调强适形放疗同步吉西他滨治疗36例局部晚期胰腺癌的临床观察

目的:探讨调强适形放疗(IMRT)联合吉西他滨同步治疗晚期胰腺癌的疗效及毒性。方法:36例接受IMRT联合吉西他滨同步放化疗治疗的晚期胰腺癌患者,放疗采用IMRT技术,GTV D95 2Gy/次,总量66Gy～70Gy。同步化疗方案为吉西他滨1 000mg/m2,d1,d8,四周重复与放疗同步,放疗结束后行同方案化疗,共4周期～6周期。结果:所有患者均完成同步放化疗。有效率为88.9%,局部控制率为91.6%,中位生存期为18.6个月,1年生存率为60.8%,2年生存率为22.1%。疼痛缓解率94%(34/36),生活质量明显改善。19例(52.8%)ECOG评分改善。结论:IMRT同步吉西他滨治疗局部晚期胰腺癌近期疗效及患者的耐受良好,生活质量明显改善。     

单药顺铂与顺铂联合吉西他滨同步放化疗治疗中晚期宫颈癌的预后分析

摘 要：［目的］ 探讨中晚期宫颈鳞状细胞癌单药顺铂与顺铂联合吉西他滨同步放化疗的近期疗效、不良反应及生存率之间的差异。 ［方法］ 回顾分析121例宫颈鳞状细胞癌,FIGO分期为ⅡB~ⅢB期,卡氏评分≥70分。顺铂组（63例）接受外照射加锎252中子后装治疗及顺铂同步化疗;顺铂+吉西他滨组（58例）接受同样放疗及顺铂联合吉西他滨同步化疗。比较两组患者的近期疗效、不良反应及生存率。［结果］ 顺铂组近期有效（CR+PR）率为90.48%,顺铂+吉西他滨组近期有效率为91.38%,差异无统计学意义(P>0.05);顺铂+吉西他滨组中患者不良反应中骨髓抑制、肝功能损害与顺铂组相比,差异有统计学意义(P<0.05),其余不良反应无统计学差异;放射性肠炎和膀胱炎的发生率两组无差异;两组生存率差异无统计学意义(P>0.05)。 ［结论］ 在中晚期宫颈鳞状细胞癌的临床治疗中,对患者实施放射治疗的同时选择顺铂或顺铂联合吉西他滨的近期疗效和生存率之间无差异,联合用药增加患者的不良反应,还需探索更优的联合化疗方案。     

调强放疗联合吉西他滨治疗局部晚期非小细胞肺癌近期效果分析

目的 观察调强放疗联合吉西他滨在局部晚期非小细胞肺癌（NSCLC）患者中的近期疗效。方法 回顾性分析局部晚期NSCLC患者45例临床资料。予吉西他滨加顺铂方案诱导化疗2个周期后,分为调强放疗序贯吉西他滨加顺铂方案化疗组和吉西他滨加顺铂方案单纯化疗组。结果 序贯组客观缓解率为65.2 %（15／23）,单独化疗组客观缓解率为31.8 %（7／22）,差异有统计学意义（P＜0.05）;序贯组和单纯化疗组1年生存率分别为66.4 %和45.0 %,两组间差异有统计学意义（P＜0.05）。结论 调强放疗序贯吉西他滨加顺铂方案化疗治疗局部晚期NSCLC较吉西他滨加顺铂方案化疗的近期疗效好,不良反应可以耐受。     

GP方案同期放化疗治疗局部晚期鼻咽癌的近期临床观察

为了观察和比较吉西他滨联合顺铂(GP)及氟尿嘧啶联合顺铂(FP)同期放化疗治疗局部晚期鼻咽癌患者的近期疗效和耐受性,将经病理确诊的局部晚期鼻咽癌(T3-4N1-3M0)患者56例,分为GP组27例和FP组29例.GP组化疗在放疗第1,5周给予吉西他滨1 000 mg/m2,d1,d8+顺铂25 mg/m2,d1～d3,静脉滴入.FP组化疗在放疗第1,5周给予5-FU 500 mg/m2,d1～d5+顺铂25 mg/m2,d1～d3,静脉滴入.两组放疗方案相同,均为飞利浦直线加速器(能量为6MV X线)常规照射,鼻咽部总放疗剂量(70～72)Gy/(35～36)次,2 Gy/次,颈部淋巴结总放疗剂量(60～70)Gy/(30～35)次,2 Gy/次.治疗结束后行肿瘤疗效评价,GP组近期有效率为100%,CR 21例;FP组有效率为96.6%,CR 18例.GP组与FP组Ⅲ～Ⅵ级恶心、呕吐发生率分别为11.1%、13.8%(P>0.05),骨髓抑制发生率分别为29.6%、17.2%(P<0.05),皮肤反应发生率分别为18.5%、27.6%(P<0.05),口腔黏膜反应发生率分别为14.8%、24.1%(P<0.05).初步研究结果提示,采用GP方案同期放化疗治疗局部晚期鼻咽癌近期疗效优于FP方案,毒副反应可耐受,值得临床应用.     

