中医药治疗对大肠癌患者生存质量的影响

目的 观察中医药治疗对大肠癌患者生存质量的影响.方法 对90例大肠癌患者进行前瞻性临床研究,90例分为中医组(30例)、中西医组(30例)及西医组(30例),采用癌症治疗功能评价系统大肠癌量表(FACT-C)进行调查分析.结果 三组患者治疗后以中西医结合组总体得分最高,中医组次之,西医组最低,中西医结合组、中医组分别与西医组比较差异均有统计学意义(P＜0.05).三组生存质量积分均较治疗前增加,中西医组、中医组治疗前后比较差异有统计学意义(P＜0.05).提示中西医结合治疗及中医治疗均能改善患者的总体生存质量.单纯西医治疗治疗前后生存质量比较差异无统计学意义(P＞0.05).结论 中医药对于化疗的毒副作用有一定的拮抗作用,在一定程度上提高了患者的生存质量.     

大肠癌术后中西医结合治疗现状与展望

本文综述中医药学在大肠癌术后治疗中的重要的作用.目前,中西医结合治疗大肠癌术后的临床研究多从辨病结合辨证、辨证论治、中药制剂以及中药外用等几方面进行,并取得一些进展,显示中医药既可相互协同化疗和放疗杀灭肿瘤细胞,增强放化疗的敏感性,又可减轻放化疗的毒副作用,提高放化疗的治疗效果,从而起到了降低大肠癌复发转移率,改善患者生活质量的作用.文中还对中医药研究所存在的问题及今后研究方向作了探讨与展望.     

《抗癌之窗》携手中日友好医院举办——“中医药防治肿瘤”科普讲座

2011年4月27日,《抗癌之窗》编辑部携手中日友好医院中西医结合肿瘤内科联合举办大型科普讲座及义诊。此次讲座旨在为癌症患者们提供专业、实用的中医药治疗肿瘤的知识,为广大患者及家属解疑答惑,主要内容包括中医防治肿瘤概况、放化疗不良反应的中医药防治、饮食防癌、中医心理调护、中医体质与肿瘤、     

中医抗癌 贵在合理

在我国的癌症防治中,因为有中医药治疗,中西医结合成为我国防治癌症的一大特点。当前我国癌症患者,在整个诊疗过程中,大都求治过中医,而且很多西医大夫也根据患者的情况,建议他们到中医那儿接受相应得治疗。     

结直肠癌的中西医结合治疗现状与不足

我国结直肠癌发病率、病死率高,目前的治疗手段以手术治疗、放化疗、分子靶向治疗、免疫治疗及综合治疗为主。中医药治疗在防治癌前病变,减轻放化疗的不良反应,延缓复发转移,缓解症状,提高患者生活质量及延长生存期均有一定的优势。该文对近年来中西医结合治疗结直肠癌的研究进展及热点问题进行论述,以期裨益于临床。     

细胞毒抗癌药物肾脏毒性研究现状

细胞毒化学药物治疗(化疗)是癌症主要治疗手段之一，在提高癌症患者治愈率和改善生存质量的同时，不可避免地会产生许多毒副作用，如肾毒性、心脏毒性、骨髓毒性等。如何防治毒副作用的发生发展，是肿瘤内科治疗的重要研究课题之一。现将近年来对细胞毒抗癌药物所致肾脏毒性的防治概况作一简要回顾。……     

肺癌的中西医结合治疗进展

肺癌由于其生物学特性复杂，患者确诊时往往已属中晚期，失去手术、放化疗的最佳时机。中医药疗法是我国肺癌治疗的特色，实践已证明应用中西医结合治疗肺癌，在减毒增效、提高生活质量及延长生存期等方面显示了明显优势。文章就近几年来肺癌的中西医结合治疗进展作一综述。     

中西合璧 才有希望

中医药能否治疗癌症?中医药治疗癌症的优势是什么?如何充分发挥中医药在中西医结合综合治疗癌症中的重要作用?这些问题都是我们数十年来探索的主要内容。从我40多年的临床经验和研究来看,中医药治疗癌症的重点应该是中西医结合,采取中西医取长补短,相辅相成的策略。中医药在整个癌症综合治疗中有重要作用。上世纪七十年代初,我们看到大量疼痛病人在化疗中,由于化学药物抑制骨髓的造血功能,引起的白细胞、血小板下降和贫血,常使化疗中途停止,因而我们根据患者所表现的脾虚肾亏、气血双亏的证候,制定了健脾补肾、补气养血的方剂,称之为"生血汤"(生芪、太子参、黄精、鸡血藤、枸杞子、菟丝子、     

