PGC方案诱导化疗后同步放化疗治疗Ⅲ~ⅣA期鼻咽癌的Ⅱ期单中心前瞻性临床研究

目的 评价脂质体紫杉醇、吉西他滨、卡铂三药联合的诱导化疗（PGC方案）序贯同步放化疗治疗中晚期鼻咽癌患者的疗效及不良反应。方法 对初治Ⅲ~ⅣA期33例鼻咽癌患者, 给予2周期PGC方案新辅助化疗,序贯同步放化疗。诱导化疗方案：脂质体紫杉醇135 mg/m2+吉西他滨1 000 mg/m2+卡铂,血药浓度-时间曲线下面积（area under the curve,AUC）取5,第一天给药,每三周一次。第7周开始调强放射治疗同步化疗,卡铂AUC=5, 每三周一次。结果 在PGC诱导化疗两周期后评价：7例（21%）完全缓解（CR）,21例（64%）部分缓解（PR）,4例（12%）稳定（SD）,1例（3%）进展（多发性肺转移）。放疗完成3月后评价,28（85%）例CR、4（12%）例PR、1例（3% ）PD。1年总生存率100%,1年无病生存率91%。主要不良反应包括白细胞下降,血小板减少反应,肝功能损害,均可逆转。结论 PGC三药方案诱导化疗序贯同步放化疗治疗Ⅲ~ⅣA期鼻咽癌疗效较好,不良反应可耐受。     

三维适形放疗联合DP方案同步与序贯治疗中晚期非小细胞肺癌

[目的]探讨三维适形放疗联合化疗同步与序贯治疗Ⅲ期非小细胞肺癌(NSCLC)的疗效和不良反应。[方法]将95例Ⅲ期NSCLC患者随机分为两组:序贯治疗组及同步治疗组,两组均采用三维适形放射治疗(3D-CRT),序贯组先采用DP方案化疗,化疗2个周期后行放疗,放疗结束后再行2个周期化疗;同步组化疗与放疗同时进行,连续化疗4个周期,两组放疗方法及化疗药物和剂量均相同。[结果]序贯组治疗有效(CR+PR)率60.78%,同步组治疗有效(CR+PR)率81.81%,两组差异有显著性(P<0.05);1年生存率序贯组50.98%,同步组61.36%,差异无显著性(P>0.05);2年生存率序贯组17.65%,同步组36.36%,差异有显著性(P<0.05)。两组患者均能耐受治疗中的不良反应。[结论]三维适形放疗联合同步化疗的近期疗效及2年生存率优于对照组,患者可耐受。     

脂质体紫杉醇联合卡铂治疗老年晚期头颈部肿瘤的临床观察

目的探讨脂质体紫杉醇联合卡铂治疗老年晚期头颈部肿瘤的近期疗效及安全性。方法对22例老年晚期头颈部肿瘤进行化疗,方案为脂质体紫杉醇135 mg/m2,d1;卡铂300 mg/m2,d2,21~28天重复。2个周期后评价疗效及不良反应。结果 22例中21例可评价疗效,共完成周期数72个,完全缓解(CR)2例,部分缓解(PR)6例,稳定(SD)9例,进展(PD)4例,总有效率(CR+PR)38.1%,疾病控制率(CR+PR+SD)80.9%,主要不良反应为骨髓抑制、胃肠道反应、脱发、疲乏,其中Ⅲ~Ⅳ级不良反应为8例(38.1%),无化疗相关性死亡。结论脂质体紫杉醇联合卡铂治疗老年晚期头颈部肿瘤有较好的近期疗效,反应可耐受。     

