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.     

前列腺癌大分割调强放疗副反应初步分析

Objective To analyze the acute and late toxicities in patients with prostate cancer trea-ted with hypofractionated intensity-modulated radiotherapy (IMRT). Methods Between June 2006 and June 2008, 37 patients with prostate cancer were treated with hypofractionated IMRT. The clinical target vol-ume (CTV) was the prostate, seminal vesicles and pelvic lymph nodes in 24 patients, the prostate and semi-hal vesicles in 12, and only the tumor bed in 1. The dose per fraction was 2.3 - 2.8 Gy, with 2.7 Gy in 26 patients. The minimal dose was 62.5-75.0 Gy to the prostate and seminal vesicles, and 50 Gy to the pelvic lymph nodes. Results The median follow-up was 14 months. None of the patients experienced grade 4 a-cute gastro-intestinal (GI) toxicity. Grade 1, 2 and 3 acute GI toxicity occurred in 24.3%, 35.1% and 2.7% of the patients, respectively. The rectal V50>27% and V55>20% were highly significantly associat-ed with grade ≥1 acute GI toxicity. Grade 1,2 and 3 acute genitourinary (GU) toxicity occurred in 68%, 0% and 3% of the patients, respectively. The bladder V50> 10% was significantly associated with grade ≥1 acute GU toxicity. The incidence of late GI toxicity was low. No grade ≥3 late GI toxicity was observed. The incidence of late grade 1 and 2 GI toxicity was 24% and 5%, respectively. The rectal V65> 10% was highly significantly associated with grade ≥1 late GI toxicity. No late grade 4 GU toxicity was observed. The incidence of grade 1, 2 and 3 late GU toxicity was 49%, 11% and 3%, respectively. Grade ≥2 late GU toxicity was correlated with V40, V50 and mean dose of the bladder. Conclusions Acute and late toxicity of hypofractionated IMRT is acceptable in patients with prostate cancer.     

青少年或儿童原发系统性间变大细胞淋巴瘤CHOP为主化疗±放疗的远期疗效

目的 分析青少年儿童原发系统性间变大细胞淋巴瘤(ALCL)患者接受CHOP方案化疗 ±受累野放疗的疗效。方法 回顾分析本院1998—2010年收治的 28例青少年、儿童ALCL患者资料。Ⅰ、Ⅱ期 12例中单纯化疗 2例、综合治疗 10例,Ⅲ、Ⅳ期 16例中单纯化疗 14例、综合治疗 2例。CHOP方案 15例、CHOP联合其他高强度化疗 13例。化疗周期数 3~17个(中位数6个)。放疗多为受累野照射,剂量 39.6~50.0 Gy (中位数45 Gy)。结果 全组患者首程疗后达CR者 25例(89%),3例病变进展。中位随访时间45.3个月。全组 5年无事件生存率为80%,5年OS为93%。疗终达CR者 5年OS为100%,而未达CR者无 5年OS (P=0.000)。≥2个结外器官受侵者 5年无事件生存率为38%,而<2个结外器官受侵者的为85%(P=0.010)。结论 青少年、儿童原发系统性ALCL按成人方案治疗效果满意,但还需要长期随访。     

Ⅱ期和Ⅲ期直肠癌根治术后卡培他滨同期放化疗疗效及失败原因分析

目的 分析Ⅱ、Ⅲ期直肠癌根治术后卡培他滨同期放化疗Ⅱ期临床研究结果.方法 2005-2007年间共131例病理诊断明确的Ⅱ、Ⅲ期直肠癌患者纳入研究,所有患者均接受根治术后同期化放疗和辅助化疗.治疗方案为全盆腔放疗50 Gy分25次,放疗期间同期应用卡培他滨1600mg/m2,每天分2次服用,连用2周停l周.结果 同期放化疗期间3+4级不良反应发生率为28.2％.随访率为93.9％,3年总生存率、无局部区域复发生存率和无远处转移生存率分别为85.1％、96.7％和79.5％.共31例出现复发,包括5例局部区域复发和28例远处转移.单因素分析提示病理低分化或中低分化、未接受辅助化疗、ⅢC期和淋巴结阳性率＞30％是影响总生存的因素(x2=15.49、15.85、8.80和9.76,P=0.000、0.000、0.011和0.002),ⅢC期、未接受辅助化疗和淋巴结阳性率＞30％是影响无远处转移生存的因素(x2 =6.51、11.57和9.70,P=0.034、0.001和0.002).但未接受辅助化疗者中病理为低分化或T4期的患者更多(x2 =7.20、6.48,P=0.027、0.039).结论 Ⅱ、Ⅲ期直肠癌根治术及卡培他滨同期放化疗后局部区域控制率高,远处转移是主要失败原因.     

