针灸防治肿瘤化疗毒副反应

多年来，我们参与了肿瘤病区开展中西医结合治疗工作，在应用针灸疗法防治肿瘤化疗毒副反应方面，有机会观察了不少病例，经多年探索研究，积累了不少资料，现将针灸防治常见的几种化疗毒副反应总结报告如下。     

奥沙利铂联合卡培他滨辅助化疗与ECF方案治疗老年进展期胃癌的效果及毒副反应对比

目的观察奥沙利铂联合卡培他滨辅助化疗与表柔比星+5-氟尿嘧啶+顺铂(ECF方案)治疗老年进展期胃癌效果及毒副反应。方法63例进展期胃癌老年患者资料统计归纳并结合辅助化疗方式差异性分为观察组32例,围术期实施奥沙利铂+卡培他滨辅助化疗;对照组31例,实施ECF方案治疗;观察两组临床疗效,评估毒副反应症状,并追踪随访1年,记录存活率。结果观察组胃肠道毒副反应及骨髓抑制症状发生率均明显少于对照组(P<0.05);观察组辅助化疗治疗有效率(81.25%)显著高于对照组(61.29%,P<0.05);观察组12个月存活率(90.63%)显著高于对照组(67.74%,P<0.05)。结论进展期胃癌老年患者经奥沙利铂联合卡培他滨辅助化疗具有良好效果,可延长患者存活期,且化疗毒副反应低,耐受度较高。     

肺癌化疗毒副反应中西医探讨

正肺癌是肺系最常见恶性肿瘤,化疗是主要治疗手段之一,但其毒副反应较多,中西医对其认识及防治各有不同,尤其实践已证明中医药防治化疗毒副反应凸显特色和优势,所以中医药疗法辅助肺癌化疗具有重要临床价值。现代医学对肺癌化疗毒副反应的认识及防治一、血液系统血液系统的骨髓抑制是目前肺癌化疗的主要毒副反应[1],其中蒽环类、紫杉类等最易导致骨髓抑制[2],以血细胞三系减少为主要表现,其中化疗相关性白细胞减少是其中最严重的不良反应,不仅延     

益气活血方加减配合低度姑息化疗在恶性肿瘤晚期的应用

目的观察益气活血方加减配合低度姑息化疗对恶性肿瘤晚期患者生存质量的影响。方法112例晚期恶性肿瘤患者，男82例，女30例，随机分为观察组和对照组。观察组56例，男31例，女25例，采用益气活血中药加化疗，对照组进行单纯化疗。结果观察组化疗毒副反应显著低于对照组。肿瘤变化情况：PS评分变化及中医证候变化均有明显统计竽差异。结论益气活血方加减配合低度姑息化疗可减少化疗毒副反应，改善患者生活质量。     

艾迪注射液联合化疗治疗非小细胞肺癌的临床观察

目的观察艾迪注射液联合多两他赛＋顺铂的化疗方案治疗晚期非小细胞肺痛（NSCLC）的疗效及毒副反应。方法50例晚期NSCLC患者随机分为两组,治疗组为艾迪注射液＋化疗组（A组）,对照组为单纯化疗组（B组）,观察比较两组间治疗有效率、生活质量及化疗毒副反应。结果A、B两组有效率（CR＋PR）分别为40．0％和36．0％（P〉0．05）。两组生活质量提高率分别为52．0％和28．0％（P〈0．05）。A组化疗严重毒副反应明显减少。结论艾迪注射液联合化疗治疗晚期NSCLC,具有减轻化疗毒副反应,改善晚期NSCLC患者的生活质量等作用,值得临床推广应用。     

老年脑胶质瘤患者应用化疗药物的毒副反应研究

目的探讨老年脑胶质瘤患者应用化疗药物后的毒副反应。方法将146例应用化疗药物的脑胶质瘤患者根据年龄分为老年组70例（≥60岁）和中青年组76例（〈60岁）,然后进行组间比较,所有患者均采用替尼泊甙（VM-26）＋司莫司汀（Me-CCNU）联合化疗方案。结果老年组的骨髓抑制现象和呕吐反应（25．0％和23．9％）并不高于中青年组（23．8％和24．2％）（P〉0．05）。结论老年脑胶质瘤患者实施化疗是安全的,毒副反应并没有增加。     

