Neoadjuvant chemotherapy of cisplatin and fluorouracil regimen in head and neck squamous cell carcinoma: a meta-analysis

Background The benefit of neoadjuvant chemotherapy in the management of head and neck squamous cell carcinomas （HNSCC） still remains controversial. The aim of this meta-analysis is to evaluate the role of the neoadjuvant chemotherapy with the cisplatin and fluororacil （PF） regimen in enhancing the overall survival of and decreasing Iocoregional relapse and distant metastasis in HNSCC patients. Methods Medline and manual searches were performed to identify all published randomized controlled trials （RCTs） investigating the efficacy of the neoadjuvant chemotherapy with the PF regimen. Outcomes assessed by meta-analysis included Iocoregional relapse, distant metastasis, and overall survival. The odds ratio was the principle measurement of effect, which was calculated as the treatment group （chemotherapy plus Iocoregional treatment） versus the control group （Iocoregional treatment alone） and was presented as a point estimate with 95% confidence intervals （CI）. Results Eight RCTs were adopted for analysis. The meta-analysis showed that the odds ratio for the Jocoregional relapse was 0.92 （0.70-1.22, 95%CI）, which was not statistically significant. The odds ratios for distant metastasis and overall survival were 0.47 （0.33-0.68, 95% CI） and 1.28 （1.01-1.62, 95% CI） respectively, which were both statistically significant. Conclusions Neoadjuvant chemotherapy with the PF regimen in HNSCC patients has no effect on Iocoregional relapse. However, it shows a small but significant benefit in reducing distant metastasis and improving the overall survival.     

Effect and mechanism of ginsenoside Rg3 on postoperative life span of patients with non-small cell lung cancer

Objective： To explore the effect and mechanism of ginsenoside Rg3 （Shenyi Capsule, 参一胶囊） on the postoperative life span of patients with non-small cell lung cancer （NSCLC）. Methods： The prospective, randomized, controlled method was adopted. One hundred and thirty- three patients with NSCLC were randomly assigned to 3 groups： Shenyi Capsule group （43 cases）, combined therapy group （Shenyi Capsule plus chemotherapy, 46 cases）, and chemotherapy group （44 cases）. The survival rates, immune function and the correlation between vascular endothelial growth factor （VEGF） expression and clinical effect were analyzed in the three groups. Results： （1） The 1-year survival rate in the Shenyi group, the combined group and the chemotherapy group was 76.7% （33/43）, 82.6% （38/46）, and 79.5% （35/44）, respectively; the 2-year survival rate was 67.4% （29/43）, 71.7% （33/46）, and 70.5% （31/44）, respectively; and the 3-year survival rate was 46.5% （20/43）, 54.3% （25/46）, and 47.7% （21/44）, respectively. There was no significant difference among the 3 groups （P〉0.05）. （2） NK cells were increased to different degrees and the ratio of CD4/CD8 was normal in the Shenyi Capsule group and the combined group, while the ratio of CD4/CD8 was disproportional in the chemotherapy group. （3） In the chemotherapy group, the 3-year survival rate was lower in patients with positive expression of VEGF than in patients with negative expression （37.0% vs 64.7%, χ^2=17.9, P〈0.01）, but no significant statistical difference was shown in the other two groups （53.6% vs 55.6%, P〉0.05; 44.4% vs 50.0%, P〉0.05）. Conclusion： Shenyi Capsule, especially in combination with chemotherapy, can improve the life span of patients with NSCLC after operation. The mechanism might be correlated with improving the immune function and anti-tumor angiogenesis.     

加减抗癌方治疗Ⅳ期转移性胃癌患者的生存分析

Objective：To evaluate the efficacy of HangAm-Plus（HAP）on stageⅣmetastatic gastric cancer by analyzing the treated patients’overall survival outcome.Methods：Following the study eligibility,overall survival and one year survival rate of 44 stageⅣmetastatic gastric cancer patients who visited EastWest Cancer Center（EWCC）were analyzed.The study consisted of two arms：HAP treatment only（n=18）and combined treatment of concurrent conventional chemotherapy and HAP（n=26）.Patient characteristics by gender,age,surgical intervention,Eastern Cooperative Oncology Group（ECOG）score,treatment duration（〈4 weeks or≥4 weeks）,and lines of the chemotherapy received were assessed.Treatment related side effects were also assessed.Results：The median survival of combined group was longer（10.0 months）than that of HAP group（5.1 months）.One-year survival rate of combined treatment group and HAP group was 38.5%±9.5%and 33.3%±11.1%,respectively（P〉0.05）.One-year survival rate of those received more and less than 4-week treatment was 57.1%±18.7%and 8.3%±8.0%,respectively（P=0.001）.Conclusions：The study supports the safety and potential efficacy of HAP treatment in prevention of chemo-related side effects for stageⅣmetastatic gastric cancer treated with conventional chemotherapy.Further studies are needed to investigate and confirm the results before applying the treatment in clinical settings.     

