TP与EP方案治疗晚期非小细胞肺癌疗效比较

TP组给紫杉醇135mg／m^2，静脉滴入，3h,d1:DDP75mg／m^2，静脉滴入，d2(水化、止吐)。EP组给Vp-16 100mg／m^2,静脉滴入，d1～d5；DDP75mg/m^2,静脉滴入，d1(水化、止吐)。两组均21d为1个周期，完成2～3个周期后评价疗效及毒副反应。结果 TP组CR1例，PR9例，CR PR55％，中位生存时间10．6个月，1年生存率39％；EP组PR5例，CR PR33％，中位生存时间7．5个月，1年生存率18％。两组毒副反应主要表现为胃肠道反应及脱发，剂量限制性毒副反应为骨髓抑制，用集落细胞刺激因子可减轻骨髓毒性作用。TP方案是治疗晚期非小细胞肺癌的有效化疗方案。     

晚期复治性胃癌FOLFIRI方案化疗的临床观察

为了观察FOLFIRI方案治疗复治性晚期胃癌的临床疗效和毒副反应，对26例晚期复治性胃癌患者，采用FOLFIRI方案治疗。FOLFIRI方案；伊立替康180mg／m^2，持续静脉滴入90min，d1；甲酰四氢叶酸400mg／m^2，持续静脉滴入2h，d1；5氟尿嘧啶400mg／m^2，静脉推注，5-氟尿嘧啶2400mg／m^2，静脉微量泵46h持续滴入，d1，14d为1个周期。连用4个周期后评价疗效。结果26例患者均可评价疗效与毒副反应，获得CR 1例（3，8％），PR 10例（38.5％），SD 12例（46，2％），PD 5例（11.5％），近期客观有效率为42．3％（11／26）。中位肿瘤进展时间（TTP）4．5个月，中位生存期为8．3个月。毒副反应主要为骨髓抑制、迟发性腹泻。初步研究结果提示，对于晚期复治性胃癌患者，FOLFIRI方案是一种有效的、不良反应可以耐受的治疗手段，值得进一步研究。     

多西紫杉醇为主方案治疗复治的晚期上消化道癌的临床研究

目的：观察多西紫杉醇（多西他赛）为主方案治疗晚期上消化道癌的客观疗效和毒副反应。方法：全组31例患者，其中食管癌9例，贲门癌5例，胃癌17例，均为复治患者。应用TP（多西他赛30mg／m^2，静脉滴入，d1、d8、d15顺铂20mg／d，静脉滴入，d1～d5）或TF方案（多西他赛30mg／m^2，静脉滴入，d1、d8、d15；5一氟尿嘧啶500mg／m^2，静脉滴入，d1～d5），每28d重复，每例患者接受2个周期以上方可评价疗效。结果：31例患者均可评价疗效和毒副反应，PR8例，NC13例，PD10例，有效率为25．8％（8／31），疾病控制率为67．7％（21／31），中位TTP为4．9个月。主要毒副反应为骨髓抑制和乏力。结论：多西他赛为主方案治疗晚期上消化道癌患者疗效较好，毒副反应可以耐受，值得进一步观察。     

乳腺癌TAC与CAF方案新辅助化疗的临床观察

目的：评估TAC方案在可手术乳腺癌新辅助化疗（NCT）中的临床疗效和毒副反应。方法：对80例经粗针穿刺活检病理确诊的可手术乳腺癌患者进行NCT，设置CAF方案为对照组。TAC组（40例）：多西紫杉醇75mg／m^2，静脉滴入，d1；吡柔比星40mg／m^2，静脉推注，d1；环磷酰胺500mg／m^2，静脉推注，d1。CAF组（40例）：环磷酰胺500mg／m^2，静脉推注，d1；吡柔比星40mg／m^2，静脉滴入，d1；5-FU 600mg／m^2，静脉滴入，d1、d8。每21d为1个疗程，共2～4个疗程，4例锁骨上淋巴结阳性的ⅢC期患者因经2个周期的CAF变化不显著改用TAC方案而出组。结果：TAC组CR5例，PR28例，SD7例，RR为82．5％（33／40），降期率62．5％（25／40）。CAF组CR1例，PR22例，SD13例，RR为63．9％（23／36）；降期率33．3％（12／36）。两组淋巴结转阴率分别为43．75％（14／32）和38．5％（10／26）。两组间在化疗临床疗效、降期率方面差异有统计学意义，P〈0．05。毒副反应上TAC组和CAF组除在脱发、白细胞毒性方面差异有统计学意义外，其他差异均无统计学意义。结论：TAC在可手术乳腺癌治疗中疗效显著且耐受性良好，是优于CAF的NCT方案。     

