非小细胞肺癌非含铂类化疗方案的进展

本文选择了几种具有代表性的非含铂类化疗药和非含铂类化疗方案,通过综合分析,非小细胞肺癌患者容易耐受非含铂类化疗方案,且不良反应小于含铂类化疗方案.     

Preoperative chemotherapy for advanced esophageal cancer and relation with histological effect

P = 0.01), ineffective in low responders (P = 0.61), and detrimental to nonresponders (P = 0.03). Postoperative morbidity was significantly higher in the chemotherapy group than in the control group (P = 0.02). These findings suggest that preoperative chemotherapy is necessary only for high responders and we therefore need to reliably identify non-, low, and high responders before chemotherapy to improve the survival and quality of life of patients with advanced esophageal cancer. (Received for publication on June 8, 1998; accepted on Jan. 7, 1999)     

Postoperative adjuvant chemotherapy for stage I non-small cell lung cancer

Objective: Surgery constitutes the mainstay of treatment in stage I non-small cell lung cancer (NSCLC). However, a significant fraction of patients after surgical resection die mainly due to systemic relapse. Nonetheless, the best adjuvant treatment to improve survival and decrease relapse rate remains as an ever controversial issue. Therefore, we conducted a randomized trial to determine whether postoperative adjuvant chemotherapy is beneficial in prolonging survival and decreasing recurrence in patients with completely resected stage I NSCLC. Methods: It was designed as a randomized, prospective two-armed study with surgery only (control group, 59 patients) versus surgery plus adjuvant MVP (mitomycin C, vinblastin and cisplatin) chemotherapy (study group, 59 patients). Results: Data for all the patients were complete. Twenty-four patients in the control group and nine patients in the study group experienced tumor recurrence during the follow-up. Neither histological type nor surgical extent correlated with recurrence. However, the addition of adjuvant MVP chemotherapy could decrease the rate of recurrence and the incidence of cancer-related death after surgery in the patients of stage I NSCLC (P<0.05). We followed up at least 5 years, and the duration of mean follow-up was 7.3 years. The rates of the loco-regional and distant metastases were 3.4 and 40.7% in the control group, and 3.4 and 11.9% in the study group, respectively. The 5- and 10-year survival rates were 74.6 and 56.3% in the control group, and 81.4 and 65.0% in the study group, respectively (P=0.19, log-rank test). The 5- and 10-year disease-free survival rates were 64.8 and 54.8% in the control group, and 88.8 and 76.8% in the study group, respectively (P=0.002, log-rank test). Conclusions: Our results suggest that the addition of adjuvant MVP chemotherapy may reduce the incidence of distant metastasis and prolong the disease-free survival of the patients with stage I NSCLC after surgery.     

Carinal resection after induction bronchial arterial infusion for locally advanced non-small cell lung cancer

We herein describe 3 cases of a carinal resection after induction bronchial arterial infusion (BAI) for locally advanced non-small cell lung cancer (NSCLC). Case 1 was a 44-year-old man with T1N2M0 adenocarcinoma. After undergoing Nd-YAG laser treatment (5079 J) and BAI [cis -diamminedichloro platinum (CDDP) 100 mg/body], a right sleeve upper lobectomy with a carinal resection and reconstruction (Montage type) was performed. Case 2 was a 67-year-old man with T4N1M0 squamous cell carcinoma. After BAI (CDDP 120 mg/body), an operation (same as case 1) was performed. Case 3 was a 72-year-old man with T4N2M0 squamous cell carcinoma. After BAI (CDDP 120 mg/body), a right sleeve peumonectomy was performed. There was neither BAI-related intraoperative nor postoperative complications. BAI with CDDP was thus found to be a useful and effective therapeutic modality for locally advanced NSCLC invading the carina.     