Sorafenib in Liver Function Impaired Advanced Hepatocellular Carcinoma

Objective To explore the efficacy and safty of sorafenib in Child-Pugh class B to class C hepatocellular carcinoma （HCC）. Methods In this three-center open-label study from November 2011 to May 2013, we randomly assigned 189 patients with advanced Child-Pugh class B or C HCC patients into two groups, one group with 95 patient to receive sorafenib （400 mga time, twice a day） and the other group with 94 patients to receive best supportive care. The primary end points were progression-free survival and overall survival. Results The median progression-free survival was 2.2 months and 1.9 months in the sorafenib group and best supportive care group respectively （Hazard ratio in the sorafenib group, 0.55; 95% confidence interval, 0.40-0.75; P=O.O02）. The median overall survival was 4.0 months and 3.5 months in the sorafenib group and best supportive care group respectively （Hazard ratio in the sorafenib group, 0.48; 95% confidence interval, 0.35-0.68; P〈0.001）. The main adverse effect of sorafenib was rash and ache of the skin （in 51.7% patients）. The incidences of severe rash, diarrhea, and dry skin were 5.6%, 5.6%, and 2.2% in the sorafenib group. One patient reached partial response in the sorafenib group. Conclusions Sorafenib is safe in patients with liver function impaired advanced HCC. It is effective in terms of progression-free survival and overall survival compared with best supportive care. Liver functions are the important predictive factors.     

Treatment of platinum-resistant recurrent ovarian cancer using a ＂predictive molecule targeted routine chemotherapy＂ system

Background Correct drug selection, the key to successful chemotherapy, is one of the most difficult clinical decisions for the treatment of platinum-resistant recurrent ovarian cancer worldwide. The exact procedures for choosing drugs are undefined, currently relying on clinical trials and personal experience, which often results in disappointing outcomes. Here, we propose a new drug selection method, the ＂predictive molecule targeted routine chemotherapy＂, to choose relatively sensitive routine drugs and avoid relatively resistant routine drugs based on the specific predictive molecule expression of the individual tumor tissue. Methods From January 2004 to June 2008, 26 cases of platinum-resistant recurrent ovarian cancer were prospectively recruited. Their routine chemotherapy drug choice was based on the expression of 6 predictive molecules （including p53） as determined by immunohistochemistry （the predictive molecule targeted routine chemotherapy group）. A further 18 cases of platinum-resistant recurrent ovarian cancer were treated by experience and formed the control group. The response rate and the overall survival were compared between the two groups. Results The response rate to second-line chemotherapy was 28% in the control group and 77% in the predictive molecule targeted routine chemotherapy group （P=-0.002）. The response rate to third-line chemotherapy was 14% in the control group and 33% in the predictive molecule targeted routine chemotherapy group （P=0.268）. The median overall survival of the predictive molecule targeted routine chemotherapy group （88 weeks） was significantly longer than the median overall survival of the control group （56 weeks） （P=-0.0315）. Conclusion The predictive molecule targeted routine chemotherapy is a new effective protocol for choosing drugs when treating platinum-resistant recurrent ovarian cancer.     

Prognosis of R1-resection at the bronchial stump in patients with non-small cell lung cancer

