HP方案治疗晚期非小细胞肺癌临床疗效观察

目的研究HP方案治疗晚期非小细胞肺癌（NSCLC）的临床疗效及毒副作用。方法38例晚期非小细胞肺癌患者应用HCPT 10mg／m^2／d，静脉滴注，第1天至第5天；DDP 20mg／m^2／d，静脉滴注，第1天至第5天；21d为1个周期，连用3个周期。结果38例CR 13．2％（5／38），PR 39．5％（15／38），SD 36．8％（14／38），PD 10．5％（4／38），总有效率52．6％（20／38）。结论 HCPT联合DDP的HP方案治疗晚期NSCLC为较有效方案，毒性低，值得临床推广研究。     

大剂量MTX加CHOP方案治疗进展性非霍奇金淋巴瘤的疗效分析

目的探讨大剂量MTX加CHOP方案治疗在IPI分类中属于高中危的进展性NHL的效果。方法自1999年10月～2002年7月间收治的27例进展性NHL患者，按IPI分类分为低危、低中危组（L／LI）和中高危、高危组（HI／H）两组；前者11例采用CHOP方案治疗，即CTX600mg／m^2静注，第1天；ADM40mg／m^2静注，第1天；VCR1．5mg／m^2静注，第1天；Pred50mg／m^2口服，第1～5天；每3周重复。后者16例再分为对照组7例，应用方案及药物同上；治疗组9例除应用药物完全同上外，则在化疗中第4天加用大剂量MTX1．0～5．0g，静滴，仍每3周重复。结果低中危组（L／LI）有效率是63．6％（7／11），对照组有效率为42．9％（3／7），治疗组有效率为77．8％（7／9），后两者差异有非常显著性（P〈0．01）；病例随访至2003年9月，中位生存期3组分别为8．3个月，9．6个月，6．5个月，可见治疗组优于对照组；1年生存率低中危者（L／LI）是63．6％（7／11），对照组为42．9％（3／7），治疗组则为72．3％（7／9），后两者差异有非常显著性（P〈0．01）。毒副作用主要有骨髓抑制、口腔黏膜炎等。结论大剂量MTX加CHOP方案治疗按IPI分类中属于高中危的进展性NHL有着明显的疗效，毒性反应完全可以耐受。     

放疗联合NP方案治疗晚期非小细胞肺癌近期疗效观察

对21例晚期非小细胞肺癌（NSCLC）患者采用放疗联合NP方案（即长春瑞滨25mg／m^2，第1、8天静脉快速滴注；顺铂30mg／m^2，第2、3、4天静滴）化疗。结果：21例中CR1例，PR9例，NC8例，PD3例，总有效率47．6％。认为放疗联合NP方案治疗NSCLC近期疗效较好。     

小剂量阿糖胞苷FLAG方案治疗难治或复发急性髓细胞白血病的疗效观察

目的研究氟达拉宾（Flu）、小剂量阿糖胞苷（Ara—C）和粒细胞集落刺激因子（G—CSF）组成FLAG方案治疗难治复发性急性髓细胞白血病（RAML）的疗效及不良反应。方法难治复发性急性髓细胞白血病患者60例随机分成两组,研究组34例给予小剂量阿糖胞苷FLAc方案,即Flu30mg／（m^2·d）30min内静滴,d1-5;Ara—C10mg／（m^2·d）皮下注射,q12h,d1-14;G-CSF300μg/d,从化疗前1d开始。对照组26例给予标准剂量FLAG方案化疗,Flu30mg／（m^2·d）,d1-5;Ara-C500mg／（m^2·d）或1000mg／（m^2·d）,d1-5;G-CSF300μg／d,化疗前6—24h。结果研究组21例获得完全缓解（CR）,CR率61．7％,6例获得部分缓解（PR）,总有效率79．4％。对照组17例CR（65．4％）,4例PR（15．4％）,总有效率80．7％。两组比较总有效率无统计学差异（P〉0．05）,不良反应发生率有统计学差异（P〈0．01）。结论小剂量阿糖胞苷FLAG方案治疗难治复发性RAML的疗效与标准剂量FLAG方案疗效相当,但化疗相关不良反应显著减少。     

