胃癌术后OXA＋5-FU/LV联合DDP腹腔灌注辅助化疗疗效观察

目的：探讨OXA＋5-FU/LV联合DDP腹腔灌注辅助化疗对胃癌的疗效。方法：OXA85mg/m2d1＋LV0.2/m2d1-2＋5-FU0.4/m2d1-2＋5-FU1.2/m244h双周方案,共执行6个月化疗,腹腔灌注化疗：DDP60mg每周,共6周后停用。结果：2004年1月-2009年7月共收治96例胃癌术后病人,83例完成12周期化疗,4年生存率55.4%,5年生存率40.9%,13例因为年龄、不良反应和经费等原因未能完成计划,无不良反应致死,总体不良反应耐受良好。结论：OXA＋5-FU/LV联合DDP腹腔灌注辅助化疗胃癌疗效确切且不良反应低。     

多西紫杉醇腹腔灌注化疗治疗晚期胃癌Ⅱ期临床研究

目的：探讨多西紫杉醇（DOC）腹腔灌注化疗（intraperitoneal chemotherapy,IPC）联合亚叶酸钙（CF）/5-氟尿嘧啶（5-FU）/奥沙利铂（OXA）静脉用药治疗晚期胃癌的临床疗效和安全性。方法：2007年7月至2009年9月,给与43例TNMⅢb-Ⅳ期胃癌患者（Ⅲb期19例,Ⅳ24期例）DOC 40mg/m^2腹腔灌注d1,8,CF200mg/m^2静脉滴注d1-5,5-FU 375mg/m^2静脉滴注d1-5,OXA 135mg/m^2静脉滴注d1方案,每21天为一周期,共2-4个周期,每2周期评价疗效。结果：总有效率（CR＋PR）为58.1%（25/43）,其中CR6.9%（3/43）、PR51.2%（22/43）。中位疾病进展时间（mTTP）为7.5（2.3-14.2）个月。一年生存率为67.4%。常见不良反应为腹痛、腹泻、骨髓抑制、胃肠道反应、脱发、口腔黏膜炎和外周神经毒性等。结论：DOC 40mg/m^2腹腔灌注d1,8,联合CF/5-FU/OXA方案静脉用药治疗晚期胃癌疗效肯定,且不良反应可以耐受。     

胃癌术后OXA+5-FU/LV联合DDP腹腔灌注辅助化疗疗效观察

目的:探讨OXA+5-FU/LV联合DDP腹腔灌注辅助化疗对胃癌的疗效.方法:OXA 85mg/㎡ d1+LV 0.2/㎡ d1-2+5-Fu 0.4/㎡ d1-2+5-FU 1.2/㎡ 44h双周方案,共执行6个月化疗,腹腔灌注化疗:DDP60mg每周,共6周后停用.结果:2004年1月-2009年7月共收治96例胃癌术后病人,83例完成12周期化疗,4年生存率55.4%,5年生存率40.9%,13例因为年龄、不良反应和经费等原因未能完成计划,无不良反应致死,总体不良反应耐受良好.结论:OXA+5-FU/LV联合DDP腹腔灌注辅助化疗胃癌疗效确切且不良反应低.     

晚期胃癌双路化疗效果观察

目的：探讨晚期胃癌的姑息治疗方法，如何增大疗效而又降低毒副作用。方法：运用静脉和腹腔相结合的双路化疗法治疗46例晚期胃癌，对其疗效进行观察总结。静脉化疗选用ELF方案：VP-16 100mg/m^2 VD d1-5，5-FU 375mg/m^2VDd1-5,21天为1周期。腹腔化疗：在2个静脉化疗周期之间进行，以5-FU 750mg/m^2，DDP 60mg/m^2腹腔内注射。结果：对实体瘤总有效率达43.5%，对腹水有效率达89.1%。结论：双路化疗法治疗晚期胃癌效果良好，尤其适用于耐受能力差且合并有心肝肺等慢性疾患的病人，毒副反应轻，方法简单易行，易为病人接受，具有良好的实用意义。     

草酸铂为主联合化疗治疗晚期胃肠道肿瘤54例疗效观察

为观察草酸铂和羟基喜树碱、5-氟尿嘧啶（5-FU）联合化疗方案治疗晚期胃癌结肠癌的近期疗效和不良反应,制定化疗方案如下：草酸铂130 mg/m^2,静脉滴入2 h,d1;羟基喜树碱6～8 mg/m^2,静脉滴入,d1～d5;甲酰四氢叶酸钙200 mg/m^2,静脉滴入,d1～d5.5-FU 500 mg/m^2,静脉滴入,d1～d5.21 d为1个周期,完成3个周期后判定疗效.全组病例54例,胃癌36例有效率为50.0%（18/36）,结肠癌18例有效率为44.4%（8/18）,胃癌和结肠癌总的有效率48.1%（26/54）.主要不良反应为轻度的血液学毒性,恶心、呕吐和外周感觉神经异常.初步观察结果显示,草酸铂、羟基喜树碱和5-FU是治疗晚期胃肠道肿瘤有效且毒性较少的联合化疗方案.     