放疗联合吉西他滨加顺铂治疗Ⅲ期非小细胞肺癌临床观察

目的观察常规放疗联合吉西他滨（泽菲）加顺铂同步化疗治疗局部晚期非小细胞肺癌（NSCLC）的近期疗效与安全性。方法62例局部晚期NSCLC患者,实施常规放疗,计划照射剂量（60—75）Gy,（2～2．5）Gy／次,1次／d,5d／wk。同步行吉西他滨加顺铂化疗,方案为放疗d1起开始化疗,化疗方案为吉西他滨1．0g/m2,d1,d8,顺铂25mg／m2,d1～3,每21d重复。放疗后再采用该方案化疗共4-6个周期。结果近期疗效CR9例,PR41例,SD7例,PD5例。有效率80．6％。毒副反应主要为恶心、呕吐、骨髓抑制,放射性食管炎,放射性肺炎。结论常规放疗联合吉西他滨加顺铂同步治疗局部晚期NSCLC近期疗效好,毒副反应可耐受,远期疗效有待进一步随访研究。     

三维适形放疗联合吉西他滨化疗治疗局部晚期胰腺癌28例

 目的　观察三维适形放射治疗（3D-CRT）联合吉西他滨化疗治疗局部晚期胰腺癌的疗效及患者耐受性。方法　28例局部晚期胰腺癌患者行3D-CRT联合吉西他滨治疗,方案为：3D-CRT 8 MV-X线直线加速器按计划照射,2～2.5 Gy／次,1次／d,5 d／周,DT 65～70 Gy;吉西他滨250 mg／m2,静脉滴注, 每周1次,共7次。结果　28例患者全部完成治疗计划,胰腺癌原发灶完全缓解 （CR）1例（3.6 %）,部分缓解（PR）10例（35.7 %）,总有效（CR+PR）率为39.3 %,无变化和进展（NC+PD）为60.7 %,临床受益反应（CBR）有效率为71.4 %,1年及2年生存率分别为35.7 %（10例）和17.8 %（5例）。结论　3D-CRT同步联合吉西他滨化疗治疗局部晚期胰腺癌疗效较好,能提高患者的生活质量和生存期,不良反应能为大多数患者耐受。     

局部晚期非小细胞肺癌同步放化疗并序贯化疗与单纯序贯放化疗的对比研究

目的 观察局部晚期非小细胞肺癌（NSCLC）接受调强放疗（IMRT）联合同步吉西他滨和卡铂方案（GC）化疗与序贯放化疗的近、远期疗效和不良反应。方法 回顾性分析不能进行手术治疗和拒绝手术治疗的局部晚期NSCLC患者65例,其中同步放化疗并序贯化疗组给予IMRT同步联合GC治疗者32例,单纯序贯放化疗组为33例给予IMRT后序贯GC治疗。通过统计分析比较两组之间的近期有效率、远期生存率和不良反应。结果 两组均完成治疗,随访率100%,同步放化疗并序贯化疗组近期有效率为75%,单纯序贯放化疗组为66.7% ,两组比较差异有统计学意义（P＜0.05）。两组1、3年生存率相比较,同步放化疗并序贯化疗组为68. 2% 、20. 5% ;单纯序贯放化疗组为 50. 1% 、11.3%;同步放化疗并序贯化疗组明显优于单纯序贯放化疗组（P＜0.05）。两组不良反应情况对比,差异无统计学意义（P＞0.05）。结论 IMRT同步联合GC方案并序贯化疗治疗局部晚期NSCLC,可以提高患者的远期生存率且不良反应可耐受。     