奥沙利铂联合5-氟尿嘧啶与亚叶酸钙治疗大肠癌的临床分析

目的研究奥沙利铂（L-OHP）与氟尿嘧啶（5-Fu）及亚叶酸钙（CF）联合应用治疗晚期大肠癌的疗效和毒副反应。方法采用L-OHP130mg／m^2，静脉滴入4h，d1；CF200mg／m^2，静脉滴入2h，d1-5；5-Fu300mg／m^2（≤500mg／d），静脉滴入6h，d1-5（CF滴完后）；21d为1个周期。结果总有效率为53．3％，毒副反应以骨髓抑制、感觉神经毒性为主，白细胞下降发生率为46．7％，神经毒性发生率60％，本组无Ⅳ度毒副反应。结论L-OHP、5-Fu、CF联合应用治疗晚期大肠癌疗效肯定，毒副反应能耐受。     

多西紫杉醇联合顺铂对晚期鼻咽癌诱导化疗的近期疗效

为了探讨多西紫杉醇（多帕菲DOC）＋顺铂（DDP）放疗前诱导化疗对晚期鼻咽癌的近期疗效并评价毒副反应，2004年10月～2005年10月我院收治的Ⅲ、ⅣA期鼻咽癌分为诱导化疗＋放疗组（C＋R组）30例，单纯放疗组（R组）30例，诱导化疗＋放疗组（C＋R组）予DP方案（DOC＋DDP）诱导化疗1个周期，DOC75mg／m^2，静脉滴入，d1，DDP80mg／m^2，静脉滴入，d3，化疗后2d予根治性放疗，单纯放疗组仅予根治性放疗。结果C＋R组，CR86．7％（26／30），PR10．0％（3／30），RR96．7％（29／30）；R组CR63．3％（19／30），PR16．7％（5／30），RR80．0％（24／30）。C＋R组CR和RR明显高于R组，x^2=11．27，P=0．001，x^2=7．01，P=0．034。主要毒副反应是骨髓抑制、消化道反应和肝功能损害。初步研究结果提示，DOC＋DDP放疗前诱导化疗明显改善了晚期鼻咽癌的近期疗效，毒副反应可耐受，长期疗效有待于临床进一步观察。     

草酸铂治疗晚期胃癌疗效观察

目的：观察草酸铂(L-OHP)联合5-氟尿嘧啶(5-FU)和甲酰四氢叶酸钙(CF)在治疗晚期胃癌中的作用。方法：L-OHP130mg／m^2静脉滴入，持续2h，d1；CF 100mg／m^2静脉滴入，d1～d5，5-FU375mg／m^2静脉滴入，d1～d5。21d重复。结果：22例患者中，完全缓解(CR)1例，部分缓解(PR)12例，稳定(NC)5例，进展(PD)4例，有效率(CR PR)59．09％。毒副反应均比较轻，毒性特点是外周神经感觉异常，症状可逆。结论：L-OHP联合5-FU(CF)方案应用于治疗晚期胃癌可以获得比较高的疗效，显著提高患者生活质量。     

