Comparison of acute toxicities between two postoperative concurrent chemoradiotherapy regimens of capecitabine with or without oxaliplatin in patients with stage Ⅱ and Ⅲ rectal cancer

Objective To compare the acute toxicities between two prospective, non-randomize phase Ⅱ trials on adjuvant radiochemotherapy of capecitabine with or without oxaliplatin in patients with stage Ⅱ and Ⅲ rectal cancer. Methods From March 2005 to November 2007,based on two fulfilled phase Ⅰ studies,two phase Ⅱ trials were launched respectively to further observe the tolerance and toxicity. In one tria1,118 patients were treated with concurrent capecitabine and radiotherapy (Cap-CRT trial), with radio-therapy of DT50 Gy/25 F/5 wks to the pelvis, and capecitabine at a dose of 1600 mg/m2/d(d1-d14,3 weeks per cycle). In the other trial, 90 patients received concurrent oxaliplatin, capecitabine and radiothera-py(Cap-Oxa-CRT trial), with the same radiotherapy schedule, while oxaliplatin at a dose of 70 mg/m2(d1, d8) and capecitabine of 1300 mg/m2/d(d1-d14,3 weeks per cycle). Results There was no significant difference in the delay of radiotherapy (10.2% vs 6.7%, X2=0.80, P=0.460) or chemotherapy (9.3% vs 19.1%, X2=4.80,P=0.090) between Cap-CRT and Cap-Oxa-CRT trials. Grade 1-4 leukopenia,diar-rhea and nausea were the most common acute side-effects in the both trials, accounting for 70.2%, 65.9% and 42.3%, respectively. When comparing with Cap-CRT trial, Cap-Oxa-CRT trial had significantly more grade 1-4 non-hemotological toxicities, mainly in Gl,including nausea (68.9% vs 22.0%, X2=46.90, P= 0.000), diarrbea(76.7% vs 57.6%, X2=13.50, P=0.009), fatigne(47.8% vs 13.7%, X2=18.90,P= 0.000), hand-foot syndrome (14.4% vs 4.2%, X2=7.10, P=0.029), and inappetence (50.0% vs. 27.9%, X2 = 25.70, P=0.000), but not in hematological toxities of leukopenia, anemia or thrombocytope-nia. Of all the patients,grade 3 and grade 4 toxicities were diarrhea(24.0% and 1.0%),leukopenia(4.3% and 0.0%),radiation-induced dermatitis(3.8% and 0.0%),cramping abdominal pain(1.0% and 0.0%) and fatigue(0.5% and 0.0%). Only grade 3 and 4 diarrhea was significantly more in Cap-Oxa-CRT trial than in Cap-CBT trial(33.0% vs 18.6%, X2=5.90,P=0.023). Conclusions For patients with stage Ⅱ and Ⅲ rectal cancer,both the postoperative concurrent radiochemotherapy regimens are tolerable,though Cap-Oxa-CRT trial has more grade 3 and 4 diarrhea.     

中医人才与中医学术发展关系的探讨

人才,是事业的基础,学术发展的关键。达尔文创立了生物进化论,哈维发现了血液循环,牛顿创立了经典力学,爱因斯坦又把物理学引入相对论时代……一部科学技术发展史,同时又是一部人才的成长史。中医学的发展,     

B超检查在腹部闭合性损伤诊断中的应用

Ｂ超检查在腹部闭合性损伤诊断中的应用李秉 ，张世平，宋引川大同市第三人民医院Ｂ超室对腹部闭合性损伤过去主要靠临床症状、体征、腹部穿刺以及Ｘ线检查诊断。我室近年来采用Ｂ超对２２１例临床拟诊为腹部闭合性损伤的病例进行了检查，结果使１６７例排除了腹部脏器损...     

中医药治疗重症肌无力的经验特色

:本文总结了近年来治疗重症肌无力的经验体会,认为脾虚证是重症肌无力的主证,脾气虚型是重症肌无力最主要的证型,临床必须明确主证,才能执简驭繁。辨证论治必须谨守病机、各司其属,针对重症肌无力脾胃虚损的病机进行治疗,在峻补脾气时,需刻刻顾护胃阴,以免阳回气复而胃阴却伤,阴火因而上潜。对久病肝郁、思想顾虑较重者,必须把药物治疗和心理治疗有机地结合起来,并于峻补脾气的同时,加用疏肝解郁之品,对较特殊的病例,还必须知常达变,不拘一格地进行治疗,平时须加强调护,注意消除引起病情反复的因素。     

Comparison of acute toxicities between two postoperative concurrent chemoradiotherapy regimens of capecitabine with or without oxaliplatin in patients with stage Ⅱ and Ⅲ rectal cancer

