of radiotherapy. Eight patients did not meet the inclusion criteria, and the remaining 400 cases were analyzed. Grade III or IV toxicity was found in 28.4% of the patients in the IC+CCRT group and 13.1% of those in the IC+RT group (P<.001). Five-year overall survival rates were 70.3% and 71.7% (P=0.734) in the IC+CCRT and IC+RT groups, respectively. No significant differences in failure-free survival, locoregional control, and distant control were found between the two groups. Compared with the IC+RT program, the IC+CCRT program used in the present study did not improve the overall survival and failure-free survival in patients with locoregionally advanced nasopharyngeal carcinoma. Using carboplatin in the concurrent chemoradiotherapy was not suitable for nasopharyngeal carcinoma.     

Evaluation of high-dose versus standard FAC chemotherapy for advanced breast cancer in protected environment units: a prospective randomized study

Fifty-nine evaluable patients under 65 years of age with measurable metastatic breast cancer and without prior chemotherapy were randomly assigned to treatment with fluorouracil, Adriamycin (Adria Laboratories, Columbus, OH), and cyclophosphamide (FAC) at standard or high doses (100% to 260% higher than standard FAC) following a dose escalation schedule. Patients randomized to the high-dose FAC received the first three cycles of therapy within a protected environment. Subsequent cycles for this group were administered at standard doses of FAC in an ambulatory setting, the same as for the control group. After reaching 450 mg/m2 of Adriamycin, patients in both groups continued treatment with cyclophosphamide, methotrexate, and fluorouracil until there was disease progression. Analysis of pretreatment patient characteristics showed an even distribution for most known pretreatment factors, although the control group had slightly (but nonsignificantly) more favorable prognostic characteristics. Fourteen patients (24%) achieved a complete remission (CR) and 32 (54%) achieved a partial remission (PR), for an overall major response rate of 78%. There were no differences in overall, CR, or PR rates between the high-dose FAC and control groups. The median response durations were 11 and 10 months for the protected environment and control groups, respectively, and the median survival was 20 months for both groups. Hematologic, gastrointestinal (GI), and infection-related complications were significantly more frequent and severe in the group treated with high-dose chemotherapy. Stomatitis, diarrhea, and skin toxicity were dose-limiting. However, there were no treatment-related deaths. High-dose induction combination chemotherapy with the agents used in this study failed to increase the response rate or survival duration, and resulted in a substantial increase in toxicity.     

益气散结法联合化疗治疗转移去势抵抗性前列腺癌的疗效观察

目的探讨益气散结法联合化疗治疗转移去势抵抗性前列腺癌(metastatic castration-resistantprostate cancer,mCRPC)的有效性及安全性。方法将32例mCRPC患者,1∶1随机分为益气散结法联合多西他赛化疗研究组和单纯多西他赛化疗组。根据前列腺癌工作组PCWG-2标准进行疗效评价,比较2组无疾病进展生存期(progress free survival,PFS)、PSA反应率,并进行安全性评价。采用FACT-P问卷调查患者生活质量情况。结果研究组的中位PFS略长于对照组(7.4 m vs 6.6 m),但无统计学差异(P>0.05)。4周期治疗后,2组PSA水平均较治疗前有显著下降(P<0.05)。益气散结法研究组PSA反应率64.29%,对照组38.46%。安全性方面,研究组中性粒细胞减少症、疲劳发生率显著低于对照组(P<0.05)。生活质量评分2组患者均有明显下降(P<0.05)。结论益气散结法联合多西他赛方案化疗能较好提高mCRPC患者的生活质量,降低化疗毒性,改善生存,但仍需大样本随机对照临床研究加以证实。     

奈达铂联合氟尿嘧啶诱导化疗加同步放化疗在局部晚期鼻咽癌的临床应用

目的 观察奈达铂联合氟尿嘧啶诱导化疗加同步放化疗治疗局部晚期鼻咽癌的疗效及安全性。方法70例局部晚期鼻咽癌患者随机分为试验组（35例）和对照组（35例）。试验组接受诱导化疗2个周期,化疗方案为奈达铂80mg／m²静滴,d1;氟尿嘧啶500 mg／m²静滴,d1～d5。21天为1周期。诱导化疗结束14天后进行同步放化疗,同步化疗采用奈达铂80mg／m²静滴,d1、d22、d43;放疗采用常规放疗,鼻咽部原发灶剂量为68～74 Gy,每次均为2 Gy,每周5次。对照组接受顺铂同步放化疗,同步化疗采用顺铂100 mg／m²静滴,d1、d22、d43;放疗方法同试验组。同步放化疗结束21天后进行辅助化疗2个周期,化疗方案为：顺铂80mg／m²静滴,d1;氟尿嘧啶500 mg／m2静滴,d1～d5。21天为1周期。结果 试验组35例患者中,1例因经济原因退出了研究,34例可评价疗效,对照组35例患者均可评价疗效。治疗结束3个月后试验组CR 30例,PR 4例,有效率达100.0％（完全缓解率为88.2％）;对照组CR 31例,PR 4例,有效率达100.0％（完全缓解率为88.6％）,两组比较差异无统计学意义（P＞0.05）。试验组、对照组2年生存率分别为94.1％和91.4％,两者比较差异无统计学意义（P＞0.05）。在诱导化疗期间,试验组的血液学不良反应主要为白细胞减少,发生率为70.6％,与对照组辅助化疗期间白细胞减少相比无明显差异。对照组在辅助化疗期间,恶心、呕吐的发生率要明显高于试验组在诱导化疗期间的发生率（P＜0.01）。在同步放化疗期间,试验组、对照组血小板减少的发生率分别为52.9％、14.3％,差异有统计学意义（P＜0.01）;对照组恶心、呕吐的发生率则高于试验组（P＜0.01）;两组患者口腔黏膜炎、放射性皮炎的发生率均达1000％。两组患者均无治疗相关性死亡。结论 奈达铂联合氟尿嘧啶诱导化疗加同步放化疗治疗局部晚期鼻咽癌的近期疗效较好,不良反应可以耐受,远期疗效有待进一步观察。