多烯紫杉醇/吉西他滨联合顺铂序贯治疗转移复发性乳腺癌临床观察

目的观察多烯紫杉醇(DXL)联合顺铂(DDP)和吉西他滨(GEM)联合顺铂(DDP)序贯治疗转移复发性乳腺癌的临床疗效及毒副作用。方法53例经病理确诊为转移复发性乳腺癌,随机分为TP(多烯紫杉醇 顺铂)/GP(吉西他滨 顺铂)序贯组和TP组(多烯紫杉醇 顺铂)。TP:25例,多烯紫杉醇35 mg/m~2,静滴d1,d 8;顺铂25 mg/m~2静滴,d1～3,28 d为一个周期,共治疗4～6周期。TP/GP序贯组28例,先用TP方案化疗3～4周期,方案同上,后改用GP方案:GEM 1 000 mg/ m~2,静滴d 1,8;DDP 25 mg/m~2,静滴,d 1～3;28 d为一个周期,治疗3～4周期。或先用GP方案3～4周期,后改用TP方案3～4周期。至少应用4个周期。结果TP/GP组与TP组有效率(RR)分别为67.9%和56.0%(x~2=0.790,P=0.374);疾病控制率(DCR)分别为92.9%和88.0%(x~2=0.365,P =0.658)。其中TP/GP组一线治疗6例,CR 2例,PR 4例,有效率为100.0%;二线治疗22例,CR 2例,PR 11例,有效率59.1%。TP组一线治疗5例,CR 2例,PR 3例,有效率为100.0%,二线治疗20例,CR 0例,PR 9例,有效率45.0%。TP/GP、TP组中位无进展生存时间分别为9.5和8.0个月;中位生存时间分别为19.0和19.0个月(P=0.3894)。1年生存率分别为82.2%和60.0%,2年生存率分别为28.6%和30.0%,两组差异无显著性(P>0.05)。主要不良反应为骨髓抑制。结论多烯紫杉醇/吉西他滨联合顺铂序贯治疗转移复发性乳腺癌临床疗效好,不良反应轻,值得进一步扩大样本研究。     

同步放化疗与序贯放化疗治疗67例局部晚期非小细胞肺癌的疗效比较

[目的]探讨同步放化疗及序贯放化疗治疗局部晚期非小细胞肺癌（NSCLC）的疗效及不良反应。[方法]67例局部晚期NSCLC患者分为同步放化疗组（35例）及序贯放化疗组（32例）。同步放化疗组采用紫杉醇40mg/m2,卡铂AUC=2,d1;3DCRT与化疗同时开始,每周1次。序贯放化疗组先行2个周期全身化疗：紫杉醇150mg/m2,卡铂AUC=6,d1,21d为1个周期;第42d开始行3DCRT。[结果]同步放化疗组及序贯放化疗组有效率分别为77%及56%,1年生存率分别为76%和66%,2年生存率分别为39%和32%,差异均无统计学意义（P〉0.05）。两组不良反应差异无显著性（P〉0.05）。同步放化疗组、序贯放化疗组局部复发率分别为20%（7/35）和31%（10/32）,差异有统计学意义（χ2=4.521,P=0.033）。[结论]同步放化疗治疗局部晚期NSCLC疗效较好,但有增加不良反应的可能。     

局部晚期非小细胞肺癌三维适形放疗同步化疗的临床观察

为了评价三维适形放疗同步紫杉醇+顺铂化疗治疗局部晚期非小细胞肺癌(NSCLC)的疗效和放射反应,对收治的65例不能手术的Ⅲ期NSCLC患者进行三维适形放疗加同步化疗,化疗方案全部采用PC方案:紫杉醇75 mg/m2,d1、d8静脉滴入;顺铂30 mg/m2、d1～d3静脉滴入,每21 d为1个周期.放疗设备采用西门子直线加速器,6 MV-X线,CT模拟定位,放疗中位剂量60 Gy,6周完成.靶区为原发肿瘤及受侵的纵隔淋巴结区,放射治疗结束后2个月评价疗效.CR 8例(12.3%),PR 45例(69.2%),无变化12例(18.5%),总有效率(CR+PR)81.5%.1年生存率72.3%(47/65).急性毒副反应主要是骨髓抑制、放射性食管炎和放射性肺炎,以1～2级为主,7例(10.8%)出现3级骨髓抑制.晚期毒副反应均为1～2级放射性肺炎.初步研究结果提示,三维适形放疗结合紫杉醇+顺铂化疗治疗局部晚期NSCLC耐受性较好,均可完成治疗计划,短期疗效好,远期疗效有待进一步观察.     