吉西他滨联合顺铂治疗老年非小细胞肺癌毒副反应的临床观察

目前多项国际临床试验证实了老年化疗的临床疗效及生存获益.本文就老年非小细胞肺癌（NSClC）患者应用吉西他滨联合顺铂发生的化疗毒副反应与中青年（＜65岁）组进行对比观察。     

腹腔免疫化疗对老年胃肠道肿瘤患者生存质量的影响

目的探讨腹腔免疫化疗对老年胃肠道肿瘤患者生存质量的影响。方法选取老年胃肠道肿瘤患者76例,按随机数字表法分为腹腔免疫组(26例)、腹腔组(25例)和静脉组(25例),分别给予腹腔免疫化疗、单纯腹腔化疗和静脉化疗。比较3组KPS评分、生存质量和毒副反应。结果腹腔免疫组化疗后2 w KPS评分好转率均显著高于腹腔组和静脉组(P<0.05),生存质量评分均显著高于腹腔组和静脉组(P<0.05);腹腔免疫组胃肠道反应、白细胞下降、血小板减少、脱发和神经毒性均显著少于静脉组(P<0.05),其中胃肠道反应也显著少于腹腔组(P<0.05)。结论相比静脉化疗和单纯腹腔化疗,腹腔免疫化疗能有效减少毒副反应,改善生存质量,更适用于老年胃肠道肿瘤患者。     

紫杉醇联合卡铂治疗老年和中青年晚期非小细胞肺癌的研究

目的研究紫杉醇联合卡铂治疗老年和中青年晚期非小细胞肺癌患者的疗效、预后和毒副反应。方法对2002年1月~2005年12月我院收治的50例≥70岁的肺癌患者（老年组）和同一时间随机选择的50例〈70岁肺癌患者（中青年组）分别给予紫杉醇联合卡铂方案化疗。结果老年组有效率37.5%,中青年组有效率38.8%,差异无显著性（P〉0.05）。老年组中位生存时间为11.8个月,1年、2年生存率分别为31.3%、6.3%,中青年组中位生存期11.3个月,1年、2年生存率28.6%、4.1%,无显著性差异（P〉0.05）。主要毒副反应是骨髓抑制,Ⅲ及Ⅳ中性粒细胞减少老年组34.0%,中青年组30.0%,差异无显著性（P〉0.05）。结论年龄不是影响肺癌患者疗效、预后和毒副反应的主要因素。     

腹腔恶性肿瘤区域性血流阻断动脉内介入化疗临床意义

化疗是除手术外治疗腹腔恶性肿瘤的重要辅助手段。区域性血流阻断动脉内介入化疗(SFC)作为一种较新的化疗给药方法,已应用于临床。与传统的静脉化疗相比,SFC可提高肿瘤区域的药物浓度并延长高浓度化疗药物作用时间。应用SFC技术可提高肿瘤对化疗药物的反应率,不增加化疗毒副反应,并能改善临床症状,延长患者生存期。对于肿瘤晚期及复发患者可提高手术切除率。SFC技术具有较好的临床应用前景。     