Background The prognosis of R1-resection at the bronchial stump in patients with non-small cell lung cancer （NSCLC） remains unclear.This study intends to identify the prognostic factors and to optimize treatments for these patients under update conditions.Methods The data of 124 NSCLC patients who underwent R1-resection at the bronchial stump was reviewed.There were 41 patients in the surgery group （S）,21 in the postoperative radiotherapy （PORT） group （S＋R）,30 in the postoperative chemotherapy （POCT） group （S＋C）,and 32 in the PORT plus POCT group （S＋R＋C）.The constitute proportion in different groups was tested using the X2 method,univariate analysis was performed using the Kaplan-Meier and log-rank method,and multivariate analysis was done using the Cox hazard regression with entry factors including age,sex,pathological type and stage,classification of the residual disease,and treatment procedure.The process was performed stepwise backward with a maximum iteration of 20 and an entry possibility of 0.05 as well as an excluded possibility of 0.10 at each step.Results In univariate analysis,survival was more favorable for patients with squamous cell carcinoma,early pathological T or N stage,and chemotherapy or radiotherapy.There was no significant difference in the survival for patients with different types of the residual disease,except for the difference between patients with carcinoma in situ and lymphangiosis carcinomatosa （P=0.030）.The survival for patients receiving chemoradiotherapy was superior to that for those undergoing surgery alone （P=0.016）.In multivariate analysis,the pathological type （HR 2.51,95% CI 1.59 to 3.96,P=0.000）,pathological T （HR 1.29,95% CI 1.04 to 1.60,P=-0.021） or N stage （HR 2.04,95% CI 1.40 to 2.98,P=0.000）,and chemotherapy （HR 0.24,95% CI 0.13 to 0.43,P=0.000） were independent prognostic factors.Conclusion Patients with squamous cell carcinoma,early pathological T or N stage,or receiving chemotherapy had a more favorable pro     

Treatment of advanced non-small cell lung cancer with extracorporeal high frequency thermotherapy combined with Chinese medicine

Objective： To observe the clinical efficacy and benefit response of extracorporeal high frequency thermotherapy （EHFT） combined with Chinese medicine （CM） in the treatment of patients with advanced non-small cell lung cancer. Methods： The study adopted a prospective, small sample and randomized controlled method, and the advanced non-small cell lung cancer patients were assigned to two groups according to the table of random digits, one having the treatment of EHFT combined with CM （the treatment group）, the other only with CM （the control group）. The patients in the treatment group were treated with EHFT one hour once per day, together with CM differentiation decoction, 250 mL orally taken, twice daily for 14 days as one cycle, and 3-4 cycles was performed. The patients in the control group were treated only with CM differentiation decoction using the same dose as the treatment group. The efficacies were evaluated after three to four cycles of treatment. Primary endpoints were disease control rate （DCR） and time to progression （TTP）. Secondary endpoints were overall survival time and 1-year survival rate. Results： Sixty-six patients accomplished the study. After the patients underwent different treatments, none of the patients got a complete response or partial response in both groups. In the treatment group, DCR was 72.2%, and 10 had progression of disease （28.8%）, while the DCR of the control group was 63.3%, and 11 had progression of disease （36.7%）; there was a significant statistical difference （P0.05）, suggesting that the combined regimen had superiority on the DCR. As for long-term efficacy, the median survival time （MST） of the treatment group was 7.5 months, TTP was 5.5 months, and 1-year survival rate was 21.4 %; in the control group, the results were 6.8 months, 4.5 months and 16.6% respectively. There was significant statistical difference on TTP （P0.05）, but no difference on MST or 1-year survival rate. Conclusion： EHFT combined with CM differentiation has better tolerance and short-term efficacy in the treatment of patients with advanced NSCLC.     

A phase II trial of oxaliplatin plus S-1 as a first-line chemotherapy for patients with advanced gastric cancer

Background Palliative chemotherapy has been shown to have a survival benefit for patients with recurrent or metastatic gastric cancer. We conducted a Phase II trial to determine the efficacy and safety of S-1 plus oxaliplatin （SOX regimen） as first-line chemotherapy for patients with unresectable locally advanced or metastatic gastric cancer. Methods Eligible patients had measurable lesions and no previous history of chemotherapy （except adjuvant chemotherapy）. Oxaliplatin was administered intravenously at a dose of 130 mg/m2 on day 1. S-1 was administered orally in doses of 80, 100, or 120 mg/d according to body surface areas of 〈1.25 m2, 1.25-1.5 m2, or 〉1.5 m2 respectively; the total dose was divided into two daily doses on days 1-14. Treatments were repeated every 3 weeks until disease progression or intolerable toxicity occurred. Results Forty-three patients were enrolled in the study. All were assessable for efficacy and adverse events. The objective response and disease control rates were 55.8% and 76.7% respectively. The median follow-up time was 16.5 months. The median progression-free survival time was 7 months （95% CI, 5.8-8.2 months） and the median overall survival time was 16.5 months （95% CI, 9.7-23.3 months）. The one-year survival rate was 54.2%. Major adverse reactions were grade 3/4 neutropenia （9.3%） and thrombocytopenia （20.9%）. Conclusion The SOX regimen with oxaliplatin at a dose of 130 mg/m2 was found to be effective and safe as a first-line chemotherapy in Chinese patients with advanced gastric cancer.     

