奥沙利铂、羟基喜树碱、氟尿嘧啶、亚叶酸钙联合方案治疗晚期胃癌42例

[目的]评价奥沙利铂、羟基喜树碱、氟尿嘧啶、亚叶酸钙联合治疗42例晚期胃癌疗效.[方法]羟基喜树碱10mg/m2静滴第1～5d,奥沙利铂100mg/m2静滴第1d;亚叶酸钙100 mg/d静滴第6～10d,氟脲嘧啶750 mg/d静滴第6～10d.28天为1个化疗周期,完成3周期后评价疗效.[结果]42例晚期胃癌患者中CR 3例(7.14%),PR 17例(40.48%),NC 14例(40.48%),PD 8例(33.33%).总有效率(CR PR)为47.62%(20/42).毒副反应为骨髓系和消化系不良反应,发生率较高,基本上为Ⅰ度和Ⅱ度.经对症处理后均能缓解.本组未发生严重不良反应而终止治疗者,也无与化疗相关死亡病例.[结论]奥沙利铂、羟基喜树碱、氟尿嘧啶、亚叶酸钙治疗晚期胃癌疗效好,毒副反应轻.     

紫杉醇联合氟尿嘧啶、顺铂与奈达铂联合亚叶酸钙、氟尿嘧啶治疗晚期食管癌的对比研究

目的观察紫杉醇联合氟尿嘧啶、顺铂与奈达铂联合亚叶酸钙、氟尿嘧啶治疗晚期食管癌的临床疗效及毒副反应。方法 52例晚期食管癌患者随机以紫杉醇联合氟尿嘧啶、顺铂的方案或亚叶酸钙、奈达铂联合亚叶酸钙、氟尿嘧啶的方案化疗,均化疗2个周期以上,每个周期28d。结果紫杉醇联合氟尿嘧啶、顺铂方案（紫杉醇组）的有效率（CR＋PR）为50.0%,毒副反应有胃肠道反应、神经毒性、关节肌肉疼痛及血液学毒性,Ⅲ～Ⅳ级胃肠道反应占12.5%,Ⅲ～Ⅳ级血液学毒性占41.7%。奈达铂联合亚叶酸钙、氟尿嘧啶方案（奈达铂组）的有效率（CR＋PR）为46.4%,主要有血液学毒性,胃肠道反应,Ⅲ～Ⅳ级胃肠道反应为7.1%,Ⅲ～Ⅳ级血液学毒性为25.0%。结论紫杉醇联合氟尿嘧啶、顺铂治疗晚期食管癌与奈达铂联合亚叶酸钙、氟尿嘧啶治疗晚期食管癌相比,副反应均可耐受,疗效相当。奈达铂联合亚叶酸钙、氟尿嘧啶的副反应相对较少。     

小剂量化疗治疗高龄晚期胃癌21例

[目的]观察小剂量氟尿嘧啶(5-Fu)与顺铂(DDP)、羟基喜树碱(HCPT)组成的FDH方案静脉给药治疗高龄晚期胃癌的临床疗效。[方法]治疗组21例,给予FDH方案:CF100mg/d,静脉滴注,第1～5天;5-Fu250mg/d,持续静脉滴注4h,第1～5天;DDP10mg/d,静脉滴注,第1～5天;HCPT5mg/d,静脉滴注,第l～5天。对照组33例,给予FOLFOX4方案:奥沙利铂130mg/m2,静脉滴注,第1天;亚叶酸钙200mg/m2,静脉滴注,第1、2天;5-Fu400mg/m2,静脉滴注,第1天,接着以5-Fu600mg/(m2·d),持续泵入48h;每28天为1个疗程。化疗2个疗程后评价疗效及不良反应。[结果]FDH方案组21例,CR1例,PR9例,NC7例,PD5例,有效率(CR PR)47.6%。中位生存期10.3个月。FOLFOX4方案组33例,CR2例,PR14例,NC10例,PD7例,有效率(CR PR)48.5%,中位生存期10.6个月,两组疗效无显著性差异(P>0.05)。两组主要不良反应均为白细胞减少和胃肠道反应。FDH组Ⅲ～Ⅳ度的白细胞下降(4.76%)及胃肠道反应(0)均较FOLFOX4组(18.18%、12.12%)低(P<0.05)。[结论]小剂量DDP、HCPT联合5-Fu持续静脉滴注是治疗高龄晚期胃癌的有效、安全的方案。     