GP方案序贯三维适形放疗治疗老年局部晚期非小细胞肺癌疗效观察

目的:观察GP方案化疗序贯三维适形放疗(3D-CRT)治疗Ⅲ期老年非小细胞肺癌(NSCLC)的疗效及毒副作用。方法:回顾性分析我科2004年1月-2007年2月收治的62例Ⅲ期老年非小细胞肺癌(NSCLC),分成序贯放化疗组及单纯放疗组患者,序贯放化疗组32例,单纯放疗组30例。序贯放化疗组应用吉西他滨1000mg/m2,d1、8,顺铂30mg/m2,d2-4,常规止吐对症处理,21天为1个周期,接受3个周期化疗,化疗结束后3周行全程X线三维适形放疗DT66-70Gy/7周,2Gy/次,5次/周;单纯放疗组放疗方法同序贯放化疗组放疗,治疗完成4周后评价疗效和不良反应。结果:62例均完成治疗,单纯放疗组总有效率(CR+PR)为66.7%,完全缓解率(CR)为10%。单纯放疗组1、3、5年生存率分别为46.7%、13.3%、6.7%。序贯放化疗组总有效率(CR+PR)为81.3%,完全缓解率(CR)为12.5%;序贯放化疗组1、3、5年生存率分别为71.9%、37.5%、12.5%。两组总有效率差异有统计学意义(P<0.05),两组1、3年生存率差异有统计学意义(P<0.05)。放化疗的毒副反应主要是放射性肺损伤和放射性食管炎,但皆可耐受。结论:GP方案化疗序贯三维适形放疗治疗Ⅲ期老年非小细胞肺癌(NSCLC)可明显提高近期疗效和远期疗效,未增加明显不良作用。     

有高危因素的早期宫颈癌患者术后紫杉醇联合卡铂同期化放疗的疗效和安全性观察

目的评价紫杉醇联合卡铂同期放疗(CCRT)在治疗有高危因素早期宫颈癌术后的疗效和毒副反应。方法收集本科2008年7月1日至2011年6月30日收治ⅠB1～ⅡB宫颈鳞癌根治术后有高危因素的患者54例,其中行同期化放疗15例,39例行序贯放疗。同期化疗方案为紫杉醇(135 mg/m~2)联合卡铂(AUC=5)于放疗第一周进行一个疗程。辅助化疗方案同同期化疗,于放疗结束后开始,每21天一个疗程。比较同期化放疗和序贯放疗的复发率、无进展生存期(PFS)和总生存期(OS)以及急性期和晚期不良反应。结果 54例患者均按计划完成治疗,同期化放疗的中位放疗剂量50 Gy(46～52 Gy,每次2 Gy)和人均化疗次数4次(3～5次)与序贯放疗相似(P=0.60和P=0.34)。在中位随访20个月(8～43个月)期间发现,同期化放疗较序贯放疗能减少局部复发率(0/15 vs 9/39,P=0.04),而两组无进展生存期(log-rank,P=0.26)和总生存期(log-rank,P=0.51)相似。同期化放疗患者出现3～4级血液学不良反应比例高于序贯放疗(4/15 vs 1/39,P=0.03),而3级胃肠道急性不良反应相似(4/15 vs 5/39,P=0.22),随访期间两组患者未发现3～4级晚期不良反应。结论紫杉醇联和卡铂的同期化放疗能减少有高危因素的早期宫颈癌术后患者局部复发,并有较好耐受性。     

