吉西他滨联合顺铂治疗老年非小细胞肺癌效果观察

用吉西他滨联合顺铂治疗老年非小细胞肺癌患者29例。结果部分缓解10例,稳定12例,进展7例,有效率34．5％。中位肿瘤进展时间（TTP）5个月。随访超过12个月的患者19例,1a生存率为48％。常见不良反应是骨髓抑制和恶心呕吐,均为可逆性。认为吉西他滨联合低剂量顺铂化疗是治疗老年非小细胞肺癌较安全有效的方案。     

吉西他滨联合顺铂治疗老年非小细胞肺癌的临床观察

由于老年生理性功能退化与伴随疾病的存在,使老年肺癌患者对化疗的耐受性下降,副反应增加,因此在治疗方案的选择上遇到了很大的挑战.2003年美国临床肿瘤学年会(ASCO)肺癌指引推荐老年晚期非小细胞肺癌(NSCLC)治疗方案为第3代细胞毒药物单药治疗,但最近一些研究资料提示健康老年人也能接受标准化疗方案,其中低剂量顺铂(DDP)联合吉西他滨(GEM)有较好的耐受性与疗效.     

吉西他滨联合顺铂治疗非小细胞肺癌的疗效

由于肺癌病情进展快、控制率低、死亡率高等特点,肺癌初次诊断时,大部分已经出现远处转移,约10%~15%已属局部晚期肿瘤,患者手术风险较大,不宜手术治疗[1].随着新药的研发,抗癌新药如吉西他滨、多西紫杉醇正式投入临床使用,加之铂类药物联合治疗非小细胞肺癌(NSCLC),有效率较高.本文选取住院治疗的NSCLC患者为研究对象,采用吉西他滨联合顺铂治疗,观察其临床疗效.     

吉西他滨联合顺铂治疗老年晚期非小细胞肺癌的疗效

大部分非小细胞肺癌(NSCLC)患者到医院就诊时已属于癌症晚期,且患者中老年人居多,手术切除往往不是最佳选择[1].作为保守治疗,化疗是治疗老年晚期NSCLC的主要手段之一,它在延长患者生命、缓解患者痛苦和改善患者生活质量等方面有一定的作用.我院采用单纯吉西他滨静脉滴注与吉西他滨联合顺铂静脉滴注两种治疗方法对老年晚期NSCLC患者予以治疗,比较两种治疗方法的临床疗效和副作用.     

吉西他滨联合顺铂治疗晚期非小细胞肺癌的疗效观察

目的探讨吉西他滨联合顺铂治疗晚期非小细胞肺癌的安全性和疗效。方法回顾性分析该院经过GP方案（吉西他滨联合顺铂）治疗的68例晚期非小细胞肺癌的临床资料。对68例晚期非小细胞肺癌患者采用吉西他滨1000mg／m2静脉滴注,第1天和第8天,顺铂25mg／m2,静脉滴注,第1—3天,21～28d为一个周期,2个周期后对患者病情进行一次疗效评价。结果68例患者中完全缓解（CR）4例（5．9％）,部分缓解（PR）27例（39．7％）,稳定（SD）33例（48．5％）,进展（PD）4例（5．9％）,总有效率为45．6％（31／68）;鳞癌有效率为46．7％（14／30）,腺癌有效率为52．6％（20／38）。缓解期为（4．6±3．4）个月,1年生存率为44．1％（30／68）。结论吉西他滨联合顺铂治疗晚期非小细胞肺癌疗效好,副作用小,临床上值得推广应用。     

吉西他滨单药及联合顺铂治疗老年非小细胞肺癌临床疗效观察

目的本研究旨在分析年龄≥70岁的晚期非小细胞肺癌（non-small cell lung cancer,NSCLC）患者使用吉西他滨联合铂类化疗或吉西他滨单药化疗的疗效和毒性。方法选取≥70岁Ⅱ～Ⅳ期不能手术,并且东部肿瘤协作组（eastern cooperative oncology group,ECOG）体力状态评分（performance status,PS）为0～1分的NSCLC患者83例,仅用吉西他滨的单药化疗组40例,吉西他滨联合顺铂的联合化疗组43例,主要的研究终点为无进展生存期（progression free survival,PFS）。结果单药组患者平均年龄（74．75±1．72）岁,29例（占72.5％）患者有合并症,平均完成4．65个周期化疗。总有效率（overall response rate,ORR）为25％,疾病控制率（disease control rate,DCR）为70％,PFS为4月;联合组平均年龄（75．72±1．29）岁,28例（占65．1％）患者有合并症,平均完成4．02个周期化疗。ORR为39．5％,DCR为79．1％,PFS为6月。2组间差异有统计学意义（P〈0．05）。联合组不良反应更重。结论联合组疗效优于单药组,但Ⅲ-Ⅳ度不良反应发生率也较单药组高。吉西他滨联合铂类化疗在具有良好体力状态的≥70岁老年人是一种有效的治疗方案,并且具有可接受的毒性水平。     