癌症放化疗不良反应的中医药治疗

手术、放化疗作为癌症的主要治疗手段虽有一定疗效，但其不良反应较多。中医药疗法作为一种辅助治疗的方法，对放化疗不良反应的预防及治疗有较好的疗效。本文总结中医药疗法在癌症放化疗不良反应中的应用进展。     

中医药序贯和巩固治疗模式对Ⅲ/Ⅳ期胃癌生存期影响的对比观察

目的:观察Ⅲ/Ⅳ期胃癌患者接受中医药序贯治疗或中医药巩固治疗的不同中西医结合治疗模式对总生存(overall survival,OS)和中位生存期(median survival time,MST)的影响.方法:回顾性分析2007年1月1日—2010年1月1日接受中西医结合治疗的88例Ⅲ/Ⅳ期胃癌患者,分为中医药序贯治疗组(38例)和中医药巩固治疗组(50例).电话随访患者生存情况,分析2组患者的生存情况及其影响因素,应用Kaplan-Meier法计算中位OS和MST.结果:88例患者的中位OS为16.0个月,中医药序贯治疗组中位OS为33.0个月,较中医药巩固治疗组的20.0个月明显延长(P=0.047).服用中药汤剂患者的中位OS较未服用中药汤剂患者明显延长(分别为23.8和15.6个月,P=0.012).Borrmann Ⅲ与BorrmannⅣ患者的中位OS差异有统计学意义(分别为16.8和11.3个月,P=0.029).分层分析结果显示,中医药序贯治疗组化疗或临床Ⅳ期患者的MST均较中医药巩固治疗组明显延长(P＜0.05);而2组单—证型、复合证型和服用汤剂患者之间的MST差异无统计学意义.结论:中西医结合治疗能够延长iⅢ/Ⅳ期胃癌患者的生存期,中医药序贯治疗与中医药巩固治疗相比,在延长患者生存期方面更具优势.     

Enrichment of CD133‐expressing cells in rectal cancers treated with preoperative radiochemotherapy is an independent marker for metastasis and survival

BACKGROUND:

The transmembrane glycoprotein CD133 (cluster of differentiation 133; also known as Prominin or PROM1) has been described as a potential stem cell marker in colorectal cancer and is associated with higher tumorigenic potential and resistance to radiochemotherapy (RCT). In this study, CD133 expression was evaluated in pre‐RCT tumor biopsies and the corresponding post‐RCT surgical specimens from patients with locally advanced rectal adenocarcinoma, and expression levels were correlated with histopathologic features and clinical follow‐up.

METHODS:

One hundred twenty‐six patients with International Union Against Cancer (UICC) stage II/III rectal cancer who received preoperative 5‐fluorouracil (5‐FU)‐based RCT within the German Rectal Cancer Trials were investigated. Pre‐RCT and post‐RCT CD133 expression levels were determined using immunohistochemistry and were correlated with histopathologic parameters, tumor regression grade, cancer recurrence, and patient survival.

RESULTS:

Compared with pre‐RCT biopsies, significantly higher CD133 expression was observed in tumor specimens (P = .01). However, no correlations were observed for either biopsies or tumor specimens between CD133 expression levels, histopathologic characteristics, or survival. In matched analyses of corresponding biopsy/tumor pairs, patients who had an increased fraction of CD133‐expressing (CD133+) cells after preoperative RCT had significantly higher residual tumor stages (P = .02) and lower histopathologic tumor regression (P < .01). Moreover, these patients had significantly reduced disease‐free survival and cancer‐specific overall survival in univariate analysis (P < .001 and P = .004, respectively) and multivariate analysis (P = .003 and P = .024, respectively).

CONCLUSIONS:

The enrichment of CD133+ cancer cells during preoperative RCT was correlated with minor local tumor response, increased distant cancer recurrence, and decreased survival. The current results indicate that the up‐regulation of intratumoral CD133 expression, in contrast to absolute pre‐RCT and post‐RCT CD133 levels, plays an important role in tumor progression and metastasis in patients with rectal cancer who are receiving neoadjuvant RCT. Cancer 2013. © 2012 American Cancer Society.     