晚期胃癌姑息性术后腹腔热灌注化疗联合静脉化疗与单纯静脉化疗的临床观察

目的:探讨晚期胃癌姑息性切除术后腹腔热灌注化疗联合静脉化疗的临床疗效及毒副反应。方法:65例晚期胃癌姑息性切除术后患者随机分为两组,治疗组34例采用术后腹腔热灌注化疗联合静脉化疗,对照组31例术后采用单一静脉化疗,对65例患者的临床资料作回顾性分析。结果:治疗组1、2、3年生存率分别为83.4%(28/34)、61.8%(21/34)、38.2%(13/34),对照组为90.3%(28/31)、32.3%(10/31)、16.1%(5/31),两组1年生存率比较无显著性差异(χ2=1.04,P>0.05),2、3年生存率比较有显著性差异(χ2=6.18,P<0.05;χ2=4.93,P<0.05);两组化疗毒副反应比较无显著性差异。治疗组存在的腹腔化疗并发症主要为腹痛、腹胀、腹泻、便秘。结论:晚期胃癌姑息性切除术后腹腔热灌注化疗联合静脉化疗在晚期胃癌的综合治疗中是一可取的治疗措施。     

胃体贲门癌全胃切除术后腹腔热灌注化疗160例

目的探讨胃体贲门癌全胃切除术后腹腔热灌注化疗联合全身化疗对腹腔内复发或转移的影响。方法304例胃癌术后患者随机分为两组：治疗组（160例）应用腹腔热灌注化疗,即卡铂（CBP）0．2g／m^2＋丝裂霉素6mg／m^2＋5-氟尿嘧啶（5-Fu）1．0g／m^2＋斑螫酸钠维生素跣1．0mg／m^2＋0．9％氯化钠注射液1500～2000ml（40℃～44℃）＋地塞米松10mg＋利多卡因20mg,热灌注化疗后加用辅助静脉化疗。对照组（144例）仅做辅助静脉化疗,两组4周为1个化疗周期,均实行4～6个周期。结果1、3、5年生存率分别为：治疗组83．8％、56．2％、39．4％,对照组80．6％、45．1％、29．9％,两组比较差异有统计学意义;5年中肝转移率、腹腔转移率、腹腔积液发生率,治疗组分别是30．0％、21．9％、30．0％,对照组分别为38．2％、36．1％、35．4％,两组比较差异有统计学意义;两组化疗的毒副作用比较差异无统计学意义。结论胃体贲门癌全胃切除术后腹腔热灌注化疗是提高胃癌术后患者生存率的有效措施。     

FOLFOX4方案在治疗晚期胃癌中的应用

目的:探索草酸铂/5-FU/CF组成的FOLFOX4方案在治疗晚期胃癌中的近期疗效和毒副作用。方法:103例晚期胃癌(ⅢB～Ⅳ期)患者随机分为2组:采用PLF方案化疗组52例及采用FOLFOX4方案化疗组51例,至少治疗2周期后按WHO标准进行疗效及毒副作用评价。各组中,化疗药物用法分别为PLF方案组:CF200mg/m2d1～d5,5-FU500mg/m2d1～d5,DDP25mg/m2d1～d3;每28d为1个周期。FOLFOX4方案组:FOLFOX4方案,即OXA85mg/m2,静脉滴入2h,d1、d15;亚叶酸钙(CF)200mg/m2,静脉滴入d1、d2、d15和d16;5-FU400mg/m2,静脉推注d1、d2、d15和d16,600mg/m2,持续静脉输注22h,d1、d2、d15和d16;每28d为1个周期。结果:FOLFOX4方案组的短期有效率及1年生存率与疾病无进展时间均高于PLF方案组,并且1年生存率与疾病无进展时间的差异具有统计学意义(29.1%vs11.7%,P=0.031;10.1±3.2vs8.7±2.9,P=0.037)。结论:FOLFOX4方案是治疗晚期胃癌相对理想化疗方案,可以作为一线或二线化疗方案应用,值得进一步应用和研究。     