吉西他滨联合顺铂治疗晚期非小细胞肺癌的临床观察

目的探讨吉西他滨联合顺铂治疗晚期非小细胞肺（NSCLC）的疗效及毒性。方法对26例晚期非小细胞肺癌患者予以顺铀80mg／m^2,VD,第1天,吉西他滨800—1000／m^2,VD,第1、8天,21d为一个周期,完成3个周期后评价疗效。结果全组总有效率为38．5％,其中鳞癌为40％,腺癌为36．4％,中位生存期12．1个月,1年生存率为41％。主要毒性反应为骨髓抑制和恶心呕吐,绝大多数患者可以耐受良好。结论吉西他滨联合顺铂治疗晚期非小细胞肺癌是安全、有效的化疗方案,可延长患者生存存期,毒性反应可以耐受。     

吉西他滨联合顺铂治疗晚期非小细胞肺癌临床观察

目的观察吉西他滨(GEM)与顺铂(DDP)联合治疗晚期非小细胞肺癌(NSCLC)的临床疗效及副作用。方法吉西他滨1 000 mg/m2,静脉滴注,第1、8天;顺铂40 mg/m2,第1、2天静脉滴注,每28 d为一周期。每2个周期评定疗效。治疗33例患者,其中有2例因吉西他滨过敏退出治疗组。结果完全缓解(CR)0例、部分缓解(PR)13例、稳定(SD)7例、进展(PD)11例,总有效率(CR+PR)41.9%(13/31),疾病控制率(CR+PR+SD)64.5%(20/31)。主要不良反应为骨髓抑制和恶心、呕吐。结论吉西他滨联合顺铂治疗非小细胞肺癌有效率41.9%。     

吉西他滨联合顺铂对老年晚期非小细胞肺癌患者的疗效及不良反应

非小细胞肺癌(NSCLC)约占肺癌的75%～80%,恶性程度较高,治疗困难,50%以上的患者确诊时已经失去了手术机会,需行放疗及(或)化疗[1].对老年晚期NSCLC患者来说,选择合理的化疗方案对其延长生命、提高生存质量非常重要.吉西他滨(GEM)属核糖核苷酸还原酶抑制剂,是美国食品药品管理局(FDA)批准的治疗NSCLC的一线药物.顺铂为周期非特异性药物,在肿瘤的治疗中应用较广泛,两者联合应用,患者耐受性较好,疗效明显优于其他常规的化疗方案.     

吉西他滨联合顺铂治疗老年晚期非小细胞肺癌的临床疗效

目的评价吉西他滨联合顺铂（GP方案）治疗老年晚期非小细胞肺癌的临床疗效与毒副反应。方法对30例经病理和（或）细胞确诊的老年晚期非小细胞肺癌患者,采用吉西他滨联合顺铂化疗。吉西他滨1000mg／m^2,静脉点滴,第1,8天各静滴1次;顺铂25mgc／m^2,静脉点滴,第1,2,3天各静滴1次,每28d为一个周期,化疗中记录毒副反应。2个周期为1个疗程。疗程结束后,评定疗效与毒副反应。结果全组完全缓解（CR）0例,部分缓解11例（11／30）,总有效率36．67％。最常见的毒副反应为白细胞减少和血小板减少。结论吉西他滨联合顺铂方案治疗老年晚期非小细胞肺癌患者临床疗效较好,毒副反应可耐受,值得推广应用。     

肺小细胞癌的综合治疗研究

肺小细胞癌经长期、间歇、ＶＣＭＢ为主的联合化疗和根治性放疗，以及中西医药综合治疗５４例，并做了连续追踪观察，结果完全缓解率为５９．２％部分缓解率为３８．９％总有效率达９８．１％．按Ｋａｐｌａｎ－Ｍｅｉｅｒ法计算，１、３、５年生存率局限期分别为７８．１％４２．６％和３２．１％广泛期分别为９０．５％，１３．４％１３．４％；其中属     

CHEMOTHERAPY FOR SMALL CELL LUNG CANCER: INPUCTION AND REINDUCTION WITH VOCA

Abstract Sixty-five patients with small cell lung cancer were treated with VP16, vincristine, cyclophosphamide, and doxorubicin (VOCA) intravenously at three-week intervals. Patients with limited disease received four cycles with responders receiving radiation to the primary site and prophylactic cranial irradiation. Patients with extensive disease received chemotherapy only. Of 59 patients evaluable for chemotherapy response, eight (14%) achieved complete remission and 30 (51%) partial remission. Major side-effects included myelosuppression, alopecia, nausea, and vomiting. Reinduction with VOCA at relapse yielded objective or subjective response in four of seven patients. This regimen is active in small cell lung cancer and was well tolerated by patients. Reinduction of resDonse was Dossible in a small number of Datients retreated and mav provide useful palhation for those who relapse when treatment is discontinued.     