重组人血管内皮抑素联合常规化疗、体部立体定向放疗治疗局部晚期胰腺癌的临床观察

目的 观察重组人血管内皮抑素联合常规化疗、体部立体定向放疗治疗局部晚期胰腺癌的有效性和安全性.方法 64例不能手术切除的局部晚期胰腺癌患者接受体部立体定向放疗、吉西他滨+顺铂化疗、重组人血管内皮抑素靶向治疗.治疗后评价疗效和毒副反应.结果 治疗后3个月全组总有效率为73.4%(47/64),生活质量改善率达到78.1%(50/64).全组患者出现的Ⅲ~Ⅳ度毒副反应主要是白细胞减少(4.7%)、血小板减少(7.8%)及恶心呕吐(6.2%),主要与化疗有关.未出现治疗相关性死亡.结论 重组人血管内皮抑素联合吉西他滨+顺铂化疗、体部立体定向放疗治疗局部晚期胰腺癌患者近期疗效较好,毒副反应可耐受,且能提高患者的生存质量,是治疗局部晚期胰腺癌较好的方法.     

三维适形放疗同步奥沙利铂联合吉西他滨化疗治疗局部晚期胰腺癌的临床观察

目的 探讨三维适形放疗(3DCRT)同步奥沙利铂联合吉西他滨化疗治疗局部晚期胰腺癌的疗效和毒副反应.方法 入组局部晚期胰腺癌30例均接受3DCRT,总剂量45.0～50.4 Gy,5～6周内完成.在放疗的同时接受化疗,放疗结束后继续化疗2～4个周期,方案为:奥沙利铂100mg/m2,静脉滴注,d1;吉西他滨1 000 ...     

多西他赛联合顺铂同步放化疗治疗局部晚期鼻咽癌的临床观察

目的:观察多西他赛联合顺铂同步放化疗治疗局部晚期鼻咽癌的近期疗效及不良反应。方法:回顾性分析42例同步放化疗的初治局部晚期鼻咽癌患者,放疗期间全身静脉化疗2周期,于放疗第1周、第5周进行。多西他赛联合顺铂(TP)化疗组17例,采用多西他赛75mg/m2,d1,顺铂30mg/(m2.d),d1-3,顺铂联合氟尿嘧啶(PF)化疗组25例,采用顺铂30mg/(m2.d),d1-3,氟尿嘧啶750mg/(m2.d),d1-5。全组给予同步常规分割放疗,鼻咽病灶DT 66-78Gy/33-39次,颈部转移淋巴结DT 62-70Gy/31-35次。结果:多西他赛联合顺铂(TP)同步放化疗组,鼻咽部病灶完全缓解率82.35%(14/17),颈部转移淋巴结完全缓解率88.24%(15/17),1年、2年生存率分别为94.12%、82.35%。顺铂联合氟尿嘧啶(PF)同步放化疗组,鼻咽部病灶完全缓解率76.0%(19/25),颈部转移淋巴结完全缓解率84.0%(21/25),1年、2年生存率分别为88.0%、76.0%。两组间均无显著性差异(P>0.05),两组间急性口腔黏膜反应、胃肠道反应差异有统计学意义(P<0.05)。结论:多西他赛和顺铂(TP)同步放化疗治疗局部晚期鼻咽癌近期疗效较好,不良反应可以耐受。     

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.     

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.     

Varicella-Zoster Virus Prophylaxis with Low-Dose Acyclovir in Patients with Multiple Myeloma Treated with Bortezomib

BackgroundVaricella-zoster virus (VZV) reactivation is a common complication in patients with multiple myeloma (MM) treated with bortezomib, with an incidence rate of 10%-60%. The aim of our study was to analyze the effect of acyclovir prophylaxis in this patient population.Patients and MethodsWe studied 98 consecutive patients with relapsed MM treated with bortezomib. Bortezomib 1.3 mg/m² was given on days 1, 4, 8, and 11 of a 21-day cycle. At first, patients did not receive any VZV prophylaxis, but because of the high incidence of VZV reactivation, VZV prophylaxis with acyclovir was implemented subsequently.ResultsA total of 11 patients treated with bortezomib did not have any VZV prophylaxis, and 4 of these 11 patients (36%) developed VZV reactivation in the form of herpes zoster. No VZV reactivations were observed in the 32 patients who received acyclovir 400 mg 3 times daily or the 55 patients who received acyclovir in a dose reduced to 400 mg once daily during bortezomib treatment.ConclusionVaricellazoster virus reactivation is a common and serious adverse effect of bortezomib treatment. Acyclovir 400 mg once daily is sufficient to protect from VZV reactivation in patients with MM treated with bortezomib.