多西他赛联合希罗达治疗蒽环类失败复发转移性乳腺癌的疗效评价

背景与目的:随着蒽环类药物在乳腺癌治疗中的广泛应用,对蒽环类耐药患者日渐增多,如何治疗蒽环类耐药的复发转移性乳腺癌已成为临床难题.本研究初步探讨了多西他赛联合希罗达治疗蒽环类药物治疗失败的复发转移性乳腺癌的疗效和安全性.方法:回顾性分析64例蒽环类药物治疗失败的复发转移性乳腺癌患者接受多西他赛联合希罗达方案的治疗情况.其中多西他赛75 mg/m2,静脉滴注第1天;希罗达1250 mg/m2,口服,每日2次,第1～14天,每21 d为1个周期.每2个周期评价疗效同时记录不良事件.结果:对64例患者评价疗效,完全缓解(CR)6例,部分缓解(PR)33例,有效率(CR+PR)60.9%(39/64):64例患者可评价不良反应,无严重不良事件导致死亡的患者,主要的不良反应为乏力、骨髓抑制、胃肠道反应和黏膜炎等,其中粒细胞减少Ⅲ～Ⅳ度为45.8%.结论:多西他赛联合希罗达是治疗蒽环类失败复发转移性乳腺癌的有效方案,其不良反应能够耐受.     

泰索帝联合顺铂治疗蒽环类药物耐药的晚期乳腺癌的临床研究

目的研究泰索帝联合顺铂治疗蒽环类药物耐药的晚期乳腺癌的疗效和安全性。方法28例蒽环类药物治疗失败的晚期乳腺癌患者均接受泰索帝联合顺铂方案治疗泰索帝75mg/m2静滴,第1天;顺铂80mg/m2静滴,第1天或分3天给予;每3周重复,完成3个周期化疗后评价疗效,有效病例4周后确认。结果28例患者均可评价疗效,CR3例,PR13例,SD11例,PD1例,总有效率(CR PR)57.1%(16/28)。主要不良反应为骨髓抑制。结论泰索帝联合顺铂是治疗蒽环类药物耐药的晚期乳腺癌的有效化疗方案,不良反应能够耐受。     

长春瑞滨联合卡培他滨治疗转移性乳腺癌30例临床观察

目的观察长春瑞滨联合卡培他滨对蒽环类药物治疗后无效或复发的转移性乳腺癌的疗效.方法转移性乳腺癌患者30例,长春瑞滨20 mg/m2第1天和第8天静脉滴注,卡培他滨每天1 250 mg/m2,分早晚两次服用,连续服用2周,3周为一个周期.结果 CR 1例(33.3%),PR 7例(23.3%),MR 7例(23.3%),SD 7例(23.3%),PD 8例(26.7%),有效率达49.9%,中位缓解期4.6个月(2～13个月).常见的不良反应为骨髓抑制、胃肠道反应、手足综合征、神经毒性等.结论长春瑞滨联合卡培他滨对蒽环类药物治疗后失败的转移性乳腺癌有较好的疗效,毒性可以耐受.     

多西他赛联合希罗达治疗蒽环类失败的转移性乳腺癌的临床研究

目的 研究多西他赛（docetaxel）联合希罗达（Xeloda）治疗蒽环类治疗失败的转移性乳腺癌的疗效及可行性.方法 对12例含蒽环类方案治疗失败的复发转移性乳腺癌患者,采用多西他赛联合希罗达方案治疗,多西他赛37.5 mg/m^2静脉滴注,第1、8天;希罗达900 mg/m^2 ,口服,每日2次,第1～14天,每3周为1个周期.每个周期评价疗效,记录不良反应.结果 12例患者均可评价疗效,2例（16.7%）完全缓解（CR）,5例（41.7%）部分缓解（PR）,4例（33.3%）疾病稳定（SD）,1例（8.3%）疾病进展 （PD）,总有效率（CR＋PR）为58.3%,肿瘤控制率（CR＋PR＋SD）为91.7%.不良反应主要为骨髓抑制、胃肠道反应和手足综合征,均可耐受,无治疗相关死亡患者.结论 多西他赛联合希罗达治疗蒽环类治疗失败的转移性乳腺癌有较好的疗效,不良反应可以耐受,可以作为转移性乳腺癌的解救化疗方案.     