Non-small cell lung cancer coexisting with pulmonary aspergilloma

A 77-year-old male with a long-standing history of smoking and working in mines was referred to our department for the evaluation of an enlarging subpleural mass in the right upper lobe. Both transbron-chial and computed tomography-guided biopsies of the mass were non-diagnostic. A partial resection of the right S² mass under video-assisted thoracic surgery (VATS) confirmed the diagnosis of primary non-small cell lung cancer. VATS right upper lobectomy (ND2a) was then performed for complete resection. Histological examination revealed that the mass composed of adenocarcinoma and the dilated bronchioles contained Aspergillus, the fungal component. Here we report a rare case of non-small cell lung cancer coexisting with pulmonary aspergillosis. The morphologic coexistence pattern of the two pathologies was believed to be the colonization of saprophytic Aspergillus in the bullous air spaces, obstructed by or contained within the tumor, according to the progression of the lung cancer.     

自拟健脾除积方联合信迪利单抗及化疗对晚期非小细胞肺癌患者的影响

目的:探讨自拟健脾除积方联合信迪利单抗及化疗对晚期非小细胞肺癌患者疾病控制率、中医症候积分及不良反应的影响。方法:选取2020年10月—2022年10月在我院就诊的102例晚期非小细胞肺癌患者,随机分为观察组和对照组,每组各51例,对照组在吉西他滨+顺铂化疗的基础上给予信迪利单抗,观察组在对照组基础上联合自拟健脾除积方治疗。比较两组患者临床疗效、治疗前后中医症候积分、肿瘤标志物水平及不良反应。结果:观察组有效率和疾病控制率明显高于对照组(P＜0.05);观察组和对照组治疗后中医症候积分均显著低于治疗前;治疗后,观察组中医症候积分显著低于对照组(P＜0.05)。两组治疗后血清铁蛋白(SF)、鳞状细胞癌抗原(SCCA)及癌胚抗原(CEA)水平均显著低于同组治疗前,观察组SF、SCCA、CEA水平均显著低于对照组。观察组白细胞计数减少、恶心、呕吐症状总发生率显著低于对照组(P＜0.05)。结论:自拟健脾除积方联合信迪利单抗对晚期非小细胞肺癌患者治疗效果较好,可改善患者中医症候,具有较高的安全性。     

Outcome of patients with early stage lung cancer

A study was conducted to evaluate the outcomes of 79 patients with early stage lung cancer diagnosed according to the following criteria. Central tumors were located in the segmental bronchi, or more proximally, and tumor invasion was limited to the bronchial wall without lymph node or distant metastases. Peripheral tumors were located distal to the subsegmental bronchi and were less than 2 cm in greatest dimension, and invasion was limited to the visceral pleura, with no lymph node or distant metastases. The 5-year survival rate was 100% for patients with peripheral type early squamous cell carcinoma, 94.6% for those with central-type early squamous cell carcinoma, and 79.3% for those with early adenocarcinoma. The 5-year survival rate for patients with central-type squamous cell carcinoma without pericartilage layer invasion was 97.0%, and that for those with T1N0M0 peripheral squamous cell carcinoma was 100.0%. To define early stage lung cancer as curable, it should be defined as T1N0M0, peripheral squamous cell carcinoma, or central squamous cell carcinoma without pericartilage layer invasion. For other histologic types, some added parameters are needed. The rate of multiple lung cancers was 10.1% and that of multiple primary malignant disease was 13.9%. Thus, careful followup of patients with early stage lung cancer should be carried out, as second malignancies in the lung and elsewhere are commonly detected.     

非小细胞肺癌循环肿瘤细胞的定量检测意义

目的 探讨定量检测非小细胞肺癌病人肺静脉和外周静脉血循环肿瘤细胞与临床分期、治疗及预后监测的相关性.方法 选择25例非小细胞肺癌病人,10例良性肺疾病者(对照组)、健康志愿者10位.经CD326免疫磁珠阳性分选富集循环肿瘤细胞(CTCs)标本后,行CK-FITC、CD45PE荧光抗体标记,应用多参数流式细胞仪对CTCs进行定量检测.结果 25例非小细胞肺癌病人术中肺静脉血CTCs定量检测阳性率为64%(16/25例),明显高于外周静脉血CTCs阳性率40%(10/25例)的水平(P<0.05);Ⅰ期13例中外周血CTCs阳性3例(23.0%),肺静脉血CTCs阳性8例(61.5%).结论 非小细胞肺癌CTCs水平的定量检测是较为敏感的肿瘤进展、治疗反应和预后预测的评价指标;免疫磁珠富集联合流式细胞分析技术检测CTCs的敏感性和特异性较高,具有一定的临床应用前景.     

