内外照射结合治疗食管癌60例疗效观察

目的　探讨外照射加腔内放疗治疗食管癌的临床价值。方法　 1999年 1月～ 12月 12 0例经病理证实的食管癌患者 ,随机分为外照射加腔内放疗 (综合组 )、单纯外照射组 (对照组 )各 6 0例。 6MVX线外照射 ,综合组外照射剂量 5 5Gy 6周 ,补充腔内治疗 2次 ,剂量 10～ 12Gy ;对照组外照射剂量 6 5～ 70Gy 6～ 7周。结果　综合组的 1、2、3年生存率分别为 71.7%,42 .3%,2 8.1%,对照组的1、2、3年生存率分别为 5 1.7%、34.5 %、2 1.1%,仅 1年生存率差异有显著性 (P <0 .0 5 ) ;因局部复发或未控而死亡者综合组为48.3%,对照组为 70 .0 %,差异有显著性 (P <0 .0 5 ) ;食管溃疡、瘘和狭窄的发生率两组差异无显著性 (P >0 .0 5 )。结论　外照射结合腔内放疗可提高食管癌的局部控制率和 1年生存率。     

外照射结合腔内放疗中晚期食管癌102例疗效观察

探讨食管癌外照射加腔内放疗的临床价值。1995年1－1995年12月将102例经病理证实的食管癌患者，随机分为外照射加腔内放疗组（综合组）、单纯外照射组（对照组），各51例。6MV X线外照射，综合组外照射剂量60Gy 6周，补充腔内治疗2次，剂量10－12Gy；对照组外照射剂量65－70Gy 6－7周。结果：综合组的1、2、3、4、5年生存率分别为72．5％、42．0％、28．5％、20．4％、14．2％，对照组的1、2、3、4、5年生存率分别为52．9％、33．3％、21．5％、15．6％、11．7％，仅1年生存率差异有显著性（P＜0．05）；因局部复发或未控而死者综合组为50．9％，对照组为68．6％，差异有显著性（P＜0．05）；食管溃疡、瘘和狭窄的发生率两组差异无显著性（P＞0．05）。初步研究结果提示，外照射结合腔内放疗可提高食管癌的局部控制率和1年生存率。     

食管癌外照射加高剂量腔内治疗疗效分析

目的　研究外照射加腔内放射治疗食管癌疗效。方法　 1995年 1月～ 1996年 6月收治 6 0例食管癌随机分为两组 :30例用 8MV直线加速器X线外照射DT6 6 70Gy ;30例用 8MV直线加速器X线外照射DT6 0Gy,结束后 2周视残留病灶情况给予腔内放疗 5 10Gy/ 1 2次。结果　吞咽症状改善单放组70 % ,外照射加腔内放疗组 90 %。 1、3、5年生存率单放组分别为 43 3%、16 7%、6 7% ,外照射加腔内放疗组分别为 83 3%、40 %、2 6 7% ,生存率对比有显著性差异。结论　外照射加腔内放疗较单纯外照射生存率明显提高 (P <0 0 5 )。但要适当掌握剂量 ,选择好适应证尤为重要。     

晚期食管癌放射治疗合并力尔凡的临床观察

目的:观察放疗配合链球菌制剂(力尔凡)治疗食管癌的疗效,免疫功能及放射反应的变化。方法:对符合入组条件的118例食管癌患者随机分为综合组和常规放疗组。常规放疗组60例(对照组),食管癌常规外照射总量DT60～64Gy/6～7周,每次2Gy,每周5次。均采用8MVX线照射;综合组56例,外照射合并力尔凡,外照射同常规放疗组。力尔凡给药方案:放疗d1～3给予5mg/天皮下注射,连用3天;d4起10mg/天静脉滴注,连用30～45天与放疗同步。结果:全部患者随访2年以上,随访率99.1%。1)完全缓解率综合组和常规放疗组分别为44.64%和30.0%(χ2=4.35,P=0.0382),2年生存率分别为46.43%和31.67%,(χ2=4.47,P=0.0344),差异有显著性。2)综合组均如期完成放疗。放疗期间血常规低于正常范围者2例,对照组有11例血常规低于正常范围,放疗周期延长3～10天。3)放射性食管炎、气管炎的发生率综合组少于对照组,但差异无显著性。4)治疗后综合组T3、T4、T4/T8、NK细胞活性明显高于对照组,P<0.01。结论:食管癌放疗合并力尔凡疗效优于单纯放疗,同时能明显减轻放疗不良反应和提高患者的免疫功能。     