Management of colorectal cancer in elderly patients over 80 years old

AIM: The incidence of colorectal cancer is increasing. Surgery and chemotherapy for elderly patients are also increasing. We evaluated the characteristics of elderly colorectal cancer to clarify issues related to surgical therapy for elderly patients. METHOD: We studied 67 patients (38 men, 29 women) over 80 years old on whom we operated for colorectal cancer from 1990 to 2004. We compared them with 130 patients aged from 70 to 74 who were operated on in the same period, examining clinicopathological factors, operative methods, preoperative morbidity, postoperative complications, chemotherapy and postoperative survival ratio. RESULTS: In the elderly patients aged over 80, the rate of Dukes' B was high, whereas the rate of Dukes' A was high in patients aged from 70 to 74. No significant differences were observed in operative methods for colon cancer but Hartmann's operation and transanal local excision were frequent for rectal cancer in patients aged over 80. The rate of lymph node dissection was low in patients aged over 80 with rectal cancer. A significant difference was observed in lymph node dissection of rectal cancer between patients aged over 80 and those aged from 70 to 74, but there was no significant difference in curative ratio. Preoperative morbidity were recognized in 76% of patients aged over 80. Postoperative complications occurred in 51% of patients aged over 80. There were many cases showing delirium, but no differences in other complications between patients aged over 80 and those aged from 70 to 74. There was no operative mortality in patients aged over 80. CONCLUSION: Even elderly patients can anticipate safe operations without postoperative complications or decreased quality of life, if the appropriate operative procedure is selected with regard to their general condition.     

7O岁以上老年卵巢癌患者的化学治疗

目的观察70岁以上卵巢癌患者化疗的情况。方法选择1988年1月至2003年8月间我科初治的年龄≥70岁的卵巢癌化疗患者28例（老年组），年龄〈60岁卵巢癌化疗患者49例（非老年组），比较两组患者的临床资料、化疗的耐受性、生存期等。结果老年组和非老年组的化疗率分别为82．4％和98．0％，化疗的平均疗程数分别为5个和9个，两组比较差异有统计学意义（P〈0．05）。两组的化疗方案和按时化疗率比较，差异无统计学意义（P〉0．05）。老年组出现消化道反应的发生率（39．3％）明显低于非老年组（77．6％）。两组患者骨髓抑制需要治疗的比率分别为91．7％和52．0％，差异有统计学意义（P〈0．01）。随访期间，两组的生存时间差异无统计学意义（P〉0．05）。结论年龄大于70岁的卵巢癌患者能够耐受化疗；但化疗前应详细地评价全身状态，治疗方案个体化，严密监测和处理化疗的毒副反应。     

Risk of Dementia in Older Breast Cancer Survivors: A Population-Based Cohort Study of the Association with Adjuvant Chemotherapy

OBJECTIVES: To assess whether there is an association between delivery of adjuvant chemotherapy to older women with breast cancer and development of dementia over time.
DESIGN: Retrospective cohort study using Surveillance, Epidemiology, and End Results (SEER) data linked to Medicare claims data.
SETTING: Women residing in geographic areas included in the SEER registry.
PARTICIPANTS: Women aged 66 to 80 diagnosed with non-metastatic invasive breast cancer from 1992 to 1999 were included. It was determined whether patients had undergone chemotherapy within 6 months of diagnosis.
MEASUREMENTS: Whether women developed dementia over time was determined using diagnostic codes. The effect of adjuvant chemotherapy on development of dementia was evaluated, adjusting for confounders using a proportional hazards model stratified for age.
RESULTS: Twenty-one thousand three hundred sixty-two women met selection criteria; 2,913 received chemotherapy, and 18,449 did not. Women who received chemotherapy were younger than those who did not (median aged 70 vs 73; P <.001). Median follow-up time was 59 months. After controlling for other factors, it was found that chemotherapy was not associated with a greater risk of development of dementia over time for any age group (hazard ratio for dementia in women receiving chemotherapy: aged 66–70=0.83, 95% confidence interval (CI)=0.48–1.45, P =.5; aged 71–75=0.74, 95% CI=0.46–1.18, P =.2; aged 76–80=0.49, 95% CI=0.28–0.88, P =.02).
CONCLUSION: Receipt of chemotherapy in older women with breast cancer was not associated with a greater risk of dementia diagnosis over time; very elderly women who undergo chemotherapy may be at lower baseline risk. The use of a claims-based definition of dementia limited the study.     