多西紫杉醇联合卡培他滨治疗晚期乳腺癌的临床观察

目的 观察多西紫杉醇联合卡培他滨治疗蒽环类药物治疗失败复发转移性乳腺癌的近期疗效和不良反应,并与长春瑞滨(NVB)和顺铂(DDP)组成的NP方案进行比较.方法 蒽环类药治疗失败的复发转移性乳腺癌患者,选择匹配68例,分为A(治疗组)和B(对照组)两组. A组32例接受多西紫杉醇联合卡培他滨方案,多西紫杉醇75 mg/m2,静滴,第1天;卡培他滨950 mg/m2,每日2次口服,第1～14天.B组36例采用NP方案,NVB 25 mg/m2,第1、8天,静滴;DDP 80 mg/m2,分3 d(d1～3)静滴,每3周重复一次.治疗2个周期以上评价疗效.结果 68例患者均可行疗效和不良反应评价,A组和B组有效率分别为71.9%(23/32)和44.4%(16/36),两组差异有显著性(P＜0.05);中位肿瘤进展时间(TTP)A组和B组分别为5.7个月和3.8个月,差异有显著性(P＜0.01).两组主要不良反应均为中性粒细胞减少,A组和B组Ⅲ、Ⅳ度中性粒细胞减少发生率分别为53.1%和44.4%,差异无显著性(P＞0.05).A组主要不良反应还有手足综合征,多为Ⅰ～Ⅱ度.结论 多西紫杉醇联合卡培他滨是治疗蒽环类治疗失败复发转移性乳腺癌的有效方案,其有效率优于NP方案,不良反应可以耐受.     

泰索帝联合希罗达治疗21例晚期乳腺癌

[目的]观察泰索帝联合希罗达方案治疗晚期乳腺癌的疗效及不良反应。[方法]以泰索帝联合希罗达方案治疗术后晚期乳腺癌21例。泰索帝70mg/m2,静滴d1,希罗达2500mg/(m2·d)分2次口服,d1～14,21d为1个周期,2个周期评价疗效。[结果]21例均可评价疗效。完全缓解(CR)2例(9.5%),部分缓解(PR)9例(42.8%),稳定(SD)5例(23.8%),进展(PD)5例(23.8%),总有效率(CR PR)52.3%,中位达进展时间(TTP)6.2个月,主要毒性为骨髓抑制和手足综合征。[结论]泰索帝联合希罗达方案治疗晚期乳腺癌疗效好,毒性反应轻,是治疗晚期乳腺癌的有效解救治疗方案。     

含卡培他滨方案治疗复发转移性乳腺癌的临床观察

目的观察含卡培他滨方案对蒽环类和(或)紫杉类药物治疗后复发转移性乳腺癌的疗效和不良反应。方法 70例蒽环类和(或)紫杉类药物治疗后复发转移性乳腺癌患者分为两组,卡培他滨联合长春瑞滨(NX组,36例),卡培他滨800～1000mg/m2,分早晚两次服用,第1～14天,长春瑞滨25mg/m2,第1天和第8天,静脉滴注,3周为1个周期。卡培他滨联合吉西他滨(GX组,34例),卡培他滨800～1000mg/m2,分早晚两次服用,第1～14天,吉西他滨1g/m2,静脉滴注,第1天和第8天,3周为1个周期。每两个周期评价疗效,均至少治疗2个周期以上。结果 NX组患者中,完全缓1例(2.8%),部分缓解20例(55.6%),疾病稳定11例(30.6%),疾病进展4例(11.1%),有效率为58.3%,中位疾病进展时间13.5个月;完全缓解1例(2.9%),部分缓解19例(55.9%),疾病稳定12例(35.3%),疾病进展2例(5.9%),有效率为58.8%,中位疾病进展时间13.8月。常见的不良反应主要为骨髓抑制、胃肠道反应、手足综合征等。结论含卡培他滨方案治疗蒽环类和(或)紫杉类药物治疗后复发转移乳腺癌疗效确切,毒性可耐受,是治疗复发转移性乳腺癌的较好方案。     