外照射同期配合腔内近距离照射治疗中晚期食管癌疗效观察

目的:观察外照射同期配合腔内放疗治疗中晚期食管癌的疗效及不良反应.方法:160例食管癌患者随机分为外照射加腔内放疗组(治疗组)80例、单纯外照射组(对照组)80例.治疗组:外照射开始同期腔内照射,每周先外照射4次,1.8-2Gy/次,后腔内照射1次,5Gy/次,共4-5次,腔内照射当天不做外照射;对照组:采用常规分割单纯外照射,1.8-2Gy/次,5次/周.结果:两组的1、2和3年生存率分别为88.8%、61.3%、30.0%和57.5%、45.0%、23.8%,1、2年生存率两组有统计学差异(P＜0.05).治疗组和对照组急性放射性食管炎的发生率分别为33.8%(27/80)和18.8%(15/80)(P＜0.05),但Ⅲ级及以上的食管炎发生率相当,晚期并发症无增加.结论:外照射同期加腔内照射治疗食管癌疗效优于单纯外照射.此方法对控制原发灶、减少复发和转移、提高生存率有一定临床意义.     

局部晚期食管癌体外放射联合腔内放疗同期化疗的随机研究

目的　分析体外放射联合腔内放疗加同期化疗治疗局部晚期食管癌的疗效。方法　 1995年 12月至 1997年 12月 ,88例局部晚期食管癌随机分为两组 :44例用60 Co γ射线或 6MV X射线外放射DT=5 5 2 0～ 6 0 0 0CG/4 6～ 5 0次 /2 3～ 2 5天 ;平均 3天后用192 Ir源HDR腔内放疗DT=5 0 0～ 10 0 0CGY/2～ 4次。DF方案化疗于放疗前一周开始 ,共化疗两周期 (综合组 ) ;对照组 44例单用放疗。结果　综合组 1、2、3年生存率分别为 79.2 %、33 .4%、15 .6 % ,对照组 77.3 %、36 .4%、12 .5 %。两组局部未控、复发和转移率相似 (P >0 .0 5 ) ,非癌死亡率综合组明显高于对照组 (P <0 .0 5 )。结论　体外放射联合腔内放疗加同期化疗不能进一步提高局部晚期食管癌 3年生存率。     

鼻咽癌外照射后的高剂量率近距离放疗疗效观察

[目的]探讨腔内放疗对鼻咽癌外照射后鼻咽腔内未消退病灶的治疗效果 ,研究近距离放疗时8个剂量参照点的剂量分布及其影响因素。[方法]1994年4月至1998年11月共对34例鼻咽癌外照射后鼻咽腔内未消退病灶行高剂量率近距离放疗(外照射剂量60Gy～71Gy,外照射结束后2天～5天进行首次治疗 ,多数病例剂量参考点深度1 0cm ,放射源驻留长度2 0cm～3 5cm ,多数病例单次剂量8Gy、总剂量16Gy/2次。[结果]CR38例(38/39,97 4 %) ,PR1例(1/39,2 6%) ,中位随访期17月 ,无严重副作用发生 ,通过计算明确了8个参照点的剂量分布情况。[结论]腔内放疗是控制鼻咽腔内外照射后未消退病灶的有效治疗方法 ,但应注意适应证     

同时放化疗治疗局部晚期子宫颈癌疗效分析

目的:探讨同时放化疗治疗晚期子宫颈癌的疗效.方法:选取1997年12月至1999年6月87例Ⅱb～Ⅳa期子宫颈癌患者,随机分为综合组(同时放化疗)和放疗组.放疗组43例外照射加腔内治疗,当放疗剂量达到30Cy时用192Ⅰ腔内治疗,8.0Gy/次·周.当外照射剂量达到46Gy时中间挡铅.A点剂量70Gy,B点剂量56Gy结束放疗.综合组44例,放射治疗同单纯放疗组,放疗开始给予顺铂(DDP)20mg iv d1～d5,5-FU 750 mg iv d1～d5,每28天为一周期,共用4周期.结果:全部病例随访5年以上,随访率93.0%.综合组3、5年生存率分别为86.4%,65.9%;单纯放疗组3、5年生存率分别为55.8%,39.5%,有显著性两组差异(P＜0.05,x2=4.144;5.09).不良反应无显著性差异.结论:同时放化疗治疗晚期子宫颈癌疗效好,可以提高3、5年生存率,不良反应并无明显增加.     