双路化疗治疗胃癌术后复发转移36例

对72例胃癌术后复发转移患者进行随机分组对照研究。治疗组36例行常规腹腔穿刺，有腹水者尽量放尽腹水，给生理盐水1000mL加5-FU1500mg/m^2,DDP50-100mg/m^2腹腔灌注，HCPT10mg/m^2，静脉滴入，d1-d5；对照组36例给DDP40mg/m^2,d1-d3,5-FU500mg/m^2,HCPT10mg/m^2,d1-d5，静脉滴入，研究结果提示，腹腔静脉双路化疗是治疗胃癌术后复发转移的一种有效方法。     

奥沙利铂联合化疗治疗76例晚期胃癌的近期疗效观察

目的 观察国产奥沙利铂（L-OHP）联合亚叶酸钙（LV）和5-氟脲嘧啶（5-Fu）治疗晚期胃癌的疗效和毒副反应,并与传统方案进行比较.方法 采用非随机分组方法将76例晚期胃癌患者分为治疗组（A组）40例和对照组（B组）36例.A组：L-OHP 130 mg/m^2,静脉滴注3～4 h,d1;LV 200 mg/m^2,静脉滴注2h,d1～5;5-Fu 400 mg/m^2,静脉滴注6 h,d1～5 .B组：DDP 15 mg/m^2,静脉滴注,d1～5;VP-16 75 mg/m^2,静脉滴注2 h,d1～3;LV与5-Fu用法同A组.21天重复1次,2个周期后评价疗效.结果 A组有效率为55.0% （22/40）,B组有效率为33.3% （12/36）,有显著性差异（P＜0.05）;A组中位生存时间10.0个月,1年生存率为42.5%（17/40）,B组中位生存时间8.5个月,1年生存率为36.1%（13/36）（P＞0.05）.有效患者中位缓解时间：A组为7.5个月,B组为5.3个月,有显著性差异（P＜0.05）.A组主要不良反应为外周神经毒性,其发生率为60.0%（24/40）,较B组30.5%（11/36）为高（P＜0.01）,恶心呕吐及白细胞下降的发生率分别为45.0%（18/40）、57.5%（23/40）,较B组的发生率83.3%（30/36）、80.5%（29/36）明显为低（P＜0.01）.结论 L-OHP联合LV和5-Fu方案治疗晚期胃癌临床疗效较好,不良反应可以耐受,而且安全.     

Chemotherapy

Cancer chemotherapy in the treatment of colorectal cancer has been evolving so extensively than ever. 5-fluorouracil (5-FU) has been a pivotal and a single active agent in the treatment of colorectal cancer. Reproducing and consistent better response rate has been shown since the introduction of the concept of biochemical modulation of 5-FU by leucovorin, a reduced folate, to the clinic and a combination chemotherapy of 5-FU and leucovorin (FL) has enable us to obtain a response rate around 20-30% and a median survival time ranging from 10 to 12 months. IFL regimen combing CPT-11 with FL showed a better MST ranging from 14 to 15 months, but now serious toxicity precludes general use outside of clinical trials. In the Europe, de Gramont regimen, an unique dose and schedule of 5-FU using a combination of continuous intravenous infusion of 5-FU with leucovorin over two days and bolus infusion of 5-FU twice over the same period, has been developed and shown improved antitumor activity and toxic profiles. FOLFOX 4, a combination chemotherapy of de Gramont regimen and oxaliplatin which is a third generation of cisplatin and a uniqe toxic profile with neuropathy, has demonstrated improved MST over a year and acceptable toxic profiles. Now FOLFOX 4 is considered to be a standard chemotherapy for the patients with advanced colorectal cancer, since a large phase III randomized study has shown that FOLFOX 4 was the most active and less toxic treatment regimen among active regimens such as IFL and IROX (CPT-11 and oxaliplatin). More recently, a combination of IFL and bevacizumab which is one of the molecular target agents and a antibody agent against vascular endothelial growth factor (VEGF), has demonstrated better MST reaching 20 months. Future large scale trials will attempt to develop more active regimen incorporating so-called molecular target agents.     