脂质体紫杉醇联合顺铂及氟尿嘧啶一线治疗43例晚期胃癌的临床研究

[目的]评价脂质体紫杉醇（力扑素）联合顺铂、氟尿嘧啶（5-Fu）组成的PCF方案一线治疗43例晚期胃癌的临床疗效和毒副反应。[方法]脂质体紫杉醇135～175mg/m2,静滴3h,d1;顺铂20mg/m2,静滴2h,d1～5;5-Fu750mg/m2持续静脉滴注d1～5。21d为1个周期。按RECIST标准评定疗效,按WHO标准评价毒副反应,Kaplan-Meier法绘制生存曲线。[结果]全组共完成化疗167个周期,中位治疗3个周期。39例患者完成2个周期以上化疗并可评价疗效,其中CR1例,PR19例,SD11例,PD8例,总有效率51.3%。中位无进展生存时间6.0个月,中位总生存时间11.5个月,1年生存率41.0%。主要的Ⅲ~Ⅳ级血液学毒性为白细胞减少及中性粒细胞减少,发生率分别为16.2%和25.6%。全组仅1例发生过敏反应。无患者因毒性反应而停药,无治疗相关性死亡发生。[结论]脂质体紫杉醇联合顺铂及氟尿嘧啶一线治疗晚期胃癌疗效肯定,毒副反应轻,对患者生活质量改善明显。     

HLFP与VLFP方案治疗晚期大肠癌的临床研究

[目的]评价羟基喜树碱（HCPT）、甲酰四氢叶酸（LV）、氟尿嘧啶（5-Fu）、顺铂（DDP）方案（HLFP方案）与鬼臼噻吩苷（VM26），甲酰四氢叶酸、氟尿嘧啶和顺铂方案（VLFP方案）治疗晚期大肠癌的近期疗效和毒副反应。[方法]晚期大肠癌60例．27例应用HLFP方案：HCPT10mgd1-5、LV300mgd1-3、5-Fu750mgd1-3、DDP30～40mgd1-3；33例应用VLFP方案：VM26100mgd1-3、LV300mgd1-3、5-Fu750mgd1-3、DDP30～40mgd1-3，每21～28d重复，2个周期为1个疗程。[结果]VLFP组无CR病例，PR9例，ST20例，PD4例，有效率273％：HLFP组无CR病例，PR9例，ST16例，PD2例，有效率333％（P〉0．05）。两组主要毒剐反应为骨髓抑制、恶心呕吐等，未发生与化疗相关的死亡病例：[结论]HLFP、VLFP方案治疗晚期大肠癌有望进．步提高临床疗效，值得临床推广使用.     

国产奥沙利铂与氟尿嘧啶、亚叶酸钙联合治疗晚期大肠癌

[目的]研究奥沙利铂(L-OHP)与氟尿嘧啶(5-Fu)及亚叶酸钙(CF)联合治疗晚期大肠癌的疗效和毒副反应.[方法]38例晚期大肠癌,国产奥沙利铂130mg/m2,静脉滴注2h,d1;亚叶酸钙200 mg/d,静脉滴注2h,d1～5;氟尿嘧啶500mg/m2,静脉滴注4h,d1～5(CF滴完后);21天为1个周期,治疗2个周期后评定疗效.[结果]37例可评定疗效患者中,CR1例,PR11例,SD22例,PD3例,有效率(CR PR)32.4%.毒副反应以Ⅰ～Ⅱ度消化道症状、骨髓抑制、感觉神经毒性为主,有一定的肝损害.[结论]奥沙利铂与氟尿嘧啶、亚叶酸钙联合治疗大肠癌疗效确切,毒副反应能耐受.     