尼妥珠单抗联合三维适形放疗及化疗治疗局部晚期鼻咽癌的初步临床研究

  目的   探讨尼妥珠单抗联合同期三维适形放疗(3D-CRT)及化疗治疗Ⅲ、ⅣA期鼻咽癌的疗效及不良反应。   方法  经组织病理确诊的Ⅲ、ⅣA期(2008分期)鼻咽癌初诊患者63例随机分为对照组(33例)和治疗组(30例), 均采用3D-CRT及同期和序贯紫杉醇顺铂方案化疗, 治疗组每周一放疗前行尼妥珠单抗100mg治疗, 共6~7次。   结果   放疗结束后2个月原发灶CR率、颈部淋巴结CR率治疗组分别为100.0%、96.7%, 明显高于对照组的81.8%及75.8%(P均 < 0.05), 放疗后1年局部控制率、无转移生存率在治疗组及对照组分别达到100.0%vs.89.3%、95.5%vs.82.1%(P > 0.05), 两组主要不良反应为放射性咽喉炎、放射性皮炎和恶心呕吐、白细胞减少、疲乏等, 耐受性较好。治疗组发生3度以上放射性咽喉炎(P < 0.05)、放射性皮炎(P > 0.05)较对照组偏高。   结论   尼妥珠单抗联合3D-CRT及紫杉醇及顺铂同期及序贯化疗治疗局部晚期鼻咽癌, 可提高近期完全缓解率及局部控制率, 耐受性较好, 远期生存率有待进一步观察研究。      

奈达铂联合氟尿嘧啶诱导化疗治疗局部晚期鼻咽癌的疗效及安全性分析

目的 探讨治疗局部晚期鼻咽癌时奈达铂联合氟尿嘧啶诱导化疗的近期疗效和不良反应,并对其安全性进行分析.方法 选自120例局部晚期鼻咽癌患者;以患者入院时间先后顺序进行随机分组,实验组60例、对照组60例.实验组:静脉滴注奈达铂(80 mg/m2),d1;持续微泵输入氟尿嘧啶(500 mg/m2/d),d1~d5;每21天为1个疗程,连用2个疗程.对照组:静脉滴注卡铂(300 mg/m2),d1;持续微泵输入氟尿嘧啶(500 mg/m2/d),d1~d5;每21天为1个疗程,连用2个疗程.两组诱导化疗2个周期完成后14 d开始序贯适型调强放疗.序贯适型调强放疗:直线加速器适型调强放疗,每次2.18 Gy,每周5次.序贯放疗结束后进行MRI检查.结果 2个周期诱导化疗后,实验组鼻咽部CR+PR 48例,总有效率为80.00%,淋巴结总有效率为73.34%,对照组鼻咽部CR+PR 46例,总有效率为76.67%,淋巴结总有效率为71.43%,两组治疗疗效比较无显著差异(P>0.05);诱导化疗序贯放疗后,实验组鼻咽部和淋巴结总有效率分别为96.67%和100.00%,对照组鼻咽部和淋巴结总有效率分别为96.67%和100.0%,两组间疗效对比无显著差异(P>0.05),但两组诱导化疗后,疗效均显著提高;诱导化疗序贯放疗后总疗效对比,实验组CR率为83.33%;对照组CR率为70.00%.两组近期总疗效比较无显著差异(P>0.05);实验组血小板减少发生率为16.67%,明显低于对照组46.67%,两组比较差异显著(P<0.05);特别在Ⅲ、Ⅳ度,实验组发生率(1.67%)显著低于对照组(16.67%),两组比较有明显差异(P<0.05).实验组恶心呕吐发生率(76.67%)与对照组(83.33%)比较差异不大,无显著差异性.结论 在治疗局部晚期鼻咽癌时奈达铂联合氟尿嘧啶具有疗效好,不良反应轻的特点,值得在鼻咽癌诱导化疗中推广应用.     