FOLFOX7方案治疗晚期胃肠道肿瘤的疗效观察

目的观察FOLFOX7方案在治疗晚期胃肠道肿瘤中的作用。方法L—OHP 130mg／m^2静脉滴入，2h，d1；CF500mg／m^2静脉滴入，2h，d1；5-Fu2．4—3．0／m^2．Civ．46—48小时，21d重复最少2个疗程后评价疗效。结果24例患者中，完全缓解0例(CR)，部分缓解12例(PR)50％，稳定9例(NC)37．5％、进展4例(PD)16．67％。毒副反映较轻。特殊毒性是外周神经感觉异常，停药消失。骨髓抑制不明显，只有1例为Ⅳ度抑制。较轻微胃肠道反应。结论FOLFOX7方案应用于治疗晚期胃肠道肿瘤有一定疗效，可一定程度提高患者生活质量，且毒副反应轻，较易耐受。     

奥沙利铂联合氟尿嘧啶与醛氢叶酸治疗42例进展期胃癌的近期疗效观察

将取得病理确诊的42例进展期胃癌患者，采用FOLFOX4方案化疗(奥沙利铂85mg／m^2，静脉滴入2h，d1；醛氢叶酸200mg／m^2，静脉滴入2h，d1、d2；5-FU 400mg／m^2，静脉推注，随后5-FU 600mg／m^2持续静脉滴入22h，d1、d2)；每2周重复为1个周期，至少2个周期评价疗效。42例患者均可评价疗效，其中完全缓解(CR)2例(4．8％)，部分缓解(PR)18例(42．9％)，稳定(SD)16例(38．1％)，进展(PD)6例(14．2％)；全组总有效率(ORR)为47．7％。初治组有效率59．1％(13／22)．有2例CR；复治组有效率35．0％(7／20)，无CR病例。两组差异无统计学意义，P=0．118，x^2=2．438。主要的毒副反应为神经性毒性、骨髓抑制和恶心／呕吐。     

长春瑞滨联合铂类治疗中晚期子宫内膜癌

目的：比较长春瑞滨和紫杉醇分别与铂类联合治疗中晚期子宫内膜癌的近期疗效及毒副反应。方法：33例晚期子宫内膜癌，治疗组（NP方案组）21例，长春瑞滨＋顺铂或卡铂化疗，长春瑞滨25mg／m^2，静注d1、8；顺铂25mg／m^2，静注d1～3，或卡铂（300mg／m^2或者AUC4～5）静脉滴注d1。对照组（TP方案组）12例：紫杉醇135～150mg／m^2，静注d1；顺铂或卡铂用法同前。结果：全组均完成2周期以上化疗，其中CR4例．PR14例，NC10例，PD5例。有效率（CR＋PR）54．54％。NP方案组，CR2例，PR9例，有效率（CR＋PR）52．38％；TP方案组，CR2例，PR5例，有效率（CR＋PR）58．33％，两组间无统计学差异（P〉0．05）。副反应主要为骨髓抑制、白细胞、血小板减少，Ⅲ～Ⅳ度发生率，NP组为71．43％，TP组为75．0％（P〉0．05）。结论：长春瑞滨＋铂类联合与紫杉醇＋铂类联合化疗治疗中晚期子宫内膜癌有相同的疗效且毒副反应可以耐受。     

Chemotherapy with mitomycin C and capecitabine in patients with advanced colorectal cancer pretreated with irinotecan and oxaliplatin

AIMS AND BACKGROUND: To assess the activity and tolerability of the combination of mitomycin C and capecitabine in patients with metastatic colorectal cancer after failure of irinotecan and oxaliplatin-containing regimens. METHODS: We retrospectively reviewed 28 patients with pretreated advanced colorectal cancer who had been treated with mitomycin C, 6 mg/m2 on day 1, and capecitabine, 1900 mg/m2 on days 1-14, every 3 weeks. Tumor assessment was performed every 3 cycles, toxicity assessed at each cycle. RESULTS: Main patient characteristics were median age, 61 years (range, 35-73); male/female ratio, 16/12; single metastatic site involvement, 5/28 (18%); > or =3 metastatic sites, 10/28 (36%). Ninety-six courses of therapy were given (median number, 3; range, 1-9). Twenty-six patients were assessable for response, and all were assessable for toxicity. There was 1 partial response (4%) and 12 had stable disease (43%). Median time to progression was 2 months (range, 1-9) and median overall survival was 6 months (range, 1-29+), with a 1-year overall survival rate of 25%. The regimen was very well tolerated without significant hematological toxicity. CONCLUSIONS: Our results are disappointing. Despite the good safety profile, they do not support further investigation or the routine use of this regimen in this setting.     