Surgical treatment of solitary metastasis in the male breast from non-small cell lung cancer

Detection of metastases in the breast from extramammary neoplasms is rare. We present a case of metastases in breast tissue from surgically treated non-small cell bronchogenic carcinoma. A histologic and immunohistologic study was essential for choosing the appropriate treatment for the patient. The patient is alive and disease-free 18 months after the breast surgery.     

紫杉醇加顺铂的新辅助化疗对提高ⅢA期非小细胞肺癌手术切除率的临床作用

目的探讨紫杉醇加顺铂(TP方案)的新辅助化疗对提高ⅢA期非小细胞肺癌(NSCLC)手术切除率的影响。方法46例ⅢA期NSCLC患者随机分为新辅助化疗组(23例)和单纯手术组(23例)。新辅助化疗的患者确诊后即接受2个周期全身化疗然后手术。单纯手术组患者确诊的直接手术治疗。结果新辅助化疗有效率为56.5%,化疗毒副作用较轻,患者可以耐受。新辅助化疗组的手术切除率为95.6%,根治切除率为60.8%,明显高于单纯手术组患者(P<0.05)。后者的手术切除率和根治性切除率分别为73.9%和30.4%。新辅助化疗并未增加手术并发症。结论新辅助化疗可明显提高ⅢA期NSCLC患者的手术切除率和根治切除率。     

以手术为主综合治疗Ⅲa期非小细胞肺癌的临床分析

目的 探讨对Ⅲa期非小细胞肺癌行以手术为主的综合治疗的疗效。方法 回顾分析2000年1月至2003年12月间在我院以手术为主综合治疗的83例Ⅲa期非小细胞肺癌患者（手术组）的临床资料,选择同期33例非手术治疗的Ⅲa期非小细胞肺癌患者作为对照（非手术组）,采用Kaplan—Meier法计算生存率,比较两组的中位生存时间和1,2,3年的生存率。结果 手术组中位生存时间为20．3个月,1,2,3年生存率分别为85％,70％和35％。非手术组中位生存时间为14．5个月,1,2,3年生存率分别为75％,33％和15％。结论 对Ⅲa期非小细胞肺癌行以手术为主的综合治疗的疗效明显优于非手术的放射与化学治疗。     

Preoperative chemotherapy and radiotherapy for locally advanced rectal cancer

BACKGROUND: The adjuvant treatment of rectal cancer is a rapidly evolving field. The standard approach is a combination of chemotherapy and radiotherapy, with the optimal treatment combination and sequencing yet to be determined. Here, we report our early experience of preoperative chemotherapy and radiotherapy (CRT) in locally advanced rectal cancer at Radiation Oncology Victoria to determine its efficacy and the rate of sphincter preservation. METHODS: Sixty-nine patients (46 men and 23 women) with locally advanced rectal cancer (T3-4 or N1) were treated with preoperative CRT followed by surgical resection of disease. Chemotherapy consisted of either bolus or continuous venous infusion of 5-fluorouracil (5-FU). Radiotherapy to a dose of 45 Gy was delivered to the pelvis followed by a boost of 5.4-14.4 Gy in the majority of patients. Surgical resection was carried out 4-8 weeks following completion of preoperative CRT. Univariate and multivariate analyses were performed to examine variables that may influence local recurrence and overall survival rates. RESULTS: All patients underwent a complete macroscopic resection, including the three patients that had unrecognized distant metastases discovered at the time of operation. Only two patients had microscopic residual disease. Sphincter preservation was achieved in 16 of 25 patients who were thought to require an abdominoperineal resection. Tumour and/or nodal downstaging were achieved in 47 patients (68%), with a pathological complete response in 12 (17%). At a median follow up of 29 months post-surgery, five patients (7.2%) have developed a local recurrence. Overall 21 patients (30%) have progressed and 12 (18%) have died. Treatment-related toxicity was acceptable and there was no treatment-related mortality. There was no significant relationship found between the pathological response to treatment and any clinical endpoint. CONCLUSIONS: Our results confirm the high response rates and acceptable toxicity of preoperative treatment. Further studies are required to better define the impact of preoperative chemotherapy and radiotherapy on long-term outcomes.     