多西他赛联合三维适形放疗治疗老年局部晚期非小细胞肺癌70例

[目的]观察多西他赛联合三维适形放疗（3D-CRT）治疗老年局部晚期非小细胞肺癌（NSCLC）的疗效与安全性。[方法]2005年5月至2009年1月共70例（ⅢA期37例,ⅢB期33例）老年局部晚期NSCLC患者入组,其中68例完成放化疗,多西他赛70mg/m2,d1,静脉滴注,28d为1个周期,共2～3个周期;化疗第2d行3D-CRTDT56～64Gy/28～32f,38～44d。[结果]68例中CR13例（19.12%）,PR38例（55.88%）,SD7例（10.29%）,PD10例（14.71%）,总有效率（RR）75.00%,中位生存时间（MST）13.75个月（5～48个月）,中位肿瘤进展时间（TTP）10.50个月（4～36个月）。鳞癌的TTP、MST优于腺癌（P值均〈0.001）;ⅢA期TTP、MST优于ⅢB期（P值均〈0.001）。毒副反应主要表现为骨髓抑制、放射性食管炎、放射性肺炎、放射性皮炎、脱发、消化道反应、周围神经毒性及皮疹等。[结论]多西他赛联合3D-CRT治疗老年局部晚期NSCLC疗效较好,毒性反应可以耐受,为老年局部晚期NSCLC患者综合治疗的有效方案。     

Induction therapy with paclitaxel and carboplatin followed by hyperfractionated radiotherapy plus weekly concurrent chemotherapy and subsequent consolidation therapy in unresectable locally advanced non-small-cell lung cancer

AIMS AND BACKGROUND: The purpose of this pilot study was to determine the safety and feasibility of a complete integrated approach, including induction chemotherapy with carboplatin/paclitaxel followed by accelerated hyperfractionated radiotherapy with concurrent chemotherapy, and then by consolidation chemotherapy for locally advanced stage III non-small cell lung carcinoma. METHODS: Systemic doses of carboplatin AUC 6 and paclitaxel (200 mg/m2), 3 weeks out of 4, were planned as induction and consolidation chemotherapy. Weekly carboplatin AUC of 2 plus paclitaxel (50 mg/m2) were given during thoracic radiotherapy. RESULTS: Eighteen patients were enrolled: 10 were evaluated at the end of chemoradiation and 8 received consolidation chemotherapy. On an intent-to-treat basis, 55% of patients achieved a response after induction therapy, whereas chemoradiation and consolidation therapy increased the response rate by 33% and 16%, respectively. No patient experienced grade > 3 acute hematologic toxicity during systemic-dose chemotherapy. With the exception of one episode of a severe cardiac adverse event, non-hematologic toxicity was similarly tolerable. Severe acute adverse events observed during concurrent chemoradiation were mainly represented by esophagitis, resulting in interruption of the radiotherapy in 25% of patients. More notably, only one patient experienced serious non-hematologic late toxicity. CONCLUSIONS: Although the present approach seemed feasible, our data did not support any possible advantage in favor of this three-phase integrated treatment, and therefore the design will not be investigated in a subsequent phase II study.     

Organ preservation therapy using induction plus concurrent chemoradiation for advanced resectable oropharyngeal carcinoma: a University of Pennsylvania Phase II Trial.