改良FAM方案治疗晚期胃癌临床观察

目的增加FAM方案治疗胃癌疗效．方法我们自1989－04／1997－03用5－FU＋ADM＋MMC方案治疗晚期胃癌共73例．其中标准FAM方案治疗42例（对照组）；改良FAM方案治疗31例，用药的剂量及方法进行了调整（治疗组）．73例均为初治病例．两组临床资料对比无统计学差异（P＞0．05）．对照组治疗方案：5－FU600ms／m2，静脉滴注，d1，d8，d29，d36；ADM30mg／m2，静脉注射，d1，d29；MMC10mg／m2，静脉注射，d1，每56d为一疗程，用1～3疗程．治疗组治疗方案：5－FU600mg／m2，静脉滴注（6h～8h），d1～d5；ADM50mg／m2，静脉注射，d1；MMC10mg／m2，静脉注射，d1，每28d为一疗程，用2～6疗程．结果治疗组有效率58．1％（8／3）优于对照组33．3％（1／42），（X2=4．4，P＜0．05）．对照组中位生存期9mo，治疗组为16mo（P＜0．05）．两组有效病例的中位生存期比较无显著差异（P＞0．05）．两组病例的毒副反应均不严重，患者能耐受，因此治疗组化疗方案优于标准FAM方案，值得推广应用．结论改良FAM方案疗效优于标准FAM方案，毒副作用无明显加重．     

纤维支气管镜下氩气刀治疗中心型肺癌临床研究

目的 观察经纤维支气管镜（纤支镜）氩气刀联合全身化疗治疗原发气管支气管肺癌的近期疗效。方法 20例经纤支镜氩气刀治疗，氩气刀功率20-40W，时间2～3S，每次治疗总时间100～150S，1周后重复治疗，共3～5次。非小细胞性肺癌用GP方案：吉西他滨（GEM）1000mg／m^2，第1天和第8天静脉注射；顺铂（DDP）100mg／m^2，第1天静脉注射；小细胞性肺癌用CE方案：卡铂（CBP）400或500mg，第1天静脉注射；足叶乙甙（VP-16）100mg，第1～5天静脉注射。28d为1周期。结果 20例氩气刀联合全身化疗后，18例症状明显改善，纤维支气管镜下病灶好转率为90％，胸部X线复查病灶吸收率达75％。结论 氩气刀联合全身化疗治疗管内型肺癌疗效明显。     

多西紫杉醇联合顺铂治疗乳腺癌肺转移32例的临床观察

目的观察多西紫杉醇联合顺铂治疗乳腺癌肺转移的临床疗效和毒副作用。方法32例乳腺癌肺转移患者，多西紫杉醇2550mg／m^2，静脉滴注1小时，第1、8、15日给药；顺铂20mg／m^2，第2～4日。28天为1个周期，完成2个周期后评价疗效。化疗前1天口服地塞米松8mg，2次／天，连服三天以防水潴留。结果32例患者完全缓解（CR）10例（31．2％），部分缓解（PR）11例（34．5％），稳定（SR）7例（21．8％），进展（PD）4例（12．5％），总有效率（CR＋PR）65．7％。不良反应主要是骨髓抑制及胃肠道反应，对症处理获得缓解。结论多西紫杉醇联合顺铂治疗肺转移性乳腺癌疗效较好，不良反应患者能耐受。     

