The role of information in patients' adaptation to chemotherapy and radiotherapy: a review of the literature

This paper reviews the literature concerning the role of information in facilitating patients' adaptation to chemotherapy and radiotherapy. The relationship between information and patient self-efficacy is examined, and the information requirements of cancer patients receiving treatment are reviewed. Finally, studies evaluating informational interventions for patients receiving either chemotherapy or radiotherapy are critiqued before recommendations for practice are formulated.     

以顺铂为基础的不同化疗方案在宫颈癌同步放化疗中的疗效

目的对宫颈癌同步放化疗中的以顺铂为基础的两种化疗方案进行对比研究,比较发现更合理的化疗方案及给药周期。方法将我院1998~2001年收治的58例拟进行宫颈癌同步放化疗的病人随机分为PVB方案组(33例)和DF方案组(25例),对它们的生存率和毒副反应进行对比研究。结果PVB组中位生存期46个月,平均生存期39个月;DF组中位生存期34个月,平均生存期30.23个月。两组生存率比较,差异有显著性(P=0.0218)。两组的远期毒副反应评价经比较无统计学差异。结论在宫颈癌同步放化疗中的以顺铂为基础的化疗方案中,PVB方案在生存率方面优于DF方案,在远期毒副反应方面两种化疗方案无明显差异。     

Simultaneous adjuvant radiotherapy and chemotherapy for stage I and II breast cancer

The purpose of the present paper was to evaluate treatment outcome after conservative breast surgery or mastectomy followed by simultaneous adjuvant radiotherapy and cyclophosphamide, methotrexate and fluorouracil (CMF) therapy. Two hundred and sixty eight (268) patients were treated at two Australian and two New Zealand centres between 1981 and July 1995. One hundred and sixty-nine patients underwent conservation surgery and 99 had mastectomies. Median follow-up was 53 months. Conventionally fractionated radiation was delivered simultaneously during the first two cycles of CMF, avoiding radiation on the Fridays that the intravenous components of CMF were delivered. In conservatively treated patients, 5-year actuarial rates of any recurrence, distant recurrence and overall survival were 34.5 ± 5.2%, 25.4 ± 4.5% and 75.5 ± 4.8%, respectively. Crude incidence of local relapse at 4 years was 6.3% and at regional/distant sites was 26.3%. Highest grades of granulocyte toxicity (< 0.5 × 10⁹/L), moist desquamation, radiation pneumonitis and persistent breast oedema were recorded in 10.7, 8.5, 8.9 and 17.2%, respectively. In patients treated by mastectomy, 5-year actuarial rates of any recurrence, distant recurrence and overall survival were 59.7 ± 7.3%, 56.7 ± 7.4% and 50.1 ± 7%. The crude incidence of local relapse at 4 years was 5.6% and at regional/distant sites it was 45.7%. The issue of appropriate timing of adjuvant therapies has become particularly important with the increasing acknowledgement of the value of anthracycline-based regimens. For women in lower risk categories (e.g. 1–3 nodes positive or node negative), CMF may offer a potentially better therapy, particularly where breast-conserving surgical techniques have been used. In such cases CMF allows the simultaneous delivery of radiotherapy with the result of optimum local control, without compromise or regional or systemic relapse rates. Further randomized trials that directly address the optimal integration of the two modalities, such as the one carried out in Boston, are clearly necessary.     

同步放化疗治疗Ⅲ期非小细胞肺癌

背景与目的：同步放化疗是肿瘤综合治疗的一种新形式，它具有放化疗协同作用，提高局控和控制远处转移缩短疗程等优点，但毒副反应值得关注。本文旨在探讨同步放射治疗加化疗及序贯化疗加放射治疗Ⅲ期非小细胞肺癌的疗效.方法：62例Ⅲ朗非小细胞肺癌患者分成两组，序贯化疗加放射治疗（序贯化放组）31例，采用EP方案治疗2～4个周期，每4周为1个周期，完成后行常规放射治疗。同步放射治疗加化疗组（同步化放组）31例，采用EP方案化疗第一天开始行放射治疗，化疗两个周期：放射治疗总量DT60～70Gy，6～7周完成。结果：两组患者伞部完成治疗计划。同步化放组CR25．8％，PR51．6％，CR＋PR77．4％；序贯化放组CR19．4％，PR45．1％，CR＋PR65％一同步化放组中位乍存期为20．6个月，序贯化放组中位生存期为14．5个月，差异有显著性（P〈0．05）。1、2、3年生存率同步化放组为76．2％、42．5％、28．6％，序贯化放组为66．5％、23．2％、11．6％（x^2=6．76，P〈0．01）。结论：同步化放疗能延长中晚期非小细胞肺癌患者的中位生存期，提高患者的生存率。     