PURPOSE: To determine the efficacy, feasibility, and toxicity of a new regimen for locally advanced oropharyngeal carcinoma. PATIENTS AND METHODS: Patients had technically resectable stage III/IV squamous cell carcinoma of the oropharynx, exclusive of T1-2N1. Induction chemotherapy consisted of carboplatin (area under the curve formula equal to 6) and paclitaxel 200 mg/m(2) for two cycles, followed by re-evaluation. Patients with major response continued to definitive radiotherapy (70 Gy over 7 weeks) plus concurrent once-weekly paclitaxel (30 mg/m(2)/wk). Patients with advanced neck disease also underwent post-radiation therapy neck dissection and two more chemotherapy cycles. RESULTS: Fifty-three patients were enrolled. Median follow-up was 31 months (minimum follow-up for survivors was 18 months). The major response rate to induction chemotherapy was 89%; 90% of patients had a complete response after concurrent chemoradiation. Actuarial survival at 3 years was 70%, and 3-year event-free survival was 59%. The 3-year actuarial locoregional control was 82% and the 3-year actuarial rate of distant metastases was 19%. Organ preservation was achieved in 77% of all patients. One patient (2%) died during therapy. Late grade 3 toxicity occurred in 24% of patients, consisting mainly of chronic dysphagia/aspiration and/or radiation soft tissue ulceration. The treatment-related mortality rate was 4% (two patients died from respiratory failure). CONCLUSION: Response to induction chemotherapy as studied in this trial was not useful as a predictive marker for ultimate outcome or organ conservation. Overall, however, this regimen offers good disease control and survival for patients with locally advanced oropharyngeal carcinoma, comparable with other concurrent chemoradiation programs. Further study of similar protocols is indicated.     

Phase II trial of paclitaxel, carboplatin, and concurrent radiation therapy for locally advanced non-small-cell lung cancer

We conducted a phase II trial to investigate the efficacy of concurrent chemoradiation in patients with stage III non-small-cell lung cancer (NSCLC). Thirty patients with inoperable NSCLC were enrolled onto a multicenter phase II trial of concurrent chemoradiation therapy. Patients received six weekly cycles of paclitaxel 45 mg/m(2) over 1 h; carboplatin at (area under the curve) AUC 2; and radiation therapy of 60 Gy. Radiation was administered to the primary tumor and regional lymph nodes (40 Gy over 4 weeks) followed by a boost to the primary tumor (20 Gy in 2 weeks). After the initial phase of concurrent chemoradiation, patients received an additional four cycles of paclitaxel 175 mg/m(2) over 3 h and carboplatin at AUC 6 every 3 weeks. The overall objective response rate of 30 assessable patients was 76.7%. At the median follow-up time of 13.1 months, the median survival time was 14.5 months (95% CI, 10.59-18.48). The median progression-free survival was 10.5 months (95% CI, 7.72-13.28). The major toxicity was hematologic. The incidence of grade 3 esophagitis was 10%. In conclusion, this chemoradiation regimen is well tolerated and shows significant clinical results for locally advanced NSCLC. Locoregional failure rate remains an important issue with this newer chemotherapeutic regimen. A novel chemotherapy and radiation therapy is clearly needed.     

Combined chemoradiotherapy regimens of paclitaxel and carboplatin for locally advanced non-small-cell lung cancer: a randomized phase II locally advanced multi-modality protocol.

PURPOSE: This phase II noncomparative randomized trial was conducted to determine the optimal sequencing and integration of paclitaxel/carboplatin with standard daily thoracic radiation therapy (TRT), in patients with locally advanced unresected stage III non-small-cell lung cancer (NSCLC). Survival data were compared with historical standard sequential chemoradiotherapy data from the Radiation Therapy Oncology Group. PATIENTS AND METHODS: Patients with unresected stages IIIA and IIIB NSCLC, with Karnofsky performance status > or = 70% and weight loss < or = 10%, received two cycles of induction paclitaxel (200 mg/m2)/carboplatin (area under the plasma concentration time curve [AUC] = 6) followed by TRT 63.0 Gy (arm 1, sequential) or two cycles of induction paclitaxel (200 mg/m2)/carboplatin (AUC = 6) followed by weekly paclitaxel (45 mg/m2)/carboplatin (AUC = 2) with concurrent TRT 63.0 Gy (arm 2, induction/concurrent), or weekly paclitaxel (45 mg/m2)/carboplatin (AUC = 2)/TRT (63.0 Gy) followed by two cycles of paclitaxel (200 mg/m2)/carboplatin (AUC = 6; arm 3, concurrent/consolidation). RESULTS: With a median follow-up time of 39.6 months, median overall survival was 13.0, 12.7, and 16.3 months for arms 1, 2, and 3, respectively. During induction chemotherapy, grade 3/4 granulocytopenia occurred in 32% and 38% of patients on study arms 1 and 2, respectively. The most common locoregional grade 3/4 toxicity during and after TRT was esophagitis, which was more pronounced with the administration of concurrent chemoradiotherapy on study arms 2 and 3 (19% and 28%, respectively). CONCLUSION: Concurrent weekly paclitaxel, carboplatin, and TRT followed by consolidation seems to be associated with the best outcome, although this schedule was associated with greater toxicity.     