乳腺癌患者接受术后辅助化疗的影响因素分析

目的 探讨65岁以上乳腺癌患者接受术后辅助化疗的影响因素. 方法 采用χ2检验和Logistic回归分析方法对590例65岁以上浸润性乳腺癌患者术后辅助化疗的影响因素进行分析. 结果 全组接受术后辅助化疗者231例,占39.15%.结果表明,并存糖尿病、年龄、手术方式及肿瘤的病理生物学特征对患者接受术后辅助化疗有影响(χ2值分别为4.49、88.27、23.49及9.40,均为P<0.05).Logistic回归分析结果显示.年龄、术后病理肿瘤最大径(pT)、术后病理淋巴结状况(pN)、雌激素受体(ER)对接受术后辅助化疗有影响(χ2值分别为68.857、15.284、43.540、7.009,均为P<0.01).淋巴结阳性激素受体阴性的患者中44例(66.7%)接受了术后辅助化疗. 结论 肿瘤大小、淋巴结状况、激素受体状况和年龄是老年乳腺癌患者接受术后辅助化疗的独立预测因素.     

Effectiveness of adjuvant chemotherapy for node-positive operable breast cancer in older women

BACKGROUND: Randomized clinical trials have shown the efficacy of adjuvant chemotherapy in treating node-positive operable breast cancer in women aged < or = 69 years, but the benefit of chemotherapy in women aged > or = 70 is questionable. This study was to examine if adjuvant chemotherapy is effective for these women with breast cancer. METHODS: We studied a cohort of 5464 women diagnosed with node-positive operable breast cancer at age > or = 65 in 1992 through 1996 with last follow-up of December 31, 1999 in five states and six metropolitan areas. Hazard ratio (HR) for all-cause mortality was used for survival analysis with adjustment for patient and tumor characteristics; propensity analysis was used to control for observed factors; and sensitivity analysis was used to estimate potential effects of unmeasured confounders. RESULTS: After adjusting for propensity to receive chemotherapy, the chemotherapy-treated and untreated groups were not statistically significantly different for covariates except for age and hormone receptor status. Mortality was significantly reduced in women aged 65-69 who received adjuvant chemotherapy compared to those who did not, after adjusting for patient and tumor characteristics (HR = 0.70, 95% confidence interval [CI], 0.57-0.88) or after adjusting for propensity scores (HR = 0.76, 95% CI, 0.62-0.94). HR did not significantly differ between the treated and untreated women aged > or = 70 (HR = 0.96, 95% CI = 0.83-1.09, and HR = 0.99, 95% CI, 0.87-1.14). These results were relatively insensitive to changes in unmeasured confounders. CONCLUSIONS: Adjuvant chemotherapy is associated with improved survival in women with node-positive operable breast cancer aged 65-69 living in the community, but not in women aged > or = 70. These findings are consistent with those found in randomized controlled trials.     

老年肿瘤患者的特点与化学治疗

恶性肿瘤是老龄化相关疾病,是60-79岁老年人的第一死因。人体老化进程具有高度个体差异,因此,老年肿瘤患者的化疗需要进行综合性老年医学评估,根据综合性老年医学评估结合肿瘤特征,制定个体化治疗方案。本文介绍了老年人生理和药物代谢动力学的变化及其对肿瘤化疗的影响,并综述了综合性老年医学评估和老年肿瘤患者化疗的要点。随着人口的老龄化,提高老年肿瘤患者的化疗水平已成为临床研究的重要课题之一。     

紫杉醇联合卡铂化疗同期调强适形放疗在老年晚期宫颈癌患者中的应用

目的:探讨采用紫杉醇联合卡铂化疗同期调强适形放疗治疗老年晚期宫颈癌的临床效果。方法:选取2107年2月至2018年7月本院所收治老年晚期宫颈癌患者82例,按照治疗方案的不同分为观察组(紫杉醇联合卡铂化疗＋同期调强适形放疗)和对照组(单纯常规化疗方案的患者),对两组患者的临床治疗效果、不良反应发生情况进行评估分析。结果:...     