肝癌术后放疗锥形束CT配准方法研究

目的 比较肝癌术后辅助性放疗锥形束CT (CBCT)不同配准方法结果。
方法 12例患者在瘤床放置金属标记,放疗前后共行214次CBCT。对CBCT图像分别用标记配准、常规骨性配准、常规灰度配准、椎体配准、膈顶配准方法进行配准,并以标记配准作为金标准与其他配准结果行配对t检验和Pearson相关分析。
结果 214次CBCT数据分析结果显示4种配准方法的左右(x)、上下(y)、前后(z) 方向中仅常规骨性配准y方向和椎体配准x方向的与标记配准结果相似(t=0.75、－0.97,P=0.452、0.333),其余各方向与标记配准结果间均不同(t=－13.48~14.56,P均<0.05)。4种配准结果与标记配准结果仅在常规灰度配准的y方向与标记配准相关性较好 (r=0.852,P=0.000),其余的相关性均较差(r=0.367~0.777,P均=0.000)。4种配准结果与标记配准结果的绝对差值在 x、y、z方向上至少有1次>2 mm的比例占 84.1%~93.0%,至少有1次>3 mm的比例占 65.9%~79.9%。
结论 肝癌术后放疗CBCT在线校位时靶区内有标记者应以金属标记为配准目标,无金属标记者用其他配准方法均存在一定误差故应适当增加计划靶体积外放边界。     

早期乳腺癌保乳术后大分割三维放疗Ⅱ期临床观察

目的 观察早期乳腺癌保乳术后大分割三维放疗的疗效、美容效果和不良反应。
方法 2009-2010年45例pT is~2N 0~1M 0期乳腺癌患者保乳术后行三维适形或简化调强放疗,全乳43.5 Gy,瘤床补量8.7Gy,2.9Gy/次, 总疗程24 d。33例接受了化疗,其中新辅助化疗2例、术后化疗31例。局部区域控制率和总生存率用Kaplan Meier法计算。
结果 随访率100%。2年局部区域控制率、生存率均为100%;1例单发骨转移。2级乳房水肿1例,2级乳房纤维化6例,2级上肢水肿1例。2级放射性皮炎4例,1、2级放射性肺炎分别为5、2例。与同期保乳术后常规分割放疗相比,放疗次数由30次降至18次,疗程由40 d缩短至24 d,费用由30450元降至19770元。
结论 乳腺癌保乳术后全乳大分割放疗的疗效和美容效果较好,不良反应可接受,且能显著降低治疗时间和费用。     

表观扩散系数预测直肠癌术前放化疗疗效分析

目的 探讨表观扩散系数(ADC)预测局部晚期直肠癌术前放化疗疗效的作用。方法 2007 —2011年间前瞻性纳入病理证实的临床Ⅱ、Ⅲ期直肠腺癌患者 70例。均行术前同期放化疗,盆腔放疗 44.0~50.4 Gy分 22~28次,同期化疗卡培他滨每天1650 mg/m²第 1~35天+奥沙利铂50 mg/m²每周1次共5次,放化疗后 4~8周行根治性手术。疗前常规行盆腔MRI及扩散加权成像检查,测量ADC值并行术后病理反应评级。Mann-Whitney U检验法分析组间ADC值差异,Kaplan-Meier法计算生存率并Logrank法检验。结果 70例患者中7例(10%) pCR、38例(54%)降期。中位随访34个月, 22例(31%)复发。疗前、疗中、疗后平均ADC值分别为(1.09±0.19)×10^－3、(1.28±0.19)×10^－3、(1.47±0.24)×10^－3 mm²/s。预后较好组(pCR、降期、无复发)疗前平均ADC值低于预后不良组(P=0.049、0.001、0.029)。取疗前ADC值1.06×10^－3mm²/s为界值预测降期,ROC曲线下面积为0.737(95% CI=0.618~0.856)。疗前ADC值<1.06×10^－3mm²/s组3年DFS和DMFS均高于≥1.06×10^－3 mm²/s组,分别为86%比58%(P=0.01)和90%比60%(P=0.01)。 结论 疗前ADC值与局部晚期直肠癌术前同期放化疗疗效有一定相关性,对预测直肠癌术前放化疗疗效有一定意义。     