常规与后加速超分割及常规加腔内照射治疗食管癌的远期疗效

目的　观察和比较常规分割、后程加速超分割及常规分割加腔内照射三种方式治疗局部中晚期食管癌的疗效及放射反应。方法　对 111例局部中晚期食管癌首治病例进行前瞻性随机分组研究。常规分割照射组 (常规组 ) 4 0例 :2 .0Gy/次 ,1次 /d ,5d/周 ,共 6 0Gy,30分次 ,6周完成。后程加速超分割组 (后超组 ) 4 1例 :前 3周常规分割 ,30Gy ,15分次 ,3周完成 ;后 2周加速超分割照射 ,1.5Gy/次 ,2次 /d ,5d/周 ,共 30Gy ,2 0分次 ,2周完成。常规外照射加腔内照射组 (腔内组 ) 30例 :常规外照射达 34～ 36Gy时与腔内照射同期进行 (腔内照射当天停外照射 1次 ) ,腔内照射 5 .0Gy/次 ,1次 /周 ,共 2次 ,外照射总量为 5 0Gy。结果　常规组和后超组及腔内组的 1、3、5年生存率分别为 5 7.5 %、2 2 .5 %、14 .1%和 5 7.5 %、2 9.3%、2 4 .4 %及 5 3.3%、2 6 .7%、2 3.3% ,急性放射性食管炎的发生率分别为 2 2 .5 %和 4 1.5 %及 5 0 .0 % ,出血、穿孔的发生率分别为 7.7%和 7.3%及 16 .7%。结论　虽然后程加速超分割放射治疗有提高生存率的趋势 ,但与常规分割照射组及常规外照射加腔内放射治疗组的生存率差异无显著性意义 ,但其是否在治疗中晚期食管癌方面占有绝对优势尚有待大样本前瞻性随机临床研究和长期观察     

食管癌外照射加高剂量腔内治疗疗效分析

目的 研究外照射加腔内放射治疗食管癌疗效。方法 1995年1月－1996年6月收治60例食管癌随机分为两组：30例用8MV直线加速器X线外照射DT66－70Gy;30例用8MV直线加速器X线外照射DT60Gy，结束后2周视残留病灶情况给予腔内放疗5－10Gy/1-2次。结果 吞咽症状改善单放组70％，外照射加腔内放疗组90％。1、3、5年生存率单放组分别为43．3％、16．7％、6．7％，外照射加腔内放疗组分别为83．3％、40％、26．7％，生存率对比有显性差异。结论 外照射加腔内放疗较单纯外照射生存率明显提高（P＜0．05）。但要适当掌握剂量，选择好适应证尤为重要。     

Experience with Impedance Phlebography Compared with Venography

Venography is a particularly reliable method for the diagnosis of deep venous thrombosis but is not suitable as a screening test. Impedance phlebography represents another attempt to discover a simple, non-invasive and reliable method of detecting deep venous thrombosis. It does not, however, meet these criteria.     

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.     

Treatment with methylnaltrexone is associated with increased survival in patients with advanced cancer

BackgroundMethylnaltrexone (MNTX), a peripherally acting μ-opioid receptor (MOR) antagonist, is FDA-approved for treatment of opioid-induced constipation (OIC). Preclinical data suggest that MOR activation can play a role in cancer progression and can be a target for anticancer therapy.Patients and methodsPooled data from advanced end-stage cancer patients with OIC, despite laxatives, treated in two randomized (phase III and IV), placebo-controlled trials with MNTX were analyzed for overall survival (OS) in an unplanned post hoc analysis. MNTX or placebo was given subcutaneously during the double-blinded phase, which was followed by the open-label phase, allowing MNTX treatment irrespective of initial randomization.ResultsIn two randomized, controlled trials, 229 cancer patients were randomized to MNTX (117, 51%) or placebo (112, 49%). Distribution of patients' characteristics and major tumor types did not significantly differ between arms. Treatment with MNTX compared with placebo [76 days, 95% confidence interval (CI) 43–109 versus 56 days, 95% CI 43–69; P = 0.033] and response (laxation) to treatment compared with no response (118 days, 95% CI 59–177 versus 55 days, 95% CI 40–70; P < 0.001) had a longer median OS, despite 56 (50%) of 112 patients ultimately crossing over from placebo to MNTX. Multivariable analysis demonstrated that response to therapy [hazard ratio (HR) 0.47, 95% CI 0.29–0.76; P = 0.002) and albumin ≥3.5 (HR 0.46, 95% CI 0.30–0.69; P < 0.001) were independent prognostic factors for increased OS. Of interest, there was no difference in OS between MNTX and placebo in 134 patients with advanced illness other than cancer treated in these randomized studies (P = 0.88).ConclusionThis unplanned post hoc analysis of two randomized trials demonstrates that treatment with MNTX and, even more so, response to MNTX are associated with increased OS, which supports the preclinical hypothesis that MOR can play a role in cancer progression. Targeting MOR with MNTX warrants further investigation in cancer therapy.Clinical trials numberNCT00401362, NCT00672477.     

Costs associated with complications are lower with capecitabine than with 5‐fluorouracil in patients with colorectal cancer

BACKGROUND:

Capecitabine, an oral alternative to 5‐fluorouracil (5‐FU) in patients with colorectal cancer (CRC), has equal clinical efficacy and a favorable safety profile; however, its use may be limited because of unit cost concerns. In this study, the authors measured the cost of chemotherapy‐related complications during treatment with capecitabine‐ and 5‐FU–based regimens.

