鼻咽癌首程放疗后颈部淋巴结复发因素探讨

目的研究鼻咽癌首程放疗后颈部淋巴结复发的相关因素。方法对3 124例鼻咽癌初诊患者采用60Co分段放射治疗和连续放射治疗后,分析淋巴结分期、照射布野、放疗剂量及分段治疗间歇与颈部淋巴结复发的相关性。结果治疗前淋巴结分期高与颈淋巴结复发有关,N0,N1,N2,N3期复发率分别为12.8 %,12.2 %,23.7 %和27.5 %(P<0.001)。全颈和半颈照射的复发率分别为19.3 %和6.9 %(P>0.05)。在终止剂量为60 Gy和65 Gy时,消退剂量为45 Gy时复发率均较55 Gy低,分别为12.4 %,24.1 %(P<0.001)和11.5 %,23.3 %(P<0.001)。连续放疗复发率为11.9 %,低于分段放疗组21.8 %(P<0.001),分段放疗间歇时间长也与复发有关(P = 0.038)。结论鼻咽癌放疗后颈淋巴结复发与N分期高以及疗程呈正比,靶区漏照或剂量不足也是复发的重要因素。     

影响N0期鼻咽癌放射治疗后颈淋巴结复发因素分析

目的分析颈淋巴结阴性(N0)鼻咽癌放射治疗后颈淋巴结复发的影响因素。方法采用Logistic回归方法回顾性分析接受放射治疗的N0期鼻咽癌211例复发因素。结果211例N0期鼻咽癌放射治疗后49例复发。采用面颈联合野放射治疗,上颈预防剂量>50 Gy比面颈分野上颈剂量50 Gy者颈淋巴结复发率低（t=12.93,P=0.000)。咽旁间隙受侵,T分期高,颈淋巴结复发率高（t=14.91,P=0.001及t=8.78,P=0.003)。全颈预防照射比单纯上颈预防照射的下颈复发率低（χ     

放疗联合卡铂同步化疗治疗晚期鼻咽癌

[目的]观察放射治疗联合卡铂同步化疗治疗鼻咽癌的疗效.[方法]回顾研究72例晚期鼻咽癌的治疗结果.其中33例予放疗联合卡铂同步化疗(综合组).以同期接受单纯放疗的39例晚期鼻咽癌患者作为对照组(单放组).两组照射方法和剂量相同.[结果]综合组和单放组在照射剂量36Gy时,颈淋巴结完全消退率分别为21.2%和20.5%(P＞0.05),鼻咽病灶均无完全消退.综合组和单放组在放疗结束时,颈淋巴结消退率分别为84.8%和59.0%(P＜0.05),鼻咽病灶完全消退率分别为78.8%和53.8%(P＜0.05).综合组的主要毒副反应为黏膜炎和骨髓抑制.[结论]放疗联合卡铂同步化疗可提高晚期鼻咽癌的近期疗效.     

不同定位法应用于鼻咽癌放疗临床分析

[目的]探讨鼻咽癌放射治疗时CT模拟定位的远期疗效及后遗症.[方法]随机将103例经病理证实的鼻咽癌病例分成CT模拟定位组53例和常规模拟定位组50例.CT模拟定位组先设面颈联合野和下颈切线野,常规分割照射,DT36～40Gy后面颈联合野后界前移避开脊髓,后上颈部采用9～12MeV电子线照射,最后阶段采用6MV X线多野适形缩野照射放疗前的肿瘤区,总量68～74Gy.常规模拟定位按骨性标记,先设面颈联合野和下颈切线野,DT36～40Gy后改成耳颞部侧野和耳后电子线野以及全颈切线野.[结果]两组随访5年以上.CT模拟定位组5年生存率、无复发生存率及复发率分别为69.8%、67.9%和7.5%,而常规组分别为50.0%、48.0%和24.0%,两组比较,差异具显著性(P＜0.05).放疗后遗症CT模拟定位组1例耳聋,常规组外展神经麻痹1例,耳聋2例,放射性脑病2例.两组均无放射性脊髓炎.[结论]鼻咽癌放射治疗时用CT定位适形放疗较常规模拟定位放疗能提高疗效,减少复发和放疗后遗症.     