贝伐珠单抗联合化疗治疗转移性结直肠癌的研究进展

结直肠癌目前常规化疗方案为FOLFOX方案(氟尿嘧啶、亚叶酸钙、奥沙利铂),大量临床试验证明贝伐珠单抗联合FOLFOX方案治疗恶性肿瘤安全有效,但有高血压、神经毒性、胃肠道出血和穿孔等不良反应产生.对转移性结直肠癌患者应用此联合方案对整体生存时间、肿瘤应答率和生存质量进行的研究得出了不同的结论,其安全性和有效性仍需大样本随机对照试验或Meta分析来进一步研究证明.     

A two-arm multicenter phase II trial of one cycle chemoselection split-dose docetaxel,cisplatin and 5-fluorouracil (TPF) induction chemotherapy before two cycles of split TPF followed by curative surgery combined with postoperative radiotherapy in patients with locally advanced oral and oropharyngeal squamous cell cancer (TISOC-1)

BackgroundInduction chemotherapy (ICT) with docetaxel, cisplatin and fluorouracil (TPF) followed by radiotherapy is an effective treatment option for locally advanced head and neck cancer. This phase II study investigated the effectivity of a split-dose TPF ICT before surgery for locally advanced resectable (stage III/IVA) oral and oropharyngeal cancer.Patients and methodsPatients received TPF split on two dosages on days 1 and 8 per cycle (30 mg/m² docetaxel, 40 mg/m² cisplatin, 2000 mg/m² fluorouracil per week). Responders (reduction tumor volume ≥30% after first cycle) received three 3-week cycles and non-responders only one cycle before surgery and postoperative radio(chemo)therapy (RCT). The primary endpoint was progression-free survival rate after 24 months. Secondary endpoints were amongst others overall survival, histopathological response to ICT, toxicity, quality of life and swallowing function.ResultsFifty-four patients (91% stage IVA, 87% male, 72% oropharyngeal cancer, 70% responders) were eligible for a per-protocol analysis. The progression-free survival rate after 24 months was 88.5% for responders and 60.6% for non-responders (P = 0.005). The overall survival rate after 24 months was 97.3% for responders and 73.7% for non-responders (P = 0.032). The rate of histopathological complete remission of the primary tumor was higher in responders (P = 0.015). High-risk classification for postoperative RCT was lower in responders (P < 0.0001). The most common grade 3+ adverse event was neutropenia in 26% of patients during ICT and mucositis in 13% during postoperative RCT. During treatment and follow-up quality of life and swallowing function was not different between responders and non-responders.ConclusionPatients with oral and oropharyngeal cancer responding to split-dose TPF before surgery and postoperative RCT show good oncological results. The tri-modal treatment regime was well tolerated. ICT using tumor response as criterion for duration of ICT before surgery of oral and oropharyngeal cancer merits additional investigation in a phase III study.Clinical trial numberNCT01108042.     

Significance of incisional biopsy in breast carcinoma: results from a clinical trial with intended excisional biopsy

The recurrence-free survival rates (RFS) after one-stage mastectomy and partial axillary dissection in 1242 low risk breast cancer patients with invasive ductal carcinoma with or without residual cancer tissue (RCT) in the wall of the biopsy cavity were compared. RFS was significantly lower in patients with RCT (RCT-positive) whether premenopausal (n = 416) or postmenopausal (n = 826). By applying the Cox multivariate analysis on RCT and various known prognostic criteria, the incidence rates for RCT-positive patients relative to RCT-negative patients were estimated. The relative risk by RCT-positivity was in the order of 1.45, indicating that RCT is an independent risk factor contributing an increased risk of recurrence of about 45%.     