三维适形放射治疗联合化疗在膀胱小细胞癌中的应用

采用三维适形放射治疗（3D-CRT）联合化疗治疗7例膀胱小细胞癌（SCC）患者，放疗前接受4-6周期化疗，化疗药物为VP-16100mg／m^3、第1-3天，DDP25mg／m^2、第1-3天，每3周重复一次。化疗结束后7-10d给予3D-CRT，1.8-2.0／次，5次／周，肿瘤量50-55Gy。随访6-48个月。结果放疗有效率100％。放疗毒副反应主要为早期胃肠道反应和泌尿系统反应，以1级为主。无瘤生存期〉48个月3例，死亡2例。认为SCC临床罕见，3D-CRT联合化疗方案治疗SCC有效。     

多西他赛联合奥沙利铂治疗晚期转移性胃癌近期疗效观察

74例晚期胃癌患者随机分为观察组31例和对照组43例。观察组多西他赛65mg／m^2，静脉滴注，第1天；奥沙利铂120mg／m^2，静脉滴注，持续2h，第1天；21d为一周期。对照组给予多西他赛75mg／m^2，静脉滴注，第1天；顺铂75mg／m^2，分5次静脉滴注，1次／d，21d为一周期。两组均治疗2—8个周期。结果观察组完全缓解率（CR）0，部分缓解率（PR）38．7％，总缓解率（RR）38．7％；对照组分别为2．3％、37．2％、39．5％。两组疗效比较差异无统计学意义（P〉0．05），Ⅲ、Ⅳ度不良反应发生率观察组低于对照组。认为多西他赛联合奥沙利铂方案治疗晚期胃癌安全、有效。     

多西紫杉醇联合顺铂与紫杉醇联合顺铂一线治疗晚期非小细胞肺癌的随机临床对照研究

背景与目的 多西紫杉醇是二线治疗晚期非小细胞肺癌的有效药物，近年来多项临床试验显示其在一线治疗晚期非小细胞肺癌的疗效与目前常用的一线方案相似。本研究拟比较多西紫杉醇联合顺铂（DC）与紫杉醇联合顺铂（PC）一线治疗晚期非小细胞肺癌的疗效、毒副反应及生存。方法细胞学或病理学确诊的90例初治晚期非小细胞肺癌患者随机分为DC组与PC组。DC组：多西紫杉醇75mg／m^2，静脉滴注1小时，第1天，顺铂75mg／m^2，分成两天静脉滴注，第2，3天。PC组：紫杉醇150mg／m^2，静脉滴注3小时，第1天；顺铂75mg／m^2，分成两天静脉滴注，第2～3天。顺铂用药时需水化。两种方案均为21天重复。至少完成2周期化疗的患者进行疗效、毒副反应评价，并分析生存情况。结果DC组总有效率为31．1％，中位生存期为10．2月，中位疾病进展时间为4．4月，1年和2年生存率分别为35．6％、8．9％；PC组总有效率为33．3％，中位生存期为10．4月，中位疾病进展时间为4．9月，1年和2年生存率分别为37．8％、11．1％。两组的总有效率、中位生存期、中位疾病进展时间及1、2年生存率均无显著性统计学差异（P〉0．05）。两组Ⅲ度和Ⅳ度毒副反应为白细胞减少、贫血、恶心呕吐及脱发，无显著性统计学差异（P〉0．05）。结论多西紫杉醇联合顺铂方案与紫杉醇联合顺铂方案比较，疗效与生存相似，毒副反应较轻，耐受性好，是一线治疗非小细胞肺癌的有效方案。     

High dose carboplatin/VP-16 plus ifosfamide with autologous bone marrow support in the treatment of refractory germ cell tumors.

We report seven patients with germ cell tumors which either recurred following a minimum of two regimens of platinum-based chemotherapy or were refractory to cisplatin. The patients were treated with one or two courses of high dose carboplatin (CBDCA) and etoposide (VP-16) plus ifosfamide (IFX) with mesna uroprotection and autologous bone marrow support. The doses given were CBDCA 500 mg/m2 every other day x 3 and VP-16 400 mg/m2 every other day x 3. IFX was given in a dose of 2 g/m2 daily x 5 days with mesna. The original intent of the protocol was to explore escalating doses of IFX, but excessive renal toxicity at the first dose level prevented escalation. Of the seven patients treated, four developed a marked decline in their renal function and three of the four required hemodialysis or hemofiltration. Six of seven patients treated had a decline in their serum markers indicating a response to therapy, but all have relapsed. Our conclusion is that while the combination of CBDCA/VP-16/IFX with ABMT is active in this group of patients, it is associated with excessive renal toxicity which is probably due to underlying renal dysfunction secondary to extensive prior cisplatin-based chemotherapy.     