髓外浆细胞瘤临床分析

目的探讨髓外浆细胞瘤的生物学行为和临床特点,以帮助临床诊断、治疗及对预后的判断。方法对40多年来笔者所在科室收治的28例髓外浆细胞瘤进行回顾性分析,其中单纯放射治疗16例(57.1%),综合治疗11例(39.3%),单纯手术1例(3.6%)。结果中位随访90个月(4～280个月),2例(7.1%)局部复发,2例(7.1%)转化为多发性骨髓瘤。3、5、10年总生存率分别为92.6%、75.6%和75.6%;单纯放射治疗组与综合治疗组3、5、10年总生存率分别为93.8%、77.3%、77.3%和90.9%、72.7%、72.7%(P>0.05)。结论单纯放射治疗是治疗髓外浆细胞瘤最有效的方法之一,局部放射治疗DT40Gy～50Gy后,可获得良好的局部控制率和长期生存率。部分髓外浆细胞瘤可向多发性骨髓瘤转化,故需密切观察。     

单味鸡内金治愈胃柿团症一例

胃柿团症系大量食入生软柿或柿饼等所致胃内异物引起的。因其较坚硬,故有“胃柿石症”之称。据资料记载,有手术取除、碱性药物及“攻坚消滞汤”等疗法。笔者用单味鸡内金治愈一例,现介绍如下: 患儿,王××,女,7岁,门诊号8712。于1987年12月13日因食柿后上腹包块27天初诊。患儿于11月16日午餐后2小时许食软柿6个,即感上腹部饱胀不适,晚间发现上腹部有一约拳头大小无痛性包块,日后见包块大小无变化,饮食量减少。既往健康。检查:一般情况良好。皮肤粘膜无出血点。浅表淋巴结无肿大。心肺(-)。剑下偏左可扪及一     

Ⅱ和Ⅲ期直肠癌术后去氧氟尿苷加四氢叶酸钙同步放化疗的Ⅰ期临床研究

目的 探讨Ⅱ、Ⅲ期直肠癌患者根治术后去氧氟尿苷+四氢叶酸钙同步放化疗中去氧氟尿苷的剂量限制性毒性(DLT)和最大耐受剂量(MTD).方法 术后病理证实为Ⅱ、Ⅲ期的直肠癌患者16例行盆腔放疗5周(总剂量50 Gy分25次),同步口服去氧氟尿苷+四氢叶酸钙30 mg/(m2·d)化疗,从放疗第1天开始,3次/d,连续服用直至放疗结束.去氧氟尿苷DLT的定义为≥3级的血液学或非血液学毒性反应.结果 16例患者分别人去氧氟尿苷450 mg/(m2·d)组3例、550mg/(m2·d)组6例、650 mg/(m2·d)组7例.550 mg/(m2·d)组出现1例DLT(1例4级腹泻),补充3例后未发现DLT,继而进入650 mg/(m2·d)组.该组中第1例因治疗第3周出现3级腹痛拒绝化疗退出研究,随后入组3例中1例先后出现3级腹痛、腹泻、恶心、乏力和2级发热以及白细胞下降,以后再补充的3例均出现了3级腹泻,试验终止于650 mg/(m2·d)组.16例中12例完成预计的去氧氟尿苷+四氢叶酸钙同步放化疗计划,4例终止或中断放化疗者分别为550 mg/(m2·d)组1例和650mg/(m2·d)组3例.DLT主要表现为3级恶心或呕吐(1人次)、腹泻(4人次)、疲劳(1人次)和腹部绞痛(2人次)以及4级腹泻(1人次).结论 Ⅱ、Ⅲ期直肠癌根治术后采用去氧氟尿苷+四氢叶酸钙同步放化疗时,去氧氟尿苷的最大耐受剂量为550 mg/(m2·d); 恶心或呕吐、腹泻、腹部绞痛和疲劳是剂量限制性不良反应,患者耐受性较差.