化疗和放疗联合治疗中晚期宫颈癌疗效分析

目的对比化疗配合放射治疗与单纯放疗治疗宫颈癌的疗效,探讨综合治疗在中晚期宫颈癌中的疗效及安全性。方法100例Ⅱ～Ⅲ中晚期宫颈癌患者分成两组,放疗同步化疗（A组）50例,在放疗同时给予PVB或PF方案化疗2～4周期,化疗第1天开始行放射治疗。单纯放疗组（B组）50例,两组放射治疗均用15MV—X线盆腔大野前后对穿体外照射,DT：45～50Gy;并加坶。IrHDR腔内后装照射,A点DT：20-25Gy。结果A组和B组近期有效率分别为94．0％和74．0％,两组的差异有显著性意义（P〈0．01）。A组和B组的3年生存率分别为76．0％和48．0％,差异有显著性意义（P〈0．05）。毒性反应方面,同步化放疗组高于单纯放疗组,尤以造血系统和消化道反应为主,但大部分能够耐受。结论中晚期宫颈癌患者PVB或PF方案同步放化疗可提高局部控制率和提高生存率。     

Insufficiency fractures in patients treated with pelvic radiotherapy and chemotherapy for uterine and cervical cancer

Insufficiency fractures are recognised consequences of radiotherapy in gynaecological malignancy with reported incidences between 2.7% and 89%. We aimed to determine the incidence and risk factors for insufficiency fractures in patients receiving radical pelvic radiotherapy for uterine and cervical cancer. A case‐note review was undertaken of patients treated between January 2007 and December 2008. Insufficiency fractures were identified from radiographs, computed tomography and magnetic resonance images. Chi‐squared and Mann–Whitney tests were performed to determine associations between insufficiency fractures and chemotherapy, steroids and age. A total of 285 patients received pelvic radiotherapy, 137 with uterine and 148 with cervical cancer. Mean age was 59 years. A total of 144 patients received chemotherapy, 101 concurrently and 35 adjuvantly. Bone abnormalities affected 67 patients, 33 had pelvic insufficiency fractures, 12 had multiple fractures and 3 patients developed femoral head avascular necrosis. Use of chemotherapy was not associated with development of fractures (P = 0.949). However, cervical cancer patients had a significantly higher incidence of insufficiency fractures (P = 0.018) and bone pain (P = 0.03) compared with uterine cancer patients. This suggests concurrent chemotherapy may be a significant factor in increasing insufficiency fractures and bone morbidity in these patients and highlights a need for further research to identify, prevent and reduce these long‐term complications.     

立体适形放疗合并化疗治疗中晚期非小细胞肺癌

目的:探讨立体定向适形放疗合并药物联合化疗治疗中晚期非小细胞肺癌(NSCLC)疗效。方法:38例ⅢA/ⅢB,Ⅳ期NSCLC实施立体定向适形放疗每次5~10Gy,每周2~3次,8~10次/疗程,肿瘤灶总生物有效量为70~80Gy;同时进行药物联合化疗长春瑞滨25mg/m2,静滴第1、8天,顺铂80mg/m2,静滴第1天,每21天1周期,共4周期。结果:立体定向适形放疗合并药物联合化疗有效率为92%,其中CR为16例,PR为19例,1年生存率为75%,2年生存率为37%。中位生存时间16个月。结论:立体定向适形放疗合并化疗可明显提高中晚期非小细胞肺癌的控制率和生存率,是安全有效的治疗手段,其量效关系尚需进一步临床观察和随访。     