A prospective study of P-IMVP-16/CBDCA: a novel salvage chemotherapy for patients with aggressive non-Hodgkin's lymphoma who had previously received CHOP therapy as first-line chemotherapy

The purpose of this study was to determine the efficacy of salvage chemotherapy with, P-IMVP-16/CBDCA, consisting of carboplatin (CBDCA), etoposide (VP-16), ifosfamide (IFM), and methotrexate (MTX), for patients with aggressive non-Hodgkin's lymphoma (NHL) who had previously received CHOP [a regimen of cyclophosphamide, hydroxydaunomycin, Oncovin (vincristine), and prednisolone], as first-line chemotherapy. The 45 consecutively enrolled patients received methylprednisolone (mPSL) 1000 mg per body for 3 d (from day 1 to day 3), IFM 1000 mg/m(2) for 5 d (from day 1 to day 5), MTX 30 mg/m(2) on day 3 and day 10, VP-16 80 mg/m(2) for 3 d (from day 1 to day 3), and CBDCA 300 mg/m(2) on day 1, with granulocyte colony-stimulating factor every 21 d. Patients 70 yr of age or older were given 75% of the standard dose. The response rate [complete response (CR) plus partial response (PR)] was 55.6% (25/45), including 12 (26.7%) CR and 13 (28.9%) PR. The overall survival rate for the 45 patients was 31.1% at 1 yr and 17.3% at 2 yr. The failure-free survival rate for the 45 patients was 6.7% at 1 yr and 4.4% at 2 yr. The survival rate for the 25 responders was 48.0% at 1 yr and 24.0% at 2 yr, and the survival rate for the 20 non-responders was 10.0% at 1 yr (P<0.001). Multivariate analysis demonstrated that prior chemotherapy (reduced-dose CHOP for age 70 yr or older) and the number of cases of extranodal involvement (>1) were significant unfavorable factors for overall survival. Although the major toxicity was neutropenia, no patient died of infection related to neutropenia. Non-hematological adverse effects were predominantly mild and tolerable. Unfortunately, the clinical outcome with P-IMVP-16/CBDCA was unfavorable, possibly because the study comprised consecutive patients who had received identified intensive chemotherapy, such as biweekly CHOP. Salvage chemotherapy with P-IMVP-16/CBDCA is not sufficient to cure relapsed or refractory aggressive NHL. Aggressive NHL should be cured by first-line chemotherapy with or without hematopoietic stem cell transplantation.     

Pilot study of cyclophosphamide plus carboplatin in advanced ovarian carcinoma

Six patients with histologically proven stage III-IV ovarian carcinoma received carboplatin (CBDCA) (150 mg/m2) plus cyclophosphamide (1000 mg/m2) monthly for 1 year unless disease progressed earlier. Six other patients received CBDCA (225 mg/m2) with the same cyclophosphamide dose monthly. Continued treatment with the higher CBDCA dose was not tolerable because of myelosuppression, but no other dose-limiting toxic effect was observed. Complete tumor regression was proven at secondary laparotomy in six of the 12 patients, and five of these remain disease-free from 26+ to 28+ months after beginning chemotherapy.     