Simultaneous Comparison of Efficacy and Adverse Events of Interventions for Patients with Esophageal Cancer: Protocol for a Systematic Review and Bayesian Network Meta-analysis

Background: Esophageal cancer is one of the most serious malignancies. Due to the aggressive nature of this cancer, the prognosis is poor. A network meta-analysis with simultaneous comparison of multiple treatments can help determine better treatment options that have higher effects on overall survival of patients with lower adverse events. The aim of this review is to simultaneously compare efficacy and adverse events of treatment interventions for esophageal cancer. Materials and Methods: In this review, only randomized control trials (RCT) will be considered for network meta-analysis. All international electronic databases including Medline, Web of Sciences, Scopus, Cochran’s library, EMBASE and Cancerlit will be searched to find randomized control trials which compared two or more treatment interventions for esophageal cancer. A network plot will be drawn for visual representation of all available treatment interventions. Bayesian approach will be used to combine the direct and indirect evidence. Treatment effects (e.g. hazard ratio for time to event outcomes, risk ratio for binary outcomes, and rate ratio for count outcomes with 95% credible interval) will be reported. Moreover, cumulative probability of the treatment ranks will be reported using the surface under the cumulative ranking (SUCRA) graphs. Consistency assumption will be assessed by the loop-specific and design-by-treatment interaction approaches. Conclusions: The results of this study may be helpful for the patients, clinicians and health policy makers in selecting treatments that have the best effect on survival and lowest adverse events.     

Induction chemotherapy with albumin-bound paclitaxel plus lobaplatin followed by concurrent radiochemotherapy for locally advanced esophageal cancer

BACKGROUNDAlbumin-bound paclitaxel (ABP) has been used as second- and higher-line treatments for advanced esophageal cancer, and its efficacy and safety have been well demonstrated. Lobaplatin (LBP) is a third-generation platinum antitumor agent; compared with the first two generations of platinum agents, it has lower toxicity and has been approved for the treatment of breast cancer, small cell lung cancer, and chronic granulocytic leukemia. However, its role in the treatment of esophageal cancer warrants further investigations.AIMTo investigate the efficacy and safety of induction chemotherapy with ABP plus LBP followed by concurrent radiochemotherapy (RCT) for locally advanced esophageal cancer. METHODSPatients with pathologically confirmed advanced esophageal squamous cell carcinoma (ESCC) at our hospital were enrolled in this study. All patients were treated with two cycles of induction chemotherapy with ABP plus LBP followed by concurrent RCT: ABP 250 mg/m², ivgtt, 30 min, d1, every 3 wk; and LBP, 30 mg/m², ivgtt, 2 h, d1, every 3 wk. A total of four cycles were scheduled. The dose of the concurrent radiotherapy was 56-60 Gy/28-30 fractions, 1.8-2.0 Gy/fraction, and 5 fractions/wk.RESULTSA total of 29 patients were included, and 26 of them completed the treatment protocol. After the induction chemotherapy, the objective response rate (ORR) was 61.54%, the disease control rate (DCR) was 88.46%, and the progressive disease (PD) rate was 11.54%; after the concurrent RCT, the ORR was 76.92%, the DCR was 88.46%, and the PD rate was 11.54%. The median progression-free survival was 11.1 mo and the median overall survival was 15.83 mo. Cox multivariate analysis revealed that two cycles of induction chemotherapy followed by concurrent RCT significantly reduced the risk of PD compared with two cycles of chemotherapy alone (P = 0.0024). Non-hematologic toxicities were tolerable, and the only grade 3 non-hematologic toxicity was radiation-induced esophagitis (13.79%). The main hematologic toxicity was neutropenia, and no grade 4 adverse event occurred. CONCLUSIONInduction chemotherapy with ABP plus LBP followed by concurrent RCT is effective in patients with locally advanced ESCC, with mild adverse effects. Thus, this protocol is worthy of clinical promotion and application.     

晚期癌症患者中医辨证分型分布及其同生存期的相关性分析研究

背景与目的：晚期癌症患者的中医辨证分型具有同西医症状评估不同的特点。通过对晚期癌症患者进行中医辨证分型的分类，研究其同西医症状及患者生存期之间的相关性。方法：通过MD Anderson症状评估量表（MD Anderson Symptom Inventory-Chinese，MDASI-C）收集临床患者症状分布及强度，并通过望闻问切判断患者的中医辨证分型。描述性分析用于人口统计学及临床特征资料的分析。对辨证分型为肝肾阴虚型（Ⅳ型）和其他型的患者进行t检验及χ²检验。应用Kaplan-Meier方法计算生存期，Log-rank进行显著性检验。结果：根据中医辨证分型，227例晚期癌症患者中，Ⅳ型共82例（36%）。Ⅳ型与其他5型相比，乏力和气急的发生频率和强度均较高。Ⅳ型患者同其他5型患者之间生存差异有统计学意义（P<0.05）。美国东部肿瘤协作组（Eastern Cooperative Oncology Group，ECOG）评分和Ⅳ型为晚期癌症患者生存期的预后因素。结论：本研究证实中医辨证分型对晚期癌症患者生存期有辨识作用，可提高晚期癌症生存期预测的准确性。在临床工作中，以此辅助检测病情变化，有助于临床医师更好地判断晚期癌症患者的生存预后。     