化疗间歇期行乳腺癌骨转移灶短程放疗止痛的疗效观察

目的　观察化疗间歇期行乳腺癌骨转移灶短程放疗止痛的疗效。方法　 1991年 1月至 2 0 0 0年 10月 ,共32例乳腺癌骨转移患者接受化疗间歇期短程放疗止痛 (化放组 ) ,将同期单纯接受化疗的乳腺癌骨转移患者与化放组病例进行配对 (单化组 ) ,进行回顾性配对分析 ,比较两组止痛疗效及毒副作用。结果　化疗组止痛总有效率为 93.8% ,单化组为 46 .9% ,两组比较 ,差异非常显著 (P <0 .0 1) ;两组病例毒副反应主要以骨髓抑制为主 ,化放组Ⅰ～Ⅱ度及Ⅲ～Ⅳ度白细胞减少发生率均高于单化组 ,两组比较 ,差异无显著性 (P >0 .0 5 )。结论　化疗间歇期行短程放疗止痛 ,对乳腺癌骨转移灶的疼痛具有良好的止痛效果 ,治疗时间短 ,且不明显增加毒副作用。     

新辅助化疗联合放疗治疗中晚期鼻咽癌的疗效观察

目的研究新辅助化疗在治疗中晚期鼻咽癌(NPC)中的疗效。方法63例中晚期NPC病人随机分为单纯放疗组30例、新辅助化疗联合放疗组33例。化疗方案PFL方案(DDP80mg/m2~100mg/m2,d1;5-FU3.5/m248h;CF0.3,d1),共2~3疗程;化疗后2周常规放射治疗鼻咽癌原发灶DT68.0Gy/7周,颈转移灶DT65.0Gy/6周,颈预防剂量55.0Gy。结果新辅助化疗联合放疗组原发灶及颈转移灶完全缓解率优于单纯放疗组,毒性反应与单纯放疗组相比无明显差异。结论新辅助化疗联合放疗可提高中晚期NPC患者近期肿瘤缓解率,毒性反应可耐受,但远期生存率需进一步观察。     

NP方案联合不同间隔时间放疗对乳腺癌MCF-7细胞作用研究

Objective： To evaluate the effect of the treatment by vinovelbine （NVB） and cisplatin （DDP） with radiation at different timing intervals on the radiosensitivity of human breast cancer cell MCF-7. Methods： Six groups （at the interval of 0 h, 4 h, 12 h, 36 h, 48 h, 72 h between chemotherapy and radiotherapy） were studied by cologenic formation assay. In addition, the effect of different timing intervals between chemotherapy and radiotherapy on cell cycle distribution and apoptosis induction in MCF-7 cells was also studied. Quantitation of the apopotic cells was performed by Flow cytometry measurements. For the qualitative detection, fluorescence microscopy analysis was used. Results： The six groups had different SF data, it was the lowest one at the intervals 12 h group, the middest one at 0 h groups, and the highest one at 48 h, 72 h groups when the radiation dose was 8 Gy. In some degree, the different SF data of the six groups could been explained by the different percentage accumulation of G2/M phase at different timing caused by the NP chemotherapy. Apoptosis index after chemotherapy increased with time extending, but the changes of apoptosis index seem not correlate with the SF differences. Conclusion： The different timing intervals between NP chemotherapy and radiotherapy affect the radiosensitivity of MCF-7 cells, but those changes according to the interactive of cycle distribution and apoptosis.     

Treatment of early childhood medulloblastoma by postoperative chemotherapy and deferred radiotherapy