Malignant lymphoma, multiple myeloma and myeloproliferative diseases in the elderly

Hematopoietic and immune function tend to deteriorate in the elderly. The incidence of hematologic diseases in the elderly is increasing as the percentage of elderly people in the whole population increases. Acute leukemia, myelodysplastic syndrome, malignant lymphoma, multiple myeloma, and myelodysplastic syndromes are commonly seen in the elderly. Malignant lymphomas are frequently seen in the elderly, and many elderly patients have poor performance status, and because they are more likely to suffer from impaired cardiac, respiratory, hepatic and renal function, as well as glucose intolerance, they are also more likely to suffer side effects due to chemotherapy. Particularly in patients aged over 80 years, to avoid side effects it is essential to adjust dosage and route of administration of chemotherapy. Although age is a significant negative prognostic factor for non-Hodgkin's lymphoma, it is possible for patients to enter complete remission with improvement of host-side factors. The clinical application of Rituximab is expected to improve chemotherapy outcomes in elderly B-cell lymphoma. The median age at the time of initial diagnosis of multiple myeloma (MM) is 60-70 years, and age is a negative prognostic factor. Clinically, higher rates of infection and heavy comorbidity are characteristic of this condition in the elderly. Although the incidence of bony lesions in elderly patients with MM is not different from the non-elderly, they do have a higher incidence of bone pain and pathologic fractures compared with the non-elderly patients. As the response to chemotherapy is good in the elderly, it is worth trying chemotherapy for MM. Polycythemia vera must be treated in the elderly, because chemotherapy decreases the incidence of thrombosis.     

Chemotherapy for non-small cell lung cancer in elderly patients

STUDY OBJECTIVE: To determine the appropriate chemotherapy regimen for inoperable, chemotherapy-na?ve non-small cell lung cancer (NSCLC) in elderly patients. SETTING: National teaching hospital in Taiwan. DESIGN: We retrospectively analyzed data from our clinical trials for a total of 270 patients and compared them with the data from other studies, addressing the elderly in particular or providing subgroup information on age, to analyze the feasibility of current chemotherapy options for elderly patients and possible alternative approaches. RESULTS: The response rates and median survival times of fit elderly patients with NSCLC who were receiving appropriate new anticancer drugs for chemotherapy, including single-agent or combination treatment, were no worse than those of younger patients, and the response rates may have been even higher in the elderly patients, while survival time was slightly poorer in this group. The risk of adverse side effects, such as myelosuppression and peripheral neuropathy, may be higher in elderly patients, who also visit the hospital more frequently. Some items on the lung cancer symptom scale for elderly patients were rated as being slightly worse than those for younger patients after chemotherapy. CONCLUSION: Advanced age alone should not preclude chemotherapy. New single-agent drugs, and non-platinum-based or platinum-based doublets, can all be considered as appropriate treatment for selected fit elderly patients with advanced NSCLC.     

长春瑞滨与铂类联合治疗70岁以上老年人非小细胞肺癌的临床观察

目的 研究长春瑞滨与铂类联合治疗70岁以上非小细胞肺癌患者的疗效和毒副反应.方法 老年肺癌患者共入选100例.化疗组50例,采用长春瑞滨25 mg/m2第1天和第5天,顺铂60～70mg/m2或卡铂250 mg/m2第2天,每4周为1个周期,连用2～4周期.对照组50例,为同期70岁以上患者,资料完整且未做治疗.结果 治疗组45例可评价疗效,部分缓解16例,有效率35.6%,1年生存率37.8%,中位生存期9.8个月;对照组中位生存期4.0个月.治疗组50例均可评价毒副反应,世界卫生组织(WHO)毒副反应标准Ⅲ度白细胞、中性白细胞、贫血发生率分别为38.0%、52.0%和2.2%,IV度中性粒细胞减少发生率35.5%.WHO毒副反应标准Ⅲ度非血液学毒性乏力、呕吐和便秘发生率分别为22.0%、14.0%和8.0%,因毒性反应终止治疗共5例.结论 长春瑞滨与铂类联合治疗高龄非小细胞肺癌有效且毒副反应可耐受.疗效稳定的患者也可从化疗受益.