Primary sarcoma of the ovary: clinicopathological characteristics, prognostic factors and evaluation of therapy

Background  The primary ovarian sarcoma is a very rare malignancy. The objective of this study was to further investigate the clinicopathologic features and outcome in patients with primary sarcoma of the ovary.

Methods  Between 1988 and 2007, 24 patients with primary ovarian sarcoma who underwent treatment at Peking Union Medical Hospital were reviewed retrospectively. Response to treatment, progression and overall survival were analyzed.

Results  Patients with ovarian sarcoma had a mean age of (54.3±10.3) years, and 16 of them were postmenopausal. The most common symptom was abdominal pain, present in 14 patients. Of the 24 patients, 16 patients were pathologically diagnosed as carcinosarcoma (known as malignant mixed mesodermal tumor (MMMT)), 2 as ovarian leiomyosarcoma (LS) and 6 patients as ovarian endometrial stromal sarcoma (ESS). The patients in optimal debulking group had a median survival period of 28 months and 1-year survival rate of 71%. The patients in suboptimal debulking group had a significantly lower median survival of 6 months (P=0.02) and 1-year survival rate of 29%. Among the patients, 23 patients received chemotherapy and most of regimens were based on platinum, 3 patients received chemoradiation. The mean number of courses of combined chemotherapy was 6.6±5.0, and the response was unsatisfactory. The median survival for the entire group was 18.7 months. The one-year survival rate was 58%, and two-year survival rate only 29%.

Conclusions  Ovarian primary sarcoma has a poor overall prognosis. Optimal debulking surgery appears to be of prognostic significance. There is a clear need for further study to explore the role and the regimen of platinum-based chemotherapy in primary ovarian sarcoma.

     

A Prospective Study on Therapeutic Gain by Concurrent Chemoradiotherapy for Stage Ⅱ-Ⅳa Nasopharyngeal Carcinoma

The benefit achieved by concurrent chemoradiotherapy(CCR) and sequential chemoradiotherapy(SCR) vs radiotherapy(RT) alone for patients with stage Ⅱ-Ⅳa nasopharyngeal carcinoma(NPC) was compared.A total of 113 patients with stage Ⅱ-Ⅳa NPC were allotted into CCR group(n=38),SCR group(n=36) and RT alone group(n=39).All patients were irradiated with the same RT technique to ≥66 Gy at 2 Gy per fraction,conventional 5 fractions/week in all groups.The CCR group received concurrent chemotherapy of weekly cisplatin for 7 weeks,and the SCR group received neoadjuvant and(or) adjuvant chemotherapy.The results showed that the 3-and 5-year overall survival rate was significantly higher in CCR group than in RT alone group(92.16% vs 61.54%,81.58% vs 51.28%,P<0.005).The median survival time was significantly longer in CCR group than in RT alone group(67.8 months vs 52.7 months,P<0.005).It was concluded that CCR could significantly improve overall survival rate,progression-free survival rate,and median survival time when compared with RT alone.     

Neoadjuvant chemotherapy in patients with stages II and III breast cancer

Background Neoadjuvant chemotherapy has been used as a primary treatment for locally advanced or inflammatory breast cancer, and recently extended to operable breast cancer. However, only a few studies have published data concerning the outcomes of patients with stages II and III breast cancer after neoadjuvant chemotherapy. Methods This study retrospectively investigated the clinical value of neoadjuvant chemotherapy for patients with stages II and III breast cancer. The patients in Group 1 （n=54） were treated with neoadjuvant chemotherapy, followed by definitive surgery and adjuvant therapy. The patients in Group 2 （n=-43） initially received definitive surgery, followed by adjuvant chemotherapy and other therapies. The operability rates for breast conservation and dermatoplasty were observed in Group 1 after neoadjuvant chemotherapy. After follow-up, the recurrence and overall and disease-free survival rates of the two groups were analyzed. Results Neoadjuvant chemotherapy increased the operability rates for breast conservation from 17.1% to 40.0% in stage II （P=0.034） and 0% to 12.6% in stage III （P=0.016）, and decreased the dermatoplasty rates from 17.1% to 2.8% in stage II （P=0.046） and 28.1% to 8.1% in stage Ill （P=0.026）. After a median follow-up of 46.8 months, there were 11 deaths and 13 recurrences in Group 1, and 15 deaths and 19 recurrences in Group 2. The overall and disease-free survival rates of stage III disease were significantly higher in Group 1 than in Group 2 （68.4% vs 31.2%, P=0.028, and 63.2% vs 25.0%, P=0.024, respectively）. There were no significant differences in the overall and disease-free survival rates of stage II disease for Group 1 compared with Group 2 （85.7% vs 85.2%, P=0.953, and 80.6% vs 74.1%, P=0.400, respectively）. Conclusions Neoadjuvant chemotherapy resulted in increased operability for breast conservation and decreased dermatoplasty. Neoadjuvant chemotherapy exhibited better recurrence control, and overall and disease-free survival rates in stage III disease. However, neoadjuvant chemotherapy did not confer greater survival on stage II disease.     