To investigate the utility of postoperative chemotherapy in delaying radiotherapy and to identify prognostic factors in early childhood medulloblastoma, we studied children younger than 3 years of age registered to the HIT-SKK’87 (Therapieprotokoll für Säuglinge und Kleinkinder mit Hirntumoren [Brain Tumor Radiotherapy for Infants and Toddlers with Medulloblastoma] 1987) trial who received systemic interval chemotherapy until craniospinal radiotherapy was applied at 3 years of age or at relapse, from 1987 to 1993. Children with postoperative residual tumor or metastatic disease received systemic induction chemotherapy prior to interval chemotherapy. Twenty-nine children were eligible for analyses (median age, 1.7 years; median follow-up, 12.6 years). In children without macroscopic metastases, rates (±SEM) for 10-year progression-free survival (PFS) and overall survival (OS) were 52.9% ± 12.1% and 58.8% ± 11.9% (complete resection), and 55.6% ± 16.6% and 66.7% ± 15.7% (incomplete resection), compared with 0% and 0% in children with macroscopic metastases. Survival was superior in nine children with desmoplastic or extensive nodular histology compared with 20 children with classic medulloblastoma (10-year PFS, 88.9% ± 10.5% and 30.0% ± 10.3%, p = 0.003; OS, 88.9% ± 10.5% and 40.0% ± 11.0%, p = 0.006). Eleven of 12 children with tumor progression during chemotherapy had classic medulloblastoma. After treatment, IQ scores were inferior compared with nonirradiated children from the subsequent study, HIT-SKK’92. Classic histology, metastatic disease, and male gender were independent adverse risk factors for PFS and OS in 72 children from HIT-SKK’87 and HIT-SKK’92 combined. In terms of survival, craniospinal radiotherapy was successfully delayed especially in young children with medulloblastoma of desmoplastic/extensive nodular histology, which was a strong independent favorable prognostic factor. Because of the neurocognitive deficits of survivors, the emerging concepts to avoid craniospinal radiotherapy should rely on the histological medulloblastoma subtype.     

28例中晚期食管癌放疗联合PF方案同期化疗近期疗效观察

目的:观察DDP加5-FU联合放疗治疗中晚期食管癌的近期疗效和毒副反应。方法:43例病人随机分为试验组和对照组,试验组予DDP加5-FU同期化疗联合放疗,对照组单纯放疗,对比观察两组病人的近期疗效和毒副反应并作统计学分析。结果:试验组有效率89.2%,对照组有效率60%,有显著差异。结论:DDP加5-FU联合放疗可有效治疗中晚期食管癌,缓解症状,近期疗效显著,且毒副作用较小,值得进一步研究。     

28例中晚期食管癌放疗联合PF方案同期化疗近期疗效观察

目的：观察DDP加5-FU联合放疗治疗中晚期食管癌的近期疗效和毒副反应。方法：43例病人随机分为试验组和对照组,试验组予DDP加5-FU同期化疗联合放疗,对照组单纯放疗,对比观察两组病人的近期疗效和毒副反应并作统计学分析。结果：试验组有效率89.2%,对照组有效率60%,有显著差异。结论：DDP加5-FU联合放疗可有效治疗中晚期食管癌,缓解症状,近期疗效显著,且毒副作用较小,值得进一步研究。     

局部晚期宫颈癌化疗联合放疗最佳模式探讨

目的 放疗是局部中晚期宫颈癌的主要治疗方式,目前同步放化疗已经成为局部中晚期宫颈癌的标准治疗模式,诱导化疗和辅助化疗在同步放化疗时代的角色未明,其疗效与预后的优劣并未达成共识,本研究旨在通过回顾性分析探讨局部中晚期宫颈鳞癌的最佳治疗模式,为临床治疗提供理论依据.方法 回顾性分析2008-01-01-2010-01-31湖南省肿瘤医院收治的212例初治中晚期宫颈鳞癌患者,根据治疗方式分为A、B和C3组,诱导及辅助化疗为TP方案,即紫杉醇联合顺铂,同步放化疗为顺铂单药或顺铂联合紫杉醇,A组(对照组):同步放化疗82例,B组(观察组):诱导化疗联合同步放化疗98例,C组(观察组):同步放化疗联合辅助化疗32例,观察比较3组的近期疗效、远期疗效和不良反应.结果 A、B和C组近期疗效分别为93.90％、94.90％和96.88％,差异无统计学意义,P＞0.05;A、B和C组总生存率(0S)第1年分别为90.24％、90.82％和87.50％;第3年分别为85.37％、87.76％和81.25％;第5年分别为82.93％、83.67％和75.00％;3组比较差异均无统计学意义,P＞0.05.A、B和C组局控率分别为86.58％、86.73％和87.50％,差异性无统计学意义,P＞0.05;A、B和C组无进展生存率分别为67.07％、74.49％和68.75％,差异均无统计学意义,P＞0.05;A、B和C组无远处转移生存率分别为70.73％、93.08％和71.88％,差异有统计学意义,P＜0.05.不良反应主要表现为观察组3级以上白细胞及血小板减少.进一步比较观察组间骨髓抑制差异无统计学意义,P＞0.05;消化道反应及肝功能损害3组比较差异均无统计学意义,P＞0.05;晚期放射性损伤主要表现为放射性直肠炎和放射性膀胱炎,3组比较差异无统计学意义,P＞0.05.结论 诱导化疗可以提高局部晚期宫颈癌的无远处转移率,有延长OS趋势;辅助化疗对局部晚期宫颈癌未见明显生存获益;诱导化疗联合同步放化疗是一种较为有效的局部晚期宫颈癌治疗方案,值得临床进一步推广使用,并通过大样本资料研究加以证实.     