Chemotherapy intensification

Today the treatment of metastatic colorectal cancer is based on several treatment options incorporating chemotherapy, targeted agents, and the surgery of metastases, and a median survival of almost 2 years has been reached. Despite these advances and the availability of multiple lines of treatment, the choice of the first-line chemotherapy indeed still matters, and the development of chemotherapy regimens associated with improved efficacy is a key question in the “biologics era.” This review discusses the development of the triple drug combination FOLFOXIRI (irinotecan [CPT-11], oxaliplatin, and 5-fluorouracil [5FU]/leucovorin [LV]). Several phase II trials demonstrated the feasibility of this combination and, more importantly, a phase III trial demonstrated that the triplet FOLFOXIRI is the first studied combination that significantly increases response rate, complete tumor resection of metastases, progression-free survival, and overall survival compared with an infusional 5FU containing doublet, such as FOLFIRI (5FU/LV and CPT-11). Therefore, FOLFOXIRI represents a new first-line option of care for patients with metastatic colorectal cancer.     

Chemotherapy for meningiomas

The most efficacious treatment for meningiomas is surgery. For incompletely resected or recurrent tumors, radiotherapy can be given. However, when the meningioma is unresectable and/or all other previous treatments have failed, immunotherapy or chemotherapy may be considered for malignant tumors and immunotherapy and hormone therapy may be considered for benign ones. Various chemotherapy treatments that have shown some efficacy in individual cases include combinations of Adriamycin and Dacarbazine or Ifosfamide and Mesna. The most effective immunotherapy appears to be administration of interferon-alpha, which is relatively non-toxic and easily tolerated. However, more studies are needed to better define the roles of these agents in the management of a recurrent, unresectable, or malignant meningiomas.     

Chemotherapy Plus Immunotherapy Versus Chemotherapy Plus Bevacizumab Versus Chemotherapy Alone in EGFR-Mutant NSCLC After Progression on Osimertinib

IntroductionPatients with EGFR-mutant lung cancer who have had disease progression on osimertinib commonly receive platinum doublet chemotherapy, but whether adding immunotherapy or bevacizumab provides additional benefit is unknown.Materials and MethodsThis was a retrospective analysis at 2 university-affiliated institutions. Patients with EGFR-mutant lung cancer who had progression on osimertinib and received next-line therapy with platinum doublet chemotherapy (chemo), platinum doublet chemotherapy plus immunotherapy (chemo-IO), or platinum doublet chemotherapy plus bevacizumab (chemo-bev), were identified; patients who continued osimertinib with these regimens were included. Efficacy outcomes including duration on treatment (DOT) and overall survival (OS) from the start of chemotherapy were assessed. Associations of treatment regimen with outcomes were evaluated using adjusted Cox regression models, using pairwise comparisons between groups.Results104 patients were included: 57 received chemo, 12 received chemo-IO, and 35 received chemo-bev. In adjusted models, patients who received chemo-IO had worse OS than did those who received chemo (hazard ratio (HR) 2.66, 95% CI 1.25-5.65; P= .011) or those who received chemo-bev (HR 2.37, 95% CI 1.09-5.65; P= .030). A statistically significant difference in OS could not be detected in patients who received chemo-bev versus those who received chemo (HR 1.50, 95% CI 0.84-2.69; P= .17).ConclusionIn this retrospective study, giving immunotherapy with platinum doublet chemotherapy after progression on osimertinib was associated with a worse OS compared with platinum doublet chemotherapy alone. Platinum doublet chemotherapy without immunotherapy (with consideration of continuation of osimertinib, in selected cases) is a reasonable choice in this setting, while we await results of clinical trials examining optimal next-line chemotherapy-based regimens in EGFR-mutant lung cancer.     

Granocyte在妇科肿瘤化疗期间及外周血干细胞移植中的应用

研究G－CSF（Granulocyte－ColonyStimulatingFactor）即粒细胞集落刺激因子在化疗中对粒细胞的刺激作用。方法：观察20例肿瘤患者化疗期间应用小剂量Granocyte（1～2μg／kg／日）治疗化疗引起的白细胞减少及应用大剂量Granocyte（5μg／kg／日），在超大剂量化疗外周血干细胞移植时的干细胞动员。A组：46个周期，为停化疗2周白细胞低于3．5×109时给小剂量G－CSF（1～2μg／kg／日）；C组：9个周期，为停化疗24小时后给小剂量G－CSF（1～2μg／kg／日）；B组：不给G－CSF，为对照组。结果：A组给药2～3天后白细胞可达5×109／L以上，C组化疗后白细胞未降至3×109／L以下。观察中同时发现大剂量G－CSF对血小板减少也有治疗作用。结论：G－CSF对化疗后白细胞降低有较好的治疗作用。