胃癌腹腔灌注化疗的应用

术后腹腔转移是胃癌治疗失败的主要原因之一,而且一旦发生转移就很难进行有效治疗.腹腔灌注是有望最大程度的减少术后胃癌腹腔转移的有效手段之一.因此本文就针对灌注化疗的应用背景、临床疗效和药物选择等问题进行文献回顾.     

笑声瑜伽对非小细胞肺癌化疗患者压力知觉的影响

目的 探讨笑声瑜伽在非小细胞肺癌化疗患者中的应用效果。方法 按照整群随机法,选取在呼吸科2个病区住院治疗的84例非小细胞肺癌化疗患者分为两组各42例。对照组实施常规护理教育,干预组在此基础上实施笑声瑜伽干预,干预前后采用知觉压力量表,焦虑、抑郁自评量表,积极心理资本量表评价干预效果。结果 干预组患者干预后压力知觉、焦虑、抑郁评分显著低于对照组,积极心理资本评分显著高于对照组（均P＜0.05）。结论 笑声瑜伽能有效缓解患者的压力知觉水平和焦虑、抑郁情绪,提高患者的积极心理资本水平。     

基于CT影像组学模型鉴别诊断小细胞肺癌与非小细胞肺癌

目的观察基于CT影像组学模型鉴别诊断小细胞肺癌(SCLC)与非小细胞肺癌(NSCLC)的效能。方法回顾性分析1 524例经手术病理确诊的肺癌患者,其中526例SCLC (SCLC组), 998例NSCLC(NSCLC组)。采用特征提取软件MaZda(Version 4.6)提取CT图像中病灶最大层面的纹理特征参数,以Correlation相关性分析和最小绝对收缩和选择算子(LASSO)算法对数据进行降维,筛选组间差异明显的影像组学特征,构建影像组学模型。以7∶3比例将全部患者分为训练集和验证集,采用7种机器学习模型,包括Logistic回归、随机森林(RF)、贝叶斯算法(NB)、决策树(DT)、卷积神经网络(CNN)、邻近算法(KNN)和支持向量机(SVM)模型对数据集进行处理,根据其在验证集的准确率选择最佳分类器模型,采用受试者工作特征(ROC)曲线分析该分类器模型对SCLC与NSCLC的鉴别诊断效能。结果针对每个病灶提取306个纹理特征参数,最终筛选出20个组间差异明显的影像组学特征,并以之构建预测模型。模型训练结果显示,KNN模型鉴别诊断SCLC与NSCLC的准确率最高,其在训练集的AUC为0.88、准确率81.34%、特异度97.00%、敏感度51.63%,在验证集的AUC为0.82、准确率78.82%、特异度95.00%、敏感度48.10%。结论基于CT影像组学结合机器学习算法建立的诊断模型可用于鉴别SCLC与NSCLC,以KNN模型的效能更优。     

术中射频治疗在剖胸探查晚期非小细胞肺癌治疗中的作用和意义

目的探讨术中射频治疗在剖胸探查晚期非小细胞肺癌治疗中的作用和意义。方法2002年1月至2004年12月23例剖胸探查无法手术切除的晚期非小细胞肺癌患者行术中射频治疗为治疗组(n=23,A组),同期无法手术切除的晚期非小细胞肺癌30例给予化疗为对照组(n=30,B组),观察术后疗效、疼痛缓解程度、ECOG评分、术后生活质量。结果A组的治疗、疼痛缓解程度、ECOG评分及治疗后生活质量的好转率分别为65.22%、65.22%、60.86%、65.21%;B组为36.67%,33.33%,33.33%,30.00%。射频治疗组优于化疗组。(P<0.05)结论术中射频治疗可有效地提高不可切除的晚期非小细胞肺癌的术后疗效和生存质量,对于晚期非小细胞肺癌提供了新的治疗途径。