榄香烯乳联合顺铂同步放化疗后PF巩固化疗治疗中晚期食管癌

  目的  探讨榄香烯乳联合顺铂同步放化疗后顺铂+5-Fu（PF）巩固化疗治疗中晚期食管癌的临床疗效。  方法  榄香烯联合顺铂同步放化疗后PF巩固化疗治疗64例中晚期食管癌: 放疗采用三维适形放疗, 常规分割, 靶区总剂量55.8~66.6 Gy; 放疗同时给予顺铂（30 mg/m2第1~3天, 21天为一周期）化疗2周期。同步放化疗结束后给予不多于4周期PF方案（顺铂30 mg/m2第1~3天, 5-Fu500 mg/m2第1~5天）巩固化疗。其中联合组34例放疗期间应用榄香烯乳500 mg, 每日1次, 每周5次, 巩固化疗期间第1~5天给予榄香烯乳500 mg, 与同期接受顺铂同步放化疗后PF巩固化疗的30例中晚期食管癌患者进行对照。  结果  1）对照组和联合组有效率分别为63.3%和85.2%, 差异有统计学意义（P < 0.05）。2）对照组1、2年局部控制率分别为56.7%和33.8%, 联合组分别为69.9%和44.7%, 联合组有改善局部控制率的趋势（P=0.133）; 对照组1、2年生存率分别为60.0%和34.6%, 中位生存时间为13个月, 联合组1、2年生存率分别为64.7%和42.6%, 中位生存时间为15个月, Log-rank检验差异无统计学意义（P>0.05）。3）对照组Ⅲ、Ⅳ级白细胞下降的发生率为30%, 明显高于联合组的8.8%（P < 0.05）, Ⅲ、Ⅳ级血小板下降、胃肠道反应、放射性食管炎、放射性气管炎等急性不良反应两组差异有无统计学意义（P < 0.05）。  结论  顺铂同步放化疗后PF巩固化疗治疗中晚期食管癌具有一定的疗效。榄香烯乳联合放化疗有助于提高近期疗效, 减轻血液学毒性, 值得进一步研究。      

三维适形放射治疗局部晚期非小细胞肺癌预后因素分析

目的评估三维适形放疗治疗局部晚期非小细胞肺癌的疗效、毒性及预后因素。方法采用三维适形放射治疗经组织学证实的局部晚期(ⅢA或ⅢB期)非小细胞肺癌患者113例,分析患者的1、2、3年生存率和中位生存期及预后因素。结果全组1、2、3年生存率分别为60.7%、31.6%和22.4%。中位生存期为17个月,其中单独放疗组16个月,序贯放化疗组18个月,同步放化疗组16个月。单因素分析显示,治疗前胸背痛、卡氏评分、血红蛋白、白蛋白水平、大体肿瘤体积(GTV)及近期疗效是影响预后的因素(P值分别为0.033、0.000、0.042、0.028、0.024和0.021);多因素分析显示,疗前卡氏评分是肺癌预后的独立因素。结论三维适形放射治疗局部晚期非小细胞肺癌显示了较好的疗效,放疗前卡氏评分是影响局部晚期非小细胞肺癌预后的主要因素。     