Postoperative radiotherapy for DukesB ‘ and C rectal cancer: Peter MacCallum Cancer Institute experience

This retrospective study reviews the outcome of patients with DukesB ‘ and C rectal cancer treated with adjuvant postoperative pelvic radiotherapy at the Peter MacCallum Cancer Institute from 1981 to 1990. Sixty-one patients (22 DukesB ‘, 36 DukesC ‘ and 3 unknown stage) received a median dose of 50 Gy of pelvic irradiation. Locoregional relapse occurred in 33% of patients. Estimated median progression-free survival was 1.7 years with 46% surviving without progression at 2 years and 30% at 5 years. There was no difference according to Dukesstage ‘. The estimated median survival was 2.6 years, with no difference according to disease stage. These results with postoperative radiotherapy alone are inferior to results achievable by combination chemotherapy and radiotherapy as adjuvant therapy which should now be considered standard therapy following surgical resection for DukesB ‘ and C rectal cancer.     

同步放疗加化疗综合治疗宫颈癌的临床研究

目的 探讨同步化疗加放射治疗宫颈癌的疗效和不良反应.方法 128例宫颈癌患者随机分为两组:同步放化疗和单纯放疗各64例.单纯放射治疗采用192Ir高剂量率腔内加体外放射治疗,开始体外全盆腔照射,5次/周,2 Gy/次,盆腔平面中心剂量26 Gy-40 Gy,2.5-4.0周完成;然后中间挡铅,4个野照射,4次/周,2 Gy/次,宫旁剂量20 Gy-25 Gy;同时腔内治疗,1次/周,66y/次,A点剂量为30 Gy-36 Gy.同步化疗加放疗组在放疗开始给予DF方案化疗即DDP50 mg/m2 dl 5-Fu 4.0/m2静注96 h,每4周重复,共3个周期.结果 两组3、5年生存率,A组分别为73.4﹪和59.4﹪,B组分别为51.6﹪和43.7﹪(P＜0.05).早期放射性直肠反应发生率A组为15.6﹪,B组为12.5﹪,膀胱反应发生率A组为6.3﹪,B组为4.7﹪.A组远处转移率明显低于B组,A组的骨髓抑制和消化的道反应明显低于B组,但患者经一般处理均能耐受.结论 同步化疗加放射治疗官颈癌能提高患者的生存率,降低远处转移率.     

Adjuvant chemotherapy vs radiotherapy in high-risk endometrial carcinoma: results of a randomised trial