Neoadjuvant intraarterial chemotherapy and embolization in treatment of advanced ovarian epithelial carcinoma

Background The purpose of the study was to evaluate the role of neoadjuvant chemotherapy and embolization via the anterior branches of the bilateral internal iliac arteries in treating patients with advanced ovarian epithelial carcinoma.Methods Forty-two patients with advanced ovarian epithelial carcinoma (study group) were treated via the anterior branches of the bilateral internal iliac arteries after cytoreductive surgery and 7 courses of adjuvant platinum-based combination chemotherapy. Primary cytoreductive surgery was performed in 43 patients with advanced ovarian epithelial carcinoma (control group), and then followed by 8 courses of adjuvant platinum-based combination chemotherapy. The rate of optimal cytoreductive surgery, survival rate, blood loss during operation and operative time were investigated in the two groups. Statistical significance was asessed using Student’s t test, the Chi-squre test and the log-rank test. Results In the study group, the rate of optimum debulking after platinum-based chemotherapy and embolization via the anterior branches of the bilateral internal iliac arteries was 71.43%(30/42) (χ2=10.06, P&lt;0.005), and 9 (21.43%) of the 42 patients showed no gross residual disease after surgery. Blood loss and operative time were significantly decreased in the study group as compared with those in the control group (665.24±37.61 ml: 849.31±41.20 ml, t1=33.21, P1&lt;0.001; 4.23±0.21 hours: 6.15±0.38 hours, t2=28.92, P2&lt;0.01). In the study group,the mean survival time and the median overall survival were 33.66 months (95% CI, 24.73 to 42.58) and 26.00 months (95% CI, 19.22 to 32.78), respectively. The median disease-free interval was 18.20 months. In the control group, the mean survival time and the median overall survival were 32.38 months (95% CI, 24.92 to 39.84) and 25.00 months (95% CI, 22.80 to 27.20), respectively. The median disease-free interval was 14.20 months.The overall survival rates were not significantly different between the two groups (χ2=6.48,P&gt;0.05).Conclusions Neoadjuvant platinum-based combination chemotherapy and embolization via the anterior branches of the bilateral internal iliac arteries is an alternative treatment for patients with advanced ovarian epithelial carcinoma, in whom the chance of optimal cytoreductive surgery is low. The treatment can reduce blood loss, decrease operative time, and increase the rate of optimal cytoreductive surgery; but the median survival can’t be improved significantly.     

Oxaliplatin-based combination chemotherapy is still effective for the treatment of recurrent and platinum-resistant epithelial ovarian cancer: results from a single center