羟基喜树碱联合顺铂治疗晚期食管鳞癌临床观察

目的观察羟基喜树碱(HCPT)联合顺铂(PDD)组成的HP方案对晚期食管鳞癌的近期疗效和不良反应。方法43例晚期食管癌患者采用HP方案:羟基喜树碱(HCPT)6 mg/m2,d1~5,静脉点滴;顺铂(PDD)20 mg/m2,d1~5,静脉点滴。21天为1个周期。化疗2个周期后评价近期疗效和不良反应。结果43例均可评价,CR 5例(11.6%)、PR 17例(39.5%)、SD 15例(34.9%)和PD 6例(14.0%)。近期总有效率51.2%。主要不良反应为骨髓抑制和胃肠道反应,多为Ⅰ~Ⅱ度,患者均可耐受,不影响治疗正常进行。结论HP方案治疗晚期食管癌近期疗效好,不良反应少,值得临床推广应用。     

吉西他滨联合顺铂治疗晚期食管癌的临床观察

目的 观察吉西他滨联合顺铂一线治疗晚期食管癌的临床疗效及毒副反应.方法 33例无法手术治疗的局部晚期食管癌患者接受吉西他滨联合顺铂方案:吉西他滨1 000 mg·m-2,d1.8,静脉滴注;顺铂30 mg ·m-2,d2～4,静脉滴注,21 d为1周期,所有患者均接受不少于2周期的化疗.治疗结束后评价疗效和毒副反应.结果　33均可评价疗效,其中CR 1例,PR 16例,SD 10例,PD 6例,总有效率为51.5％,临床获益率为81.8％,毒副反应主要是骨髓抑制和消化道反应,治疗有效的患者进食困难和胸痛均不同程度缓解.结论 吉西他滨联合顺铂一线治疗晚期食管癌可获得较好的疗效,且毒副反应可耐受.     

羟基喜树碱联合化疗治疗晚期大肠癌近期疗效分析

目的观察以羟基喜树碱为主的联合化疗方案治疗晚期大肠癌的近期疗效及毒副反应.方法 HCPT 8～10 mg/m2,静脉滴注,第1～5天;DDP 20 mg/m2,静脉滴注,第1～3天;CF 100 mg/d,静脉滴注,第1～5天;5-Fu 300 mg/m2,静脉滴注,第1～5天,每21～28 d为一周期,2周期为一疗程.结果 39例均可评价疗效,CR 0例,PR 17例,SD 16例,PD 6例.有效率(CR PR)43.6%,化疗受益率(CR PR SD)84.6%.初治有效率为50.0%,化疗受益率90.6%.毒副反应主要为骨髓抑制和消化道反应.结论羟基喜树碱为主的联合化疗疗效高,毒副反应可耐受.     

吉西他滨联合奈达铂治疗晚期鼻咽癌32例临床观察

[目的]评价吉西他滨联合奈达铂治疗晚期鼻咽癌的疗效和毒副作用。[方法]64例晚期鼻咽癌患者随机分为治疗组和对照组,各32例,治疗组采用吉西他滨联合奈达铂治疗,对照组采用氟尿嘧啶联合顺铂治疗。评价两组疗效和毒副反应。[结果]治疗组：CR6例,PR20例,SD4例,PD2例,有效率81.25%;1年生存率93.75%。对照组：CR4例,PR16例,SD7例,PD5例,有效率62.50%;1年生存率81.25%。对照组消化道反应及口腔黏膜反应发生率均明显高于治疗组（P〈0.05）,而血小板抑制发生率治疗组明显高于对照组（P〈0.05）。[结论]吉西他滨联合奈达铂一线治疗晚期鼻咽癌近期疗效较好,安全性良好。     

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.     

Sarcopenia is associated with survival in patients with urothelial carcinoma treated with systemic chemotherapy

International Journal of Clinical Oncology - Sarcopenia impacts perioperative outcomes and prognosis in various carcinomas. We aimed to investigate whether sarcopenia at the time of chemotherapy...     

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.     

超声心动图诊断26例心脏黏液瘤

应用经胸二维超声心动图（2DE）、彩色血流显像（CDFI）及频谱多普勒显像（Doppler）诊断26例心脏黏液瘤（27个瘤体）,对团块的位置、数目、大小、形状、瘤蒂附着点和活动度、心腔内及瓣膜口血流等进行探查及分析．认为心脏超声检查是心脏黏液瘤的首选检查方法,具有实时、经济、简便易行等优点。     

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