Third-line chemotherapy with paclitaxel, irinotecan hydrochloride and cisplatin for recurrent gastric cancer: a case report

With the availability of new chemotherapeutic agents such as S-1 and paclitaxel (TXL) for advanced gastric cancer, the development of a strategy for a third-line chemotherapy is urgently needed. We treated a patient with recurrent gastric cancer using TXL, irinotecan hydrochloride (CPT-11) and cisplatin (CDDP) as a third-line chemotherapy. The patient was a 46-year-old man who had undergone total gastrectomy for advanced gastric cancer with lymph node metastases. For postoperative recurrence, he was first treated with S-1 as an outpatient; however, tumor markers increased, and para-aortic lymph node metastasis was revealed by thoracic and abdominal CT scan. A second-line therapy with weekly TXL and CDDP was then added, but resulted in PD. Therefore, combination chemotherapy with TXL, CPT-11 and CDDP was started biweekly as a third-line chemotherapy. TXL (80mg/m2) was infused over 1 hour after short premedication, followed by CPT-11 (25mg/m2) and CDDP (15mg/m2) over 30 min. After 6 courses of this therapy, the serum AFP and TPA returned to normal, and the size of the metastatic para-aortic lymph nodes reduced. The effect of this therapy was judged as PR and the toxicity of this regimen was tolerable. The patient has undergone 10 courses of this therapy and is maintaining a clinical PR. The patient was able to resume his full social activities. TXL, CPT-11 and CDDP combination chemotherapy may be useful and safe for patients with recurrent gastric cancer, even after first-or second-line therapy with S-1 or taxanes.     

Phase I study of the combination of nedaplatin, adriamycin and 5-fluorouracil for treatment of advanced esophageal cancer

This trial was conducted to determine the maximum-tolerated dose, principal toxicity, and recommended dose (RD) for the phase II study of the combination of nedaplatin (NED), adriamycin (ADM), and 5-fluorouracil (5-FU) in patients with advanced esophageal cancer. Patients with previously untreated esophageal cancer were eligible if they had performance status 0-1, were 75 years or younger and had adequate organ function. The dose of NED, the key anticancer platinum complex drug, was increased from 60 to 70, and 80 mg/m(2) on day 1. ADM and 5-FU were administered at fixed doses (30 mg/m(2) on day 1, and 700 mg/m(2) on days 1-5). The dose-limiting toxicities of NED were neutropenia and severe diarrhea, and its maximum-tolerated dose and RD were 70 mg/m(2) and 60 mg/m(2), respectively. There were four responders among the six patients administered the RD. The present study thus revealed combination chemotherapy with NED, ADM, and 5-FU to be active and well-tolerated and to warrant phase II study.     

Is treatment intensification by adding etoposide and carboplatin to fractionated total body irradiation and melphalan acceptable in children with solid tumors with respect to toxicity?

Conventional chemotherapy results in high mortality rates in patients with solid tumors involving the bones or the bone marrow. High dose melphalan (MEL) with or without total body irradiation followed by bone marrow transplantation (BMT) has prolonged survival, but curative potential has remained disappointing. In order to improve survival 20 children with generalized or relapsed solid tumors (neuroblastoma, peripheral neuroectodermal tumor, Ewing's sarcoma, rhabdomyosarcoma) underwent autologous (n = 16) or allogeneic (n = 4) BMT. The myeloablative regimen consisted of 12 Gy fractionated total body irradiation (FTBI) and high dose MEL. In 12 of these patients this regimen was intensified by giving 60 mg/kg etoposide (1800 mg/m2 VP), and 1.5 g/m2 carboplatin (CBDCA) was added in seven of these 12 patients. The intensification of FTBI and MEL by adding VP and CBDCA was followed by acceptable toxicity. Acute liver toxicity in 15/20 patients (75%) and acute renal toxicity in 17/20 patients (85%) did not exceed WHO grade 1. The use of the conditioning regimen FTBI-MEL-VP-CBDCA during first chemotherapy response is a promising approach in treatment of children suffering from generalized solid tumors.     