诱导化疗和紫杉醇每周同期化疗结合三维适形放射治疗不能手术的Ⅲ期非小细胞肺癌的初步结果

背景与目的:局部晚期非小细胞肺癌(non-smallcelllungcancer,NSCLC)单纯放疗局部控制率差,放化疗综合治疗及放疗剂量递增成为提高局控的主要研究方向,但最佳治疗模式尚未确定。本研究观察诱导化疗和三维适形放射治疗(three-dimensionalconformalradiotherapy,3DCRT)联合每周紫杉醇治疗NSCLC的毒性及初步疗效。方法:Ⅲ期NSCLC患者予紫杉醇(175mg/m2,d1)加卡铂(AUC=5～6,d1)诱导化疗2～4疗程,化疗后3～4周内开始3DCRT,剂量在满足V20≤31%,脊髓≤50Gy的条件下给予尽可能的高,联合每周紫杉醇40mg/m2同期化疗。结果:31例患者入组,诱导化疗毒性可耐受。同期放化疗期间,3例因3～4度急性毒性中止治疗,2例因身体虚弱分别中断治疗7天及12天,其余26例按计划完成治疗。白细胞下降发生率为51.6%(16/31,1例为3度,余为1～2度);3度淋巴细胞下降发生率达67.7%(21/31)。主要急性毒性为放射性食管炎和放射性肺炎,3度放射性食管炎3例,3～4度放射性肺炎2例。1～4度后期食管损伤各有1例发生;肺纤维化均不超过2度。肺原发灶总有效率(CR PR)为74.1%(CR1例,PD2例)。中位生存时间18.5个月,1、2、3年生存率分别为74.2%、41.9%、34.6%,中位局部无进展生存时间为14.3个月,1、2、3年局部无进展生存率分别为64.5%、32.3%、20.5%。结论:诱导化疗后3DCRT结合每周紫杉醇治疗局部晚期NSCLC能为大多数患者耐受,初步疗效令人鼓舞。     

A phase II study of paclitaxel, carboplatin, and hyperfractionated radiation therapy for locally advanced inoperable non-small-cell lung cancer (a Vanderbilt Cancer Center Affiliate Network Study)

PURPOSE: We conducted a prospective phase II study to determine the response rate, toxicity, and survival rate of concurrent weekly paclitaxel, carboplatin, and hyperfractionated radiation therapy (paclitaxel/carboplatin/HFX RT) followed by 2 cycles of paclitaxel and carboplatin for locally advanced unresectable non-small cell lung cancer (NSCLC). The weekly paclitaxel and carboplatin regimen was designed to optimize the radiosensitizing properties of paclitaxel during the concurrent phase of treatment. METHODS AND MATERIALS: Forty-three patients with unresectable stage IIIA and IIIB NSCLC from the Vanderbilt Cancer Center and Affiliate Network (VCCAN) institutions were entered onto the study from June 1996 until May 1997. Weekly intravenous (IV) paclitaxel (50 mg/m(2)/l-hour) and weekly carboplatin (AUC 2) plus concurrent hyperfractionated chest RT (1.2 Gy/BID/69.6 Gy) were delivered for 6 weeks followed by 2 cycles of paclitaxel (200 mg/m(2)) and carboplatin (AUC 6). RESULTS: Forty-two patients were evaluable for response and toxicities. Three patients achieved a complete response (7.2%) and 30 patients achieved a partial response (71.4%), for an overall response rate of 78.6% [95% C.I. (66.2%-91.0%)]. The 1- and 2-year overall and progression-free survival rates of all 43 patients were 61.6% and 35% respectively, with a median survival time of 14.3 months. The median follow-up time was 14 months. Esophagitis was the principal toxicity. Grade 3 or 4 esophagitis occurred in 11 patients (26%). There was an incidence of 7% grade 3 and 9.5% grade 4 pulmonary toxicities. CONCLUSIONS: Weekly paclitaxel, carboplatin, plus concurrent hyperfractionated RT is a well-tolerated outpatient regimen. The response rate from this regimen is encouraging and appears to be at least equivalent to the more toxic chemoradiation trials. These findings warrant further clinical evaluation of weekly paclitaxel/carboplatin/HFX RT in a phase III study.