METHODS:

Patients with CRC who received at least 1 administration of capecitabine or 5‐FU during 2004 and 2005 were identified from the Thomson MarketScan research databases. Monthly frequency and cost for 23 complications were recorded. Logistic regression was used to predict complication probability. General linear models were used to predict monthly complication cost and total monthly expenditure.

RESULTS:

In total, 4973 patients with CRC met the inclusion criteria for this analysis. Although the most frequently observed complications were the same between capecitabine and 5‐FU (nausea and vomiting, infection, anemia, neutropenia, diarrhea), each was observed with greater frequency in 5‐FU–based regimens. The mean predicted monthly complication cost was significantly higher (by 136%) with 5‐FU monotherapy than with capecitabine monotherapy (difference, $601; 95% confidence interval [95% CI], $469‐$737). In addition, the mean predicted monthly complication cost for 5‐FU+oxaliplatin was higher than the cost with capecitabine plus oxaliplatin (difference, $1165; 95% CI, $892‐$1595). When acquisition, administration, and complication costs were taken into consideration, there were no significant differences in the total cost between capecitabine regimens and 5‐FU regimens.

CONCLUSIONS:

Capecitabine compared well with 5‐FU–based therapy in patients with CRC and was associated with lower complication rates and associated costs. Cancer 2009. © 2009 American Cancer Society.     

Second-line chemotherapy with cisplatin-ifosfamide in patients with ovarian cancer previously treated with carboplatin-cyclophosphamide.

In an effort to use antineoplastic drug combinations which are active in platinum resistant ovarian cancer or which can induce a second response after a platinum first-line treatment, we conducted a study on 30 ovarian cancer patients previously treated with carboplatin plus cyclophosphamide who were given ifosfamide 5 g/m2 i.v. divided over days 1 to 3 plus mesma combined with cisplatin 100 mg/m2 i.v. divided over days 1 to 3 every 4 weeks as second-line treatment. Eight patients had never entered remission with first-line chemotherapy while 22 patients had tumor recurrence within 6 to 18 months after the end of chemotherapy and their tumors were considered potentially platinum sensitive. Responding patients received 6 courses while palliative treatment for nonresponders was provided. Of the 22 patients with tumor recurrence, 8 patients responded with one partial response (PR) and 7 complete clinical responses (CCR). Two out of the 8 patients with platinum resistant disease demonstrated short lasting PR. Seven patients with CCR underwent second-look operation and in two a pathological CR was documented. Median time to progression was 6 mo (4-12). The median overall survival was 12 mo (4-20). Myelotoxicity despite G-CSF administration was significant with grade 4 leukopenia in 40% and grade 3 thrombocytopenia in 20% of patients. Central nervous system (CNS) toxicity was significant with 30% somnolence, 20% disorientation and an episode of grand-mal epilepsy ascribed to ifosfamide. With a 33% response rate the combination is as effective as new agents employed in relapsed ovarian cancer. Platinum-refractory disease may respond to a lesser degree. The most important determinant of response was the progression-free interval from first-line chemotherapy. Whether patients recurring after carboplatin plus cyclophosphamide have a greater chance to respond to cisplatin plus ifosfamide or vice-versa cannot be supported by the current data and therefore randomized studies should be performed to this end.     

Living with secondary breast cancer: coping with an uncertain future with unmet needs

JOHNSTON S.R.D. (2010) European Journal of Cancer Care 19 , 561–563 Living with secondary breast cancer: coping with an uncertain future with unmet needs     

奥沙利铂联合羟基喜树碱治疗晚期胃癌临床分析

背景与目的体外及体内的临床研究显示,奥沙利铂(L-OHP)对多种肿瘤有显著抑制作用并与绝大多数抗癌药物具有相加或协同细胞毒作用.本文旨在观察L-OHP联合羟基喜树碱(HCPT)治疗晚期胃癌的近期疗效和患者耐受性,并与传统的化疗方案进行对比.方法采用非随机的分组方法将43例晚期胃癌患者分为L-OHP+HCPT方案组(治疗组)与Vp-16+CF+5-FU(ELF)方案组(对照组),其中男性28例,女性15例,中位年龄59岁,KPS评分≥60,观察两组的近期疗效和患者耐受性.结果治疗组24例有效率58.3%(14/24),对照组19例有效率42.1%(8/19).治疗组有效率高于对照组,两组差异有显著性(P<0.05).两组不良反应主要是骨髓抑制、恶心、呕吐、口腔炎、周围神经炎、静脉炎、脱发等,均在Ⅰ、Ⅱ度范围内.结论L-OHP联合HCPT方案治疗晚期胃癌疗效较好,不良反应可以耐受.