Background Combination paclitaxel and carboplatin is currently a first-line regimen for ovarian cancer.However,many patients develop tumor recurrence or drug resistance to this regimen.The study aims to investigate the effectiveness and safety of an oxaliplatin ＋ epirubicin ＋ ifosfamide regimen for the treatment of recurrent and drug-resistant epithelial ovarian cancer.Methods A retrospective analysis of 73 patients with recurrent and drug-resistant ovarian cancer was performed; 38 cases of them received oxaliplatin ＋ epirubicin ＋ ifosfamide regimens （lAP group）,35 patients received non-oxaliplatinbased chemotherapy regimens （control group）.The therapeutic effects and side effects of the oxaliplatin ＋ epirubicin ＋ ifosfamide regimen were analyzed and summarized.Kaplan-Meier survival curves and Cox proportional hazards regression were used to compare progression-free and overall survival between the two groups.Results Of the 38 patients in the lAP group,14 patients （36.84％） achieved complete remission,12 （31.58％） achieved partial remission,2 （5.26％） achieved stable disease and 10 （26.32％） developed progressive disease.The overall effective rate （complete or partial remission） of the lAP regime was 68.42％.While,of the 35 patients in the control group,12 patients （34.29％） achieved complete remission,3 （8.57％） achieved partial remission,5 （14.29％） achieved stable disease and 15 （42.86％） developed progressive disease.The overall effective rate was 42.86％,which was lower than that in the lAP group （P=0.035,X2=4.836）.Progression-free survival was 9.5 months （0-64 months） in the lAP group vs.3 months （0-74 months） in the non-oxaliplatin group （P=0.014 by Kaplan-Meier survival curves; HR=-2.260; 95％C/1.117-4.573; P=0.023 by Cox proportional hazards regression）.Median overall survival was 46 months （9-124 months）in the lAP group vs.35 months （9-108 months） in non-oxaliplatin group （P=0.018 by Kaplan-Meier survival curves;HR=2.272; 95％CI 1.123-4.598; P=0.022 by Cox proportional hazards regression）.In lAP group,15.79％ （6/38）of the patients suffered grade Ⅲ-Ⅳ bone marrow arrest.The main non-hematological side effects of the lAP regimen included nausea and vomiting （21.05％,8/38）,peripheral neurotoxicity （15.79％,6/38） and hepatic or renal lesions （2.63％,1/38）.The main side effects of the two chemotherapy regimens showed no statistical difference.Conclusion The oxaliplatin-based lAP regimen is potentially effective for salvage chemotherapy in patients with recurrent and drug-resistant ovarian cancer,with a better therapeutic effect and tolerable side effects.     

中医与西医治疗晚期非小细胞肺癌病人远期生存率的临床研究

Objective： To investigate the prognostic influence on long-term overall survival （OS） from treatment with Chinese medicine （CM） and chemotherapy or targeted therapy in advanced non-small-cell lung cancer （NSCLC） patients. Methods： The clinical data of 206 advanced NSCLC patients who were treated with CM and Western medicine in Beijing Cancer Hospital from April 1999 to July 2013 were retrospectively analyzed. Long-term survivors were defined as OS ≥ 3 years after treatment with CM and chemotherapy. Twenty-eight patients had OS ≥ 3 years, 178 had OS 〈 3 years, and all clinical data were statistically analyzed with the Cox model. Variables were gender, age, smoking status, performance status （PS） score, pathological type, clinical stage, first-line chemotherapy, targeted therapy, and use of CM. Univariate survival analysis was performed using the Kaplan-Meier method and log-rank sequential inspection. Multivariate survival analysis was used to analyze the meaningful factors of univariate survival analysis with the Cox model. Results： The survival rate of patients with OS ≥ 3 years was 13.6% （28/206）. Cox multivariate regression analysis showed that PS score, clinical stage, disease control rate to first-line chemotherapy, and use of CM were independent factors of long- term OS （all P〈0.05）. However, gender, age, smoking, and use of epidermal growth factor receptor tyrosine- kinase inhibitor were not significant （P〉0.05）. Conclusion： PS score, clinical stage, disease control rate to first- line chemotherapy, and use of CM are probably independent prognostic factors for long-term OS in patients with advanced NSCLC.     

Comprehensive Treatment with Chinese Medicine in Patients with Advanced Non-Small Cell Lung Cancer: A Multicenter, Prospective, Cohort Study

Objective: To determine whether additional Chinese medicine(CM) could prolong survival and improve the quality of life(QOL) in patients with advanced non-small cell lung cancer(NSCLC) compared with Western medicine(WM) alone. Methods: This was a multicenter, prospective cohort study. A total of 474 hospitalized patients with stage Ⅲ–Ⅳ NSCLC were recruited and divided into 2 groups. Patients in the WM group received radiotherapy, chemotherapy, and optimal supportive therapy according to the National Comprehensive Cancer Network(NCCN) guidelines. In the integrative medicine(IM) group, individualized CM(Chinese patent medicines and injections) and WM were administered. The primary end point was overall survival, and the secondary end points were time to disease progression, adverse events, and QOL. Follow-up clinical examinations and chest radiography were performed every 2 months. Results: The median survival was 16.60 months in the IM group and 13.13 months in the WM group(P0.01). The incidences of loss of appetite, nausea, and vomiting in the IM group were significantly lower than those in the WM group(P0.05). The QOL based on Functional Assessment of Cancer Therapy-Lung in the IM group was markedly higher than that in the WM group at the fourth course(P0.05). Conclusions: Additional CM may prolong survival and improve the QOL patients with NSCLC. The adverse effects of radio-and chemotherapy may be attenuated as CM is used in combination with conventional treatments.     