58含长春瑞滨方案治疗(蒽环类/紫杉类治疗后)复发转移乳腺癌的临床观察

目的:观察含长春瑞滨方案对蒽环类/紫杉类药物治疗后复发转移性乳腺癌的有效性和安全性.方法:蒽环类,紫杉类药物治疗后复发转移性乳腺癌患者61例,其中58例可评价疗效;长春瑞滨联合顺铂(NP)41例,长春瑞滨25mg/m2,第1天和第8天.静脉滴注;顺铂75～80mg/m2,静脉滴注,分割为2～5天,3周为一周期;长春瑞滨联合卡培他滨或替加氟(NF)17例,长春瑞滨用法同NP组,卡培他滨800～1 000mg/m2,分早晚两次服用,第1～14天,或替加氟600mg/m2,第2～6天,3周为一周期.化疗过程中注意观察不良反应,根据不良反应的程度调整药物用量.每两周期评价疗效.结果:长春瑞滨联合顺铂(NP)组,CR 2例(4.9%),PR 23例(56.1%),SD 14例(34.1%),PD2例(4.9%),有效率为61.0%;长春瑞滨联合卡培他滨或替加氟(NF)组,CR 1例(5.9%),PR 8例(47.1%),SD 7例(41.2%).PD 1例(5.9%),有效率52.9%.常见的不良反应主要为骨髓抑制、胃肠道反应、手足综合症、神经毒性等.结论:含长春瑞滨方案治疗蒽环类,紫杉类药物治疗后复发转移乳腺癌疗效确切,毒性可耐受,是治疗复发转移性乳腺癌的较好方案.     

泰索帝治疗晚期乳腺癌

目的:观察泰索帝联合顺铂治疗晚期乳腺癌临床疗效及毒副作用。方法:晚期乳腺癌53例,治疗组17例:泰索帝30 mg/m2～40 mg/m2,第1天,第8天,第15天,顺铂40 mg,第1天～第3天,28 d为1周期,连用2周期～4周期;对照组36例:CTX600 mg/m2,ADM40 mg/m2,PDD40 mg第1天～第3天,3周～4周为1周期,连用2周期～4周期。结果:治疗组17例,CR3例,PR10例,NC3例,PD1例,有效率76.5 %;对照组36例,CR2例,PR17例,NC12例,PD5例,有效率52.8 %(P<0.05)。泰索帝组化疗毒副作用,主要是骨髓抑制,白细胞减少,腹泻、变态反应、支气管哮喘、脱发、外周神经炎。结论:以泰索帝 顺铂治疗晚期乳腺癌的疗效肯定,并优于CTX ADM PDD方案,毒副作用小,耐受性好。     

不同剂量希罗达联合诺维本治疗晚期乳腺癌临床观察

目的 观察以不同剂量希罗达联合诺维本化疗治疗晚期乳腺癌的疗效及安全性.方法 将32例具有可测量病灶的晚期乳腺癌者随机分为两组,第一组15例采用希罗达2 510 mg/m2,每天2次,连服14天,21天为1个周期.第二组17例采用希罗达1 250 mg/m2/d,bid,连服14天,21天为1个周期.两组均同时联合使用诺维本6 mg/m2,第1-5天中心静脉持续滴注(Civ),或者25 mg/m2第1,8天静点,21天为一个周期.所有患者既往均接受过1种以上化疗方案的化疗,第一组中11例患者既往接受过阿霉素和(或)紫杉醇治疗,第二组中14例患者既往接受过阿霉素和(或)紫杉醇治疗.结果 第一组15例患者中4例接受了2个周期化疗,11例完成4个周期的化疗.CR1例,PR4例,MR3例,SD2例,PD5例.最常见的不良反应为恶心、中性粒细胞减少、手足综合症、皮肤色素沉着、乏力等.3-4度不良反应仅见于少数病例,其中中性粒细胞减少5例、手足综合症4例、便秘4例,总胆红素升高2例.第二组17例患者中2例接受了2个周期化疗,15例完成4个周期的化疗.CR1例,PR5例,MR2例,SD3例,PD6例.3度不良反应仅见于少数病例,其中中性粒细胞减少6例、便秘4例,总胆红素升高1例.结论 小剂量(1 250 mg/m2/d)希罗达联合诺维本作为二线方案治疗晚期乳腺癌的疗效确切且不良反应轻,有望成为紫杉类或蒽环类药物治疗失败的晚期乳腺癌的理想方案.     

Three-dimensional treatment planning for postoperative treatment of rectal carcinoma

The role of three-dimensional (3-D) treatment planning for postoperative radiation therapy was evaluated for rectal carcinoma as part of an NCI contract awarded to four institutions. It was found that the most important contribution of 3-D planning for this site was the ability to plan and localize target and normal tissues at all levels of the treatment volume, rather than using the traditional method of planning with only a single central transverse slice and simulation films. There was also a slight additional improvement when there were no constraints on the types of plans (i.e., when noncoplanar beams were used). Inhomogeneity considerations were not important at this site under the conditions of planning, i.e., with energies greater than 4 MV and multiple fields. Higher beam energies (15-25 MV) were preferred by a small margin over lower energies (down to 4 MV). The beam's eye view and dose-volume histograms were found quite useful as planning tools, but it was clear that work should continue on better 3-D displays and improved means of translating such plans to the treatment area.     