Objective To compare the acute toxicities between two prospective, non-randomize phase Ⅱ trials on adjuvant radiochemotherapy of capecitabine with or without oxaliplatin in patients with stage Ⅱ and Ⅲ rectal cancer. Methods From March 2005 to November 2007,based on two fulfilled phase Ⅰ studies,two phase Ⅱ trials were launched respectively to further observe the tolerance and toxicity. In one tria1,118 patients were treated with concurrent capecitabine and radiotherapy (Cap-CRT trial), with radio-therapy of DT50 Gy/25 F/5 wks to the pelvis, and capecitabine at a dose of 1600 mg/m2/d(d1-d14,3 weeks per cycle). In the other trial, 90 patients received concurrent oxaliplatin, capecitabine and radiothera-py(Cap-Oxa-CRT trial), with the same radiotherapy schedule, while oxaliplatin at a dose of 70 mg/m2(d1, d8) and capecitabine of 1300 mg/m2/d(d1-d14,3 weeks per cycle). Results There was no significant difference in the delay of radiotherapy (10.2% vs 6.7%, X2=0.80, P=0.460) or chemotherapy (9.3% vs 19.1%, X2=4.80,P=0.090) between Cap-CRT and Cap-Oxa-CRT trials. Grade 1-4 leukopenia,diar-rhea and nausea were the most common acute side-effects in the both trials, accounting for 70.2%, 65.9% and 42.3%, respectively. When comparing with Cap-CRT trial, Cap-Oxa-CRT trial had significantly more grade 1-4 non-hemotological toxicities, mainly in Gl,including nausea (68.9% vs 22.0%, X2=46.90, P= 0.000), diarrbea(76.7% vs 57.6%, X2=13.50, P=0.009), fatigne(47.8% vs 13.7%, X2=18.90,P= 0.000), hand-foot syndrome (14.4% vs 4.2%, X2=7.10, P=0.029), and inappetence (50.0% vs. 27.9%, X2 = 25.70, P=0.000), but not in hematological toxities of leukopenia, anemia or thrombocytope-nia. Of all the patients,grade 3 and grade 4 toxicities were diarrhea(24.0% and 1.0%),leukopenia(4.3% and 0.0%),radiation-induced dermatitis(3.8% and 0.0%),cramping abdominal pain(1.0% and 0.0%) and fatigue(0.5% and 0.0%). Only grade 3 and 4 diarrhea was significantly more in Cap-Oxa-CRT trial than in Cap-CBT trial(33.0% vs 18.6%, X2=5.90,P=0.023). Conclusions For patients with stage Ⅱ and Ⅲ rectal cancer,both the postoperative concurrent radiochemotherapy regimens are tolerable,though Cap-Oxa-CRT trial has more grade 3 and 4 diarrhea.     

泰利必妥滴耳剂治疗化脓性中耳炎的临床观察

泰利必妥滴耳剂治疗化脓性中耳炎的临床观察广州市红十字会医院耳鼻喉科（５１０２２０）张世平，肖孟省，罗瑞莲泰利必妥（Ｔａｒｉｖｉｄ）是一种新喹诺酮类广谱抗菌药物，实验室及临床证明其对多种感染性疾病有效。近１年来我科使用日本第一制药有限公司生产的氧氟沙星...     

医院管理中的人文精神

２１世纪的医院管理，必须充分体现人文精神。这种重要的价值理念，既是现代管理科学、现代医学和现代医学伦理的共同要求，也是时代发展的必然选择。１人文精神与医疗服务观念转变１．１医学模式演变的客观结果在世纪之交回首２０世纪的医学成就，简言之，就是充分地利用现代科学技术有效地控制了大量的传染病，拯救了无数的生命。不难发现，２０世纪的医学其实关注的是生物学意义上的人及其生、老、病、死、伤，重视的是与治病、救死和疗伤有关的临床技术、实验技术和生物技术。显然，医学还是主要是同人的自然属性出发，表现为经验医学、…     

糖尿病慢性并发症的糖基化发病机制研究进展

糖基化反应是生物体内的一种自然反应 ,其反应的终末产物 (advancedglycationendproducts,AGEs)水平与糖尿病及其慢性并发症密切相关 ,其致病机制除直接促使细胞内外的某些成分发生结构与功能的改变外 ,还通过受体介导引起更复杂的细胞效应。因此 ,了解糖基化反应过程及AGEs的致病机制 ,寻找减少AGEs形成和致病作用的方法 ,有利于改善糖尿病及减少并发症。1　糖基化反应的致病机制蛋白质是构成人体的重要物质 ,存在于全身各个脏器、组织、细胞、血液、酶类及激素中 ,并可以进行非酶促糖基化反应 ,亦称为Mailard反应。此反应过程的终末产…     

不同手术方式联合放射治疗Kadish B或Kadish C期嗅神经母细胞瘤的疗效分析

目的 评估不同手术方式联合放射治疗嗅神经母细胞瘤的疗效。方法 回顾分析1979—2014年我院收治的53例接受手术联合放疗的局部晚期嗅神经母细胞瘤疗效,对比不同手术方式肿瘤残存率及治疗效果。组间比较行卡方检验,Kaplan-Meier法计算生存率并Logrank法检验。结果 全组随访时间中位数为71个月,5年OS、DFS率分别为86%、74%。全组患者按手术方式分为开放手术组31例、内镜手术组 22例,内镜手术组肿瘤残存率高于开放手术组(分别为64%、42%,P=0.166)。Kadish C期者内镜手术肿瘤残存率达78%。肿瘤完全切除者5年OS、DFS率分别为91%、80%,肿瘤残存者分别为82%、67%。内镜手术组与开放手术组5年OS、DFS率相近[83%与86%(P=0.560)、77%与71%(P=0.188)]。内镜手术组中更多患者接受术后放疗剂量>66 Gy (P=0.011),而术后接受放疗剂量>66 Gy者和≤66 Gy者的5年OS、DFS率分别为100%和67%(P=0.092)、100%和50%(P=0.052)。结论 手术联合放疗用于改良Kadish B、KadishC期嗅神经母细胞瘤可取得较好的治疗疗效。内镜手术应严格掌握指征,目前对Kadish C期或额窦受侵者不主张行内镜手术。对手术切缘状态无法保证者,术后放疗剂量建议>66 Gy。     

苏子降气汤的临床应用

苏子降气汤方出自《太平惠民和剂局方》,用以治疗咳喘病且有上盛下虚的病机证候,为降肺气的通治方剂.其方剂组成为：苏子15 g,半夏12 g,前胡12 g,生姜12 g,陈皮12 g,当归12g,肉桂9 g,甘草10 g九味药物组成（一方有沉香,而无肉桂）.本方经笔者多年来的临床加减应用,认为其治疗范围甚广,只要辨证恰当,疗效显著.