Ligustrazine as a salvage agent for patients with relapsed or refractory non-Hodgkin’s lymphoma

Background The prognosis is poor for patients with relapsed or refractory non-Hodgkin＇s lymphoma （NHL）. The main reason for poor prognosis is multidrug resistance （MDR）, for which the main phenotype is overexpression of P-glycoprotein （P-gp）. This study explored the efficacy of ligustrazine as a salvage agent in patients with relapsed or refractory NHL, and the relationship to P-gp expression. Methods Sixty patients were randomized to a reversal agent group, receiving ligustrazine plus chemotherapy, and a control group, receiving chemotherapy alone. Flow cytometry was performed to evaluate P-gp expression. Results In the 56 patients we were able to evaluate, there was no statistically significant difference in progression-free survival （PFS） in the two groups （P=0.0651）, but the reversal agent group had a higher overall response rate （ORR） than did the control group （P=0.048）. Forty-one of 56 patients had P-gp（＋） tumor cells. Among these patients, six of eighteen patients in the reversal agent group and in the control group had complete remission or complete remission/unconfirmed （CR＋CRu） reflecting a significant advantage in the reversal agent group （P=0.048）. Patients with P-gp（＋） tumor cells in the reversal agent group had a higher overall response rate （ORR） than did the control group （11/18 vs. 6/23, P=0.024）. Kaplan-Meier Survival curve and log-rank test demonstrated that patients with P-gp（＋） tumor cells in the reversal agent group had longer progression-free survival than did the control group （P=0.0464）. A small number of patients who received ligustrazine had a decrease in blood pressure. Conclusion Ligustrazine as a salvage agent in combination with chemotherapy can elevate response rate, prolong PFS with manageable toxicity, and correlate with P-gp expression in relapsed or refractory NHL.     

Chemotherapy with or without gefitinib in patients with advanced non-small-cell lung cancer: a meta-analysis of 6844 patients

Background Gefitinib is widely used in patients with advanced non-small-cell lung cancer （NSCLC）, in whom chemotherapy had failed. Previous trials reported inconsistent findings regarding the efficacy of gefitinib on overall survival （OS） and progression free survival （PFS）. This study was to evaluate the effects of chemotherapy plus gefitinib versus chemotherapy alone on survival of patients with NSCLC. Methods We systematically searched Medline, EmBase, the Cochrane Central Register of Controlled Trials, reference lists of articles, and proceedings of major meetings for relevant literature. Randomized controlled trials （RCTs） comparing chemotherapy with and without gefitinib in the treatment of patients with advanced NSCLC were included in our analysis. The primary endpoints were OS and PFS. Results Of 182 relevant studies, 12 were included in the final analysis, which consisted of 6844 patients with NSCLC. Overall, we noted that gefitinib therapy had an 8% improvement in the OS as compared to the gefitinib-free therapy, but this difference was not statistically significant （HR, 0.92; 95% CI： 0.85-1.00; P=0.051）. Furthermore, gefitinib therapy had significantly longer PFS compared to gefitinib-free therapy （HR, 0.72; 95% CI 0.60-0.87, P=0.001）. Patients receiving gefitinib therapy also had a more frequent objective response rate （ORR） than the control arm （OR, 2.51; 95% CI, 1.67- 3.78, P 〈0.001）. Rashes, diarrhea, dry skin, pruritus, paronychia, and abnormal hepatic function were more frequent in the gefitinib therapy group. Conclusions Treatment with gefitinib had a clear effect on PFS and ORR, and it might contribute considerably to the OS. Furthermore, there was some evidence of benefit for gefitinib therapy among patients with adenocarcinoma.     