A paucity of chronic electrocardiographic changes with adriamycin therapy

Serial electrocardiograms (ECGs) of 49 patients receiving adriamycin were analyzed for the development of persistent changes. The ECG changes were compared with those of a control group of 20 patients receiving other chemotherapeutic drugs, which were comparable to the additional chemotherapy received by the adriamycin patients. The only chronic ECG changes noted with adriamycin over control were the loss of P wave amplitude in the greater than 500 mg/m2 dose subgroup and the clockwise rotation of the precordial QRS in the 250-500 mg/m2 dose subgroup. In contrast, systolic time intervals demonstrated a gradual diminution in left ventricular function at increasing doses of adriamycin. The electrocardiogram itself appears to be of limited value in the assessment of cardiac toxicity with adriamycin therapy.     

Carboplatin or iproplatin in advanced non-small cell lung cancer: a Cancer and Leukemia Group B Study

The effect of the cisplatin analogs carboplatin (CBDCA) or iproplatin (CHIP) was evaluated in patients with extensive non-small cell lung cancer. The randomized phase II design was used to achieve balance between patient groups and comparison of response rates was not a primary objective of the study. CBDCA (400 mg/m2 iv) or CHIP (270 mg/m2 iv) was administered every 4 weeks until relapse of disease. Overall, 11 of 70 patients (16%; 95% confidence interval: 7%-25%) responded to CBDCA and five of 71 patients (7%; 95% confidence interval: 1%-13%) responded to CHIP. There were two complete responses to CHIP and none to CBDCA. The most frequent severe or life-threatening toxic effects were thrombocytopenia and leukopenia. Median survival for patients receiving CBDCA was 6.5 months; for those on CHIP it was 5.0 months (P = 0.59). CBDCA is probably active in patients with non-small cell lung cancer whereas CHIP has limited activity. Further evaluation of CBDCA as part of combination chemotherapy for non-small cell lung cancer is warranted.     

Phase I study of carboplatin (CBDCA) in children with cancer

A phase I study of carboplatin (CBDCA) was performed in 40 children with advanced cancer. A single course of CBDCA consisted of 4 weekly 1-hour infusions followed by a 2-week rest. The starting dose of 100 mg/m2/week was 66% of the maximum tolerated dose in adults. Escalated dose levels given were: 125, 150, 175, and 210 mg/m2. Myelosuppression was dose limiting, with thrombocytopenia more pronounced than leukopenia. There was no evidence of cumulative toxicity. The maximum tolerated dose for children with solid tumors was 210 mg/m2/week X 4. Other side effects included transient nausea and vomiting at the higher dose levels and non-dose-related, reversible changes in creatinine clearance. One patient developed hives. No hepatic toxicity was seen. Among the 28 evaluable patients with solid tumors, one of ten with osteogenic sarcoma had complete disappearance of a lung nodule for 15+ months. Two of four patients with medulloblastoma had partial responses by clinical and computerized tomographic scan for 4 and 10 months. All three responders had received prior cisplatin therapy. CBDCA has major advantages over cisplatin in terms of reduced toxicity. Responses observed in patients previously treated with cisplatin are encouraging. The recommended phase II dose for children with solid tumors is 175 mg/m2/week X 4 with a 2-week rest.     

Response to combined modality treatment in a five-year survivor of extensive small cell lung cancer with severe complications

We present a rare case of a five-year survivor of small cell lung cancer with severe complications who responded to combined modality treatment. Prior to initial chemotherapy, he experienced severe complications including sepsis, pneumonia, ileus, and a performance status of 4. He was treated with an ileus tube and IVH, and was managed by mechanical ventilation for four days. After his general condition improved, he received combination chemotherapy of carboplatin, with the target area under the plasma concentration versus the time curve (AUC) of 5 mg x min/ml day 1, and etoposide (80 mg/m2) on days 1, 2, 3 for four courses, and complete remission (CR) was obtained. Six months later, systemic relapse occurred, but he achieved complete remission again with nine courses of CODE (cisplatin, vincristine, adriamycin, and etoposide) chemotherapy and sequential chest radiotherapy. Five years after the initial chemotherapy, the patient is alive and disease free.