Adjuvant treatment of GIST: patient selection and treatment strategies

Tyrosine kinase inhibitors that target the key molecular drivers of gastrointestinal stromal tumour (GIST) are effective treatments of advanced-stage GIST. Yet, most of these patients succumb to the disease. Approximately 60% of patients with GIST are cured by surgery, and these individuals can be identified by risk stratification schemes based on tumour size, mitosis count and site, and assessment of rupture. Two large randomized trials have evaluated imatinib as adjuvant treatment for operable, KIT-positive GIST; adjuvant imatinib substantially improved time to recurrence. One of these trials reported that 3 years of adjuvant imatinib improves overall survival of patients who have a high estimated risk for recurrence of GIST compared with 1 year of imatinib. The optimal adjuvant strategy remains unknown and some patients might benefit from longer than 3 years of imatinib treatment. However, a strategy that involves GIST risk assessment following surgery using a validated scheme, administration of adjuvant imatinib for 3 years, patient monitoring during and after completion of imatinib to detect recurrence early, and reinstitution of imatinib if GIST recurs is a reasonable choice for care of patients with high-risk GIST.     

Endoscopic treatment of early gastric cancer: polypectomy and laser treatment

With the tremendous development of gastroenterological endoscopy,it has become possible to treat some types of early gastriccancer by endoscopy. There are two principal methods for thispurpose, endoscopic polypectomy using a high frequency electriccurrent and laser endoscopy. We developed the technic and instrumentsof endoscopic polypectomy, in 1972. Since then, we have experienced358 cases of gastric polypoid lesions treated by endoscopicpolypectomy. Nineteen patients with the elevated type of earlygastric cancer were treated by endoscopic polypectomy. Sevenpatients were operated on after polypectomy and 12 were followedwithout surgery. Out of the 12 patients, nine are alive aftermore than five years. On the other hand, we started researchto apply lasers for treating early gastric cancer in 1978. Sincethen, 18 patients have been treated by laser endoscopy, withNd-YAG laser, argon dye laser or a combination of both lasers.We have established criteria for these treatments for earlygastric cancer. ¹Present address: Department of Internal Medicine, Tokyo MetropolitanToshima Hospital, 33-1, Sakae-cho, Itabashi-ku, Tokyo I 73,Japan.     

Perspective of trastuzumab treatment

Trastuzumab (Herceptin) has many benefits for metastatic breast cancer patients with HER2 overexpression/amplification. Trastuzumab alone or trastuzumab in combination with chemotherapy regimens are standard treatment worldwide as first line therapy for metastatic breast cancer patients with HER2 overexpression/amplification. Furthermore, an international collaboration for adjuvant trastuzumab trials showed last year that trastuzumab treatment improves disease-free and overall survival after or in combination with adjuvant chemotherapy. However, there are many uncertain issues concerning trastuzumab adjuvant and metastatic treatment, such as treatment beyond disease progression (PD), combination with hormone therapy, duration of adjuvant treatment, and cardiac safety of long term treatment.     

Cost of leukemia treatment

Medical cost has increasingly become an important problem in the medical practice. As one of the useful fields of computer in the hospital, we have analyzed the costs of chemotherapy and bone marrow transplantation in patients with leukemia who were diagnosed between 1983 and 1986 and followed up till Dec. 1989. For CML the difference in the cost was 5 million yen and a survival rate was 75% and was higher in BMT than in chemotherapy. For Acute leukemia the difference of the costs was 8 million yen and survival rates were 89% and 30%. These data may show that BMT is a very effective and economical treatment for leukemia. In this study we have analyzed only the direct medical cost paid by the governmental insurance, however there seems necessary many other costs which are not covered by the insurance such as the cost for the family members, the cost for cryopreservation of cells and sterilization tentatively covered by the hospital or the cost of blood or marrow bank which are covered or should be covered by the government. Evaluation of the treatment outcome by the parameters such as length and quality of life, productivity of the patient, prevention of the loss of social investment including education on the patient, seemed also necessary for justification of the medical cost.