Effect of multiple-phase regional intra-arterial infusion chemotherapy on patients with resectable pancreatic head adenocarcinoma

Background Regional intra-arterial infusion chemotherapy （RIAC） has been more valuable to improve prognosis and quality of life of patients with inoperable pancreatic adenocarcinomas, and adjuvant RIAC plays an important role in prolonging survival and reducing risk of liver metastasis after radical resection of pancreatic cancer, but the effect of preoperative or multiple-phase RIAC （preoperative combined with postoperative RIAC） for resectable pancreatic cancers has not been investigated. In this prospective study, the effect of multiple-phase RIAC for patients with resectable pancreatic head adenocarcinoma was evaluated, and its safety and validity comparing with postoperative RIAC were also assessed. Methods Patients with resectable pancreatic head cancer were randomly assigned to two groups. Patients in group A （n=-50） were treated with new therapeutic mode of extended pancreaticoduodenectomy combined with multiple-phase RIAC, and those in group B （n=-50） were treated with extended pancreaticoduodenectomy combined with postoperative RIAC in the same period. The feasibility, compliance and efficiency of the new therapeutic mode were evaluated by tumor size, serum tumor markers, clinical benefit response （CBR）, surgical complications, mortality and toxicity of RIAC. The disease-free survival time, median survival time, incidence of liver metastasis, survival rate at 1, 2, 3 and 5 years were also observed. Life curves were generated by the Kaplan-Meier method. Results The pain relief rate and CBR in group A was 80% and 84% respectively. Serum tumor markers decreased obviously and tumors size decreased in 26% of patients after preoperative RIAC in group A. No more surgical complications, mortality or severe systemic side effects were observed in group A compared with group B. The incidence of liver metastasis in group A was 34% which was lower than 50% in group B. The disease-free survival time and median survival time in group A were 15.5 months and 18 months respectively. The 1-, 2-, 3- and 5-year survival rates were 54.87%, 34.94%, 24.51% and 12.25% respectively. There was no significant difference of survival time or survival rates between two groups. Conclusions Multiple-phase RIAC is effective in combined therapy of resectable pancreatic head carcinomas by enhancing inhibition of tumor growth and reduction of liver metastasis, without negative effect on patients＇ safety or surgical procedure.     

Outcome of childhood acute lymphoblastic leukemia: a report of 121 patients treated at Wuhan Union Hospital of China

Prognostic factors are biological or physical characteristics of a patient or the patient＇s cancer that can be used to predict the outcome of the individual. The prognosis of childhood acute lymphoblastic leukemia （ALL） has been improved greatly in the past 40 years, reaching a long-term event free survival （EFS） of about 75% and overall survival of about 80% in developed countries.3-6 The same result has also been achieved in China. The ALL-XH-99 Protocol at Shanghai Children＇s Medical Center adopted early intensification treatment and triple intrathecal chemotherapy with high-dose methotrexate treatment for all patients and intensive chemotherapy in median risk （MR） and high risk （HR） patients. More intensive chemotherapy might cause more complications. In order to reevaluate the outcome of childhood ALL treated with the ALL-XH-99 Protocol and to fully elucidate the prognostic factors and the sequelae, a retrospective analysis was carried out to evaluate patients diagnosed with childhood ALL who were treated with the ALL-XH-99 Protocol in the past decade.     

Long-term results of prophylactic cranial irradiation for limited-stage small-cell lung cancer in complete remission

Background Brain metastasis is one of the most important causes of treatment failure in patients with small cell lung cancer (SCLC). This study was conducted to evaluate the effects of prophylactic cranial irradiation (PCI) on survival and brain metastases for patients with limited stage small cell lung cancer in complete remission.Methods Fifty one patients with limited stage SCLC in complete remission after chemoradiotherapy were randomly divided into PCI group (n=26) and control group (n=25). Patients in the PCI group received PCI at a dose of 25.2 to 30.6 Gy in 1.8 to 2.0 Gy per fraction. The Kaplan-Meier method and Log rank test were used to analyse and compare survival rates, and χ2 test was used to compare the incidences of cranial metastases in two groups. Results There was no significant difference in clinical characteristics of patients such as age, sex, effect of treatment before PCI between the two groups. The incidence of brain metastases was 3.8% in the PCI group in contrast to 32.0% in the control group (χ2=5.15, P=0.02). The 1, 3, 5-year survival rates were 84.6%, 42.3%, 34.6% respectively in the PCI group and 72.0%, 32.0%, 24.0% respectively in the control group, with no difference between the two groups (χ2=2.25, P=0.13). No serious sequelae were observed in patients receiving PCI. Conclusion For patients with limited stage SCLC responding completely to chemotherapy plus radiotherapy, PCI can decrease the incidence of brain metastases and improve survival rate.