N0期鼻咽癌上半颈预防照射的长期随访结果

背景与目的:对N0期鼻咽癌患者的颈部预防照射,照射范围必须包括全颈还是上半颈,目前还存在争议。本研究的目的是通过回顾性分析评价N0期鼻咽癌半颈照射的合理性。方法:回顾性分析432例N0期鼻咽癌患者半颈预防照射颈部长期控制结果及相关因素。全部患者均接受根治性放疗,鼻咽中位剂量DT70Gy;颈部治疗范围只包括双侧上半颈,治疗中位剂量DT50Gy。Kaplan-Meier法计算相关生存率、颈部复发率,log-rank检验对颈部复发率差异进行分析,Cox比例风险模型进行多因素分析。结果:共有17例患者治疗后发生颈部淋巴结转移,颈部5年控制率96.06%;其中6例患者同时合并鼻咽部复发,11例单纯颈部复发。单纯野内和野外复发率分别为0.93%(4/432)和1.62%(7/432),两者差异无统计学意义(P=0.937)。63例患者有鼻咽复发,有鼻咽复发者的颈部复发率为9.52%(6/63),明显高于无鼻咽复发者的2.98%(11/371),两者差异有统计学意义(P=0.002)。多因素分析显示鼻咽复发是影响颈部控制的独立预后因素。结论:N0期鼻咽癌患者放射治疗后颈部复发率很低,颈部预防照射范围仅包括双上颈是合理的。     

NO期鼻咽癌上半颈预防照射的长期随访结果

背景与目的:对NO期鼻咽癌患者的颈部预防照射,照射范围必须包括全颈还是上半颈,目前还存在争议.本研究的目的是通过回顾性分析评价NO期鼻咽癌半颈照射的合理性.方法:回顾性分析432例NO期鼻咽癌患者半颈预防照射颈部长期控制结果及相关因素.全部患者均接受根治性放疗,鼻咽中位剂量DT 70 Gy;颈部治疗范围只包括双侧上半颈,治疗中位剂量DT 50 Gy.Kaplan Meier法计算相关生存率、颈部复发率,log-rank检验对颈部复发率差异进行分析,Cox比例风险模型进行多因素分析.结果:共有17例患者治疗后发生颈部淋巴结转移,颈部5年控制率96.06%;其中6例患者同时合并鼻咽部复发,11例单纯颈部复发.单纯野内和野外复发率分别为0.93%(4/32)和1.62%(7/32),两者差异无统计学意义(P=0.937).63例患者有鼻咽复发,有鼻咽复发者的颈部复发率为9.52%(6/3),明显高于无鼻咽复发者的2.98%(11/71),两者差异有统计学意义(P=0.002).多因素分析显示鼻咽复发是影响颈部控制的独立预后因素.结论:NO期鼻咽癌患者放射治疗后颈部复发率很低,颈部预防照射范围仅包括双上颈是合理的.     

复发性鼻咽癌三维适形放射治疗的疗效分析

目的 分析复发性鼻咽癌三维适形放射治疗的疗效及影响疗效的因素.方法 56例复发性鼻咽癌接受三维适形放射治疗,鼻咽部剂量50～70Gy/36～52d(中位64Gy/44d).结果 全组病例随访3年以上.3年总生存率、无瘤生存率和鼻咽部局部控制率分别为48.2 %、44.6%和53.6%.复发间隔时间＞2年和复发临床分期T2期者,3年生存率和局部控制率高(P＜0.05);再程放疗剂量≥60Gy者,3年生存率和局部控制率优于＜60Gy.结论 三维适形放射治疗是复发性鼻咽癌有效的治疗手段,其复发间隔时间、复发临床分期和再程放疗剂量是影响预后的因素.     

N_0期鼻咽癌颈部照射的合适范围探讨

 目的　确定N0 期鼻咽癌颈部照射的合适范围。方法　回顾性分析 196例N0 期鼻咽癌病人治疗后颈部控制结果及相关因素。全部病例接受单纯根治性放疗 ,鼻咽中位剂量DT70Gy ;颈部治疗范围只包括双侧上半颈 ,治疗剂量DT( 4 0～ 72 )Gy(平均DT4 7Gy ,中位DT5 0GY)。 结果　共有 9例病人治疗后发生颈部淋巴结转移 ,颈部 5年控制率 96 .1%。其中 4例同时合并鼻咽部复发 ,单纯颈部复发 5例 ,单纯颈部复发率 2 .5 5 % ( 5 / 196 )。颈部治疗剂量低于DT4 5Gy组的颈部复发率为9.0 % ( 6 / 6 7)明显高于剂量高于DT4 5Gy组的2 .3% ( 3/ 12 9) ;有鼻咽复发者的颈部复发率 13.3% ( 4 / 33)明显高于无复发者的 3.0 % ( 5 / 16 6 ) ;以上差异有统计学意义。结论　N0 期鼻咽癌病人放射治疗后颈部复发率很低 ,颈部治疗范围包括双上颈已足够 ,治疗剂量应高于 4 5Gy。     