中医辨证治疗乳腺癌术后高危人群的疗效评价

目的 观察中医辨证治疗对乳腺癌术后复发转移高危人群的疗效,评价中医辨证治疗对乳腺癌高危患者生存率及生存期的影响。方法 采用前瞻性队列研究设计,将接受规范化中医辨证治疗作为暴露因素,以ⅡA～ⅢC期乳腺癌术后复发转移高危患者作为研究对象,按照治疗方法将受试者分为中西医结合队列（中药+内分泌治疗）、中医队列（中医治疗）、西医队列（内分泌治疗）和观察队列,比较4队列累计无病生存率、总生存率及无病生存期（DFS）和总生存期（OS）情况。结果 中西医结合队列、中医队列、西医队列1、2、3年累计无病生存率均高于观察队列,差异有统计学意义（P＜0.05）。4个队列的累计总生存率差异无统计学意义（P＞0.05）。截至随访结束,354例受试者中共有65例乳腺癌术后高危患者发生复发转移、8例死亡,中西医结合队列、中医队列、西医队列、观察队列复发转移患者的中位DFS分别为17.00个月（95％CI：13.97～25.41个月）、16.87个月（95％CI：9.8～40.8个月）、13.93个月（95％CI：10.9～25.61个月）、12.61个月（95％CI：10.41～14.45个月）,4队列复发转移患者的DFS差异无统计学意义（P＞0.05）。4队列中ⅢB～ⅢC期患者的累计无病生存率比较,差异有统计学意义（P＜0.05）;其中中西医结合队列、中医队列、西医队列患者的累计无病生存率均高于观察队列患者,差异有统计学意义（P＜0.05）;4队列各肿瘤分期患者累计总生存率的差异无统计学意义（P＞0.05）。结论 中医辨证治疗可提高激素受体阴性乳腺癌术后高危患者的累计无病生存率,尤其是肿瘤分期为ⅢB～ⅢC期的高危患者。无论接受何种治疗方法,尚不能在短期内明显延长乳腺癌高危患者的DFS和OS。     

Patterns of failure following radiation with and without chemotherapy in patients with nasopharyngeal carcinoma

PURPOSE: Aim of this study was to retrospectively evaluate patterns of failure, results, and prognostic factors for patients with nasopharyngeal cancer (NPC) following radiotherapy (RT) with and without concurrent chemotherapy (RCT). PATIENTS AND METHODS: Between 1978 and 1999, a total of 101 patients with NPC were treated in our hospital, of whom 53 received external megavoltage RT alone with a median total dose of 76 Gy (1978-1988), and 48 patients had RCT (1989-1999). For RCT a combination of 5-FU and cisplatin was used together with a median total dose of 72 Gy. Patterns of relapse, survival rates and toxicity as well as prognostic factors were evaluated retrospectively. RESULTS: RCT was associated with a marked reduction in distant metastases: 6/48 (13%) vs. 17/53 (32%) after RT alone. Locoregional tumor persistence was only marginally lower with RCT: 10/48 (21%) vs. 17/53 (32%) following RT. Patients with RCT demonstrated a survival advantage compared to those with RT alone (5-year overall survival (OS): 64% vs. 44%, p = 0.1). OS, disease-specific survival and locoregional control rates were 53, 57, and 78% at 5 years and 47, 51 and 78% at 10 years, respectively. OS was significantly affected by histology (p = 0.007), the patients' age (p = 0.009) and gender (p = 0.01). CONCLUSION: This retrospective study provides further evidence that both reduction of distant metastasis and enhanced local tumor control by combined radiochemotherapy may be associated with improved survival rates in NPC compared to radiation alone. Concurrent RCT is therefore considered the preferable treatment option, however, confirmation in randomized trials is still warranted.