深