Excretion of nitrates with saliva and urine and nitrite excretion with saliva in patients with chronic gastritis and duodenal ulcer

The study assessed excretion of nitrates in urine and saliva and that of nitrites with saliva of patients suffering gastric and duodenal ulcer. In both study groups, a positive correlation was established between nitrate concentration in saliva, on the one hand, and that in urine, and nitrite level in urine, on the other. The groups failed to show a difference in nitrate concentrations in either urine or saliva. Since retention of nitrates in the body of chronic gastritis patients held as precancer of the stomach proved no higher than that in patients with duodenal ulcer, the authors cast doubt on endogenous nitroso compounds as a cause of gastric cancer in cases of chronic gastritis.     

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.     

Social work with stepfamilies and their children with cancer

This paper explores the complexities of medical social work undertaken with stepfamilies caring for a child suffering from cancer. Although there is a growing literature dealing with the psycho-social effects of childhood cancer, there is an unexamined assumption that children are cared for by their birth parents within a traditional nuclear family. It is argued that the paediatric oncology social worker is challenged increasingly to develop understandings and modes of intervention which are appropriate and sympathetic to the particular issues facing stepfamilies. Using a systemic and chronological framework from referral and diagnosis through to bereavement, the authors identify challenges for the stepfamily, corresponding implications for social work practice, and questions for future research.     

Treatment with lenalidomide and dexamethasone in patients with multiple myeloma and renal impairment

Renal impairment (RI) is a common complication affecting patients with multiple myeloma (MM). Timely identification of MM-related RI and early treatment with novel antimyeloma agents can reverse renal damage in a high proportion of patients and improve outcomes. The IMiDs® immunomodulatory compound lenalidomide (Len) in combination with dexamethasone (Dex) is an effective and well-tolerated regimen for patients with relapsed or refractory (RR) MM. A retrospective analysis of Phase III data has shown that Len/Dex remains effective and well-tolerated in patients with moderate or severe RI, albeit with an increase in myelosuppression. This analysis demonstrated that in a high proportion of patients Len/Dex treatment can reverse MM-related RI and restore normal function. Lenalidomide has a predominantly renal route of excretion and in patients with RI the plasma concentration and half-life of the drug are significantly increased. As a consequence, lower starting doses are required in patients with RI to avoid over-exposure and an increased risk of adverse events, while maintaining good therapeutic index. A prospective cohort study in 50 patients with RRMM has reported that when Len/Dex dosing was adjusted according to renal function, response rates and survival outcomes were similar in patients with and without RI, and there was no increase in adverse events in patients with RI. Further clinical studies are required to confirm the efficacy and tolerability of Len/Dex regimens in MM patients with RI, and to evaluate the impact of reversing renal damage in terms of patient survival.     

Distress overlaps with anxiety and depression in patients with head and neck cancer

Psychological problems in cancer patients often go unrecognized until they are specifically sought. This is more in patients with depression as they are reluctant to complain about their symptoms. The present study was carried out to evaluate the relation of distress with anxiety and depression in 123 patients with head and neck cancers using Distress Inventory for Cancer version 2 (DIC2) and the Hospital Anxiety and Depression scale (HADS). The mean DIC 2 scores were 24.6 while that of subscales ranged from 2.6 to 11.0. Fifteen patients were found to have clinical caseness for anxiety while 12 (10%) were caseness for depression. Total distress, emotional and social distress subscales were found to have positive correlation with anxiety and depression suggesting a possible overlap of two constructs. In multivariate analysis only belief in god was found to significantly affect the distress. Results of present study suggest significant psychological morbidity in head neck cancer patients undergoing curative treatment. This is the first study reporting on the psychometric properties of distress inventory on cancer version 2 since its validation, the results suggest a possible overlap of two constructs similar to that seen with other tools on distress and this may have major implications for clinical practice.