Patients with high-risk endometrial carcinoma (stage IcG3, IIG3 with myometrial invasion >50%, and III) receive adjuvant therapy after surgery but it is not clear whether radiotherapy (RT) or chemotherapy (CT) is better. We randomly assigned 345 patients with high-risk endometrial carcinoma to adjuvant CT (cisplatin (50 mg m(-2)), doxorubicin (45 mg m(-2)), cyclophosphamide (600 mg m(-2)) every 28 days for five cycles, or external RT (45-50 Gy on a 5 days week(-1) schedule). The primary end points were overall and progression-free survival. After a median follow-up of 95.5 months women in the CT group as compared with the RT group, had a no significant hazard ratio (HR) for death of 0.95 (95% confidence interval (CI), 0.66-1.36; P = 0.77) and a nonsignificant HR for event of 0.88 (95% CI, 0.63-1.23; P = 0.45). The 3, 5 and 7-year overall survivals were 78, 69 and 62% in the RT group and 76, 66 and 62% in the CT group. The 3, 5 and 7-year progression-free survivals were, respectively, 69, 63 and 56 and 68, 63 and 60%. Radiotherapy delayed local relapses and CT delayed metastases but these trends did not achieve statistical significance. Overall, both treatments were well tolerated. This trial failed to show any improvement in survival of patients treated with CT or the standard adjuvant radiation therapy. Randomised trials of pelvic RT combined with adjuvant cytotoxic therapy compared with RT alone are eagerly awaited.     

PCF方案化疗与放射治疗同步进行治疗Ⅱ/Ⅲ期宫颈癌

背景与目的：宫颈癌发病率在全世界妇科恶性肿瘤中居第二位，尽管技术设备不断改进，但其治疗并没有明显提高。近几年化疗已被广泛运用，放射治疗与化疗同步治疗也越来越受到重视。本研究探讨PCF方案配合放疗治疗Ⅱ／Ⅲ期宫颈癌患者的临床方法。方法：将2000年1月——2004年7月我院放射治疗的196例Ⅱ／Ⅲ期宫颈癌患者，随饥分成单纯放疗组和放疗同步化疗组各98例，两组在同样放疗的基础上，同步组同时给予PCF方案[顺铂（DDP）20mg第1～5天；氟尿嘧啶（5-FU）500mg第1、3、5天；环磷酰胺（CTX）400mg第2、4天]化疗2～4周期，两组放射治疗均用^60Co全盆对穿两头照射野DT30Gy后，改为^60Co盆腔四野照射并后装治疗．将两组的治疗效果和不良反应相比较。结果：两组近期有效率平均为100％，差异无显著性。放疗同步化疗组5年生存率为76．5％，单纯放疗组5年生存率为50％，两组差异有显著性（P〈0．05）.毒性反应同步组高于对照组．经积极处理后均能耐受。结论：Ⅱ／Ⅲ期宫颈癌放疗同时配合PCF方案化疗可显著提高肿瘤控制率和5年生存率，不良反应并无明显增加。     

Nonsurgical management of gallbladder cancer: cytotoxic treatment and radiotherapy

Carcinoma of the gallbladder is a rare tumor entity. Apart from surgical intervention, there is no therapeutic measure with curative potential. Therefore, patients with advanced – i.e., unresectable or metastatic – disease present a difficult problem to clinicians, whether to choose a strictly symptomatic treatment or expose the patient to the side effects of potentially ineffective treatment. Despite anecdotal reports about symptomatic palliation and survival advantages, only unrandomized Phase II studies too small to draw meaningful conclusions have been published thus far. Since there is no standard therapy for advanced gallbladder cancer, patients should be offered the opportunity to participate in controlled clinical trials.     

Combined chemotherapy and radiotherapy for intracranial germinomas in adultpatients: a single-institution study

We report on our experience in the treatment of intracranial germinomas (18 pure germinomas and two germinomas with syncytiotrophoblastic giant cells) according to a strategy of radiotherapy doses and fields reduction after a neoadjuvant chemotherapy (Cisplatin-vinblastine and bleomycin combination). Radiation therapy was delivered after the completion of the third and last course of chemotherapy. For the solitary germinoma the target volume was the gross tumour volume. In the five multifocal germinoma patients the whole ventricle volume was irradiated. For the single disseminated germinoma patient we treated the whole central nervous system. The cumulative doses were 30 Gy for the pure germinomas. For the STGCs, a cumulative dose of 35 Gy was used. The median follow-up was 55 months (range 12–120). 18 patients were alive without recurrence of disease. In the two patients with STGCs the death took place 16 and 35 months after diagnosis.