NO期鼻咽癌颈淋巴结区域预防照射方式的探讨

背景与目的:鼻咽癌一侧或双侧颈部淋巴结阴性者颈部的区域预防照射范围及剂量尚无定论。本研究通过回顾性分析,探讨鼻咽癌影像学诊断N0期患者颈部预防野照射方式,并分析颈部淋巴结复发因素及预后因素。方法:收集2002年1月至2004年12月205例N0期鼻咽癌患者资料,治疗前均行鼻咽部和颈部影像学检查。采用直线加速器产生的6～8MV高能X线,以面颈联合野为主的放疗技术,鼻咽原发灶照射剂量为60～80Gy,颈部剂量为46～64Gy。常规分割、连续照射。按颈部预防照射范围将患者分为两组,半颈预防组和全颈预防组。60例进行了化疗。随访时间3～68个月,中位随访时间44个月。累积生存率采用Kaplan-Meier计算,对生存率的差异采用log-rank进行显著性检验,多因素分析采用Cox风险比例模型前进法。结果:205例N0期鼻咽癌患者,3年总生存率及无瘤生存率分别为92.9%、91.9%。半颈、全颈预防组淋巴结复发率分别为2.27%、0,T1、T2、T3、T4期患者的颈部复发率分别为0、3.08%、0、0,鼻咽无复发时、复发时的颈部淋巴结复发率分别为1.03%、0,各组淋巴结复发率比较差异均无统计学意义(P>0.05)。半...     

鼻咽癌调强放疗后颈淋巴结复发的临床分析

[目的]探讨鼻咽癌调强放疗后颈淋巴结复发的影像学表现及临床特征。[方法]回顾分析初治鼻咽癌172例调强放疗后7例确诊为颈淋巴结复发患者的临床及影像学特点。[结果]鼻咽癌调强放疗后3年颈淋巴结复发率为3%;N2＋N3组发生颈淋巴结复发的概率大于N0＋N1组（P=0.006）;颈淋巴结复发以Ⅱ区复发最常见（100.0%,7/7）,其中单区复发85.7%（6/7）,多区复发14.3%（1/7）,均为原部位高剂量区复发;复发淋巴结常见中央液化坏死,较大淋巴结多伴有包膜外侵犯;2例行PET/CT检查,病变处18F-FDG呈明显高摄取,SUV值最大为7.9和12.8;3例颈部复发淋巴结行单纯挽救性手术治疗,均长期无瘤生存,2例分别因合并鼻咽或多区淋巴结复发行二程调强放疗,1例行伽玛刀治疗,1例未治疗。[结论]鼻咽癌调强放疗后颈淋巴结复发率低,治疗前高N分期易于复发,以Ⅱ区原部位高剂量区复发最常见;早期发现早期手术治疗疗效好。     

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.     

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.     

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     

奥沙利铂联合羟基喜树碱治疗晚期胃癌临床分析

背景与目的体外及体内的临床研究显示,奥沙利铂(L-OHP)对多种肿瘤有显著抑制作用并与绝大多数抗癌药物具有相加或协同细胞毒作用.本文旨在观察L-OHP联合羟基喜树碱(HCPT)治疗晚期胃癌的近期疗效和患者耐受性,并与传统的化疗方案进行对比.方法采用非随机的分组方法将43例晚期胃癌患者分为L-OHP+HCPT方案组(治疗组)与Vp-16+CF+5-FU(ELF)方案组(对照组),其中男性28例,女性15例,中位年龄59岁,KPS评分≥60,观察两组的近期疗效和患者耐受性.结果治疗组24例有效率58.3%(14/24),对照组19例有效率42.1%(8/19).治疗组有效率高于对照组,两组差异有显著性(P<0.05).两组不良反应主要是骨髓抑制、恶心、呕吐、口腔炎、周围神经炎、静脉炎、脱发等,均在Ⅰ、Ⅱ度范围内.结论L-OHP联合HCPT方案治疗晚期胃癌疗效较好,不良反应可以耐受.     

Varicella-Zoster Virus Prophylaxis with Low-Dose Acyclovir in Patients with Multiple Myeloma Treated with Bortezomib

BackgroundVaricella-zoster virus (VZV) reactivation is a common complication in patients with multiple myeloma (MM) treated with bortezomib, with an incidence rate of 10%-60%. The aim of our study was to analyze the effect of acyclovir prophylaxis in this patient population.Patients and MethodsWe studied 98 consecutive patients with relapsed MM treated with bortezomib. Bortezomib 1.3 mg/m² was given on days 1, 4, 8, and 11 of a 21-day cycle. At first, patients did not receive any VZV prophylaxis, but because of the high incidence of VZV reactivation, VZV prophylaxis with acyclovir was implemented subsequently.ResultsA total of 11 patients treated with bortezomib did not have any VZV prophylaxis, and 4 of these 11 patients (36%) developed VZV reactivation in the form of herpes zoster. No VZV reactivations were observed in the 32 patients who received acyclovir 400 mg 3 times daily or the 55 patients who received acyclovir in a dose reduced to 400 mg once daily during bortezomib treatment.ConclusionVaricellazoster virus reactivation is a common and serious adverse effect of bortezomib treatment. Acyclovir 400 mg once daily is sufficient to protect from VZV reactivation in patients with MM treated with bortezomib.