老年肺癌的诊治

目的对65岁以上肺癌患者进行回顾性分析。方法自1994至2003年,我们共统计934例肺癌手术病人,其中65岁以上患者共355例,占38%,手术切除率为98.6%。结果平均年龄71.4±5岁(65～81岁),其中男性293例(82.5%),女性62例(17.5%)。手术包括:全肺切除26例,肺叶切除(包括双叶切除)286例,袖状切除27例,隆凸切除术5例,电视胸腔镜辅助下楔形切除6例,剖胸探查5例。术后病理为鳞癌185例,腺癌133例,大细胞癌17例,小细胞肺癌6例,其余的占14例。Ⅰ期26例,Ⅱ期6例,Ⅲ期323例。结论常规胸片检查可作为早期高危人群中检测肺癌的手段之一。虽然老年患者术后伴有高风险并发症,但手术仍然是治疗非小细胞肺癌(Ⅰ￣Ⅲ期)的主要手段,年龄并非是一个有意义的预后因素。本组病人中合并COPD者占37.6%。如病人的FEV1>1.6L或Vo2max>10ml/kg·min或能登上三楼(11米高),手术是安全的。总之,老年患者严格掌握手术适应证和做好术前准备,其手术并发症未显著增高。以手术为主的综合治疗能有效提高老年肺癌患者的生存期。     

LONG-TERM SURVIVAL IN SMALL CELL LUNG CARCINOMA

We assessed outcome in 208 patients with small cell lung carcinoma two to seven years after treatment with combination chemotherapy, with or without chest and cranial radiotherapy. Fourteen patients (6.7%) survived cancer free for 30 months or longer. Nine of these (64%) had limited disease at diagnosis and four others had extensive disease with only one metastatic site. Two patients remain alive and disease free more than five years after diagnosis but median survival is still only 3.2 years. One patient died from intercurrent causes at 5.4 years but was free from small cell lung carcinoma at autopsy. Six patients are alive and disease free at intervals greater than 30 months but less than five years from diagnosis. All surviving patients are fully active with lifestyles similar to that prior to diagnosis. Five patients died from small cell lung carcinoma which relapsed more than 30 months after diagnosis. A few patients with small cell lung carcinoma are cured but 30-month survival is insufficient to show cure as late relapses do occur. Late toxicity from aggressive therapy does not appear to outweigh the benefits of long-term survival and potential cure in small cell lung carcinoma.     

EARLY CROSSOVER OF INDUCTION CHEMOTHERAPY IN SMALL CELL LUNG CARCINOMA

The aim of this trial was to assess whether early crossover induction chemotherapy would improve the complete response rate in patients with small cell lung carcinoma. Tumour markers were defined in all 48 patients at diagnosis. The patients were reassessed after three and six cycles of chemotherapy and classified as having either complete, partial or non response of tumour on each occasion. Initial induction therapy consisted of cyclophosphamide, vincristine and adriamycin (T1). The therapy of the patients with no tumour response was changed to a regimen (T2) consisting of VP16-213, procarbazine, CCNU and high dose methotrexate with folinic acid rescue. The patients with partial tumour response were randomised to receive either T1 or T2, while patients with complete tumour response continued with T1. In those patients classified initially as having partial tumour response, crossover chemotherapy did not improve tumour response or survival. Similarly, in patients with no tumour response there was not an acceptable improvement. We conclude that non cross resistant crossover chemotherapy using these drug regimens confers no added benefit when compared with continuing the initial therapy.     

SUCCESSFUL MANAGEMENT OF METASTASIS‐INDUCED PANCREATITIS BY ENDOSCOPIC PANCREATIC DUCT STENTING IN A CASE OF LARGE CELL LUNG CANCER

The prognosis for patients with metastasis‐induced acute pancreatitis (MIAP) is extremely poor. Although chemotherapy has been shown to improve overall survival in patients with MIAP, as well as in patients with small cell lung cancer, it is poorly tolerated by patients with severe pancreatitis. Furthermore, patients with a history of chemotherapy often develop multidrug‐resistant tumors. Here we report a first case of MIAP that was successfully managed by endoscopic pancreatic duct stenting. A 54‐year‐old man with pancreatic metastasis from large cell lung cancer developed acute pancreatitis approximately three times per month, despite a continuous conventional therapy for pancreatitis. As his disease was refractory to chemotherapy, he underwent endoscopic pancreatic duct stenting. The procedure was successful in controlling his pancreatitis, and he survived 7 months after the onset of a first acute pancreatitis. Our experience with this case suggests pancreatic duct stenting as one therapeutic method for MIAP.     

晚期血吸虫病患者肝脾内T细胞亚群的定位观察

采用免疫组织化学技术检测了22例晚期血吸虫病（下称晚血）患者肝内T细胞亚群，发现T细胞集中分布于虫卵肉芽肿外层，在非肉芽肿部位散在分布于虫卵附近，而广泛纤维化的区域内无T细胞浸润。肉芽辟和非内芽肿部位的T细胞均以CD8 细胞为主。19例患者脾脏内T细胞观察，发现脾脏动脉周围淋巴鞘和边缘区的CD4 细胞百分比和CD4 ／CD8 比值显著降低，CD8 T细胞百分比明显提高，而且由于脾脏纤维化，导致红素区T细胞稀疏，动脉周围淋巴鞘T细胞外移，本文讨论了以上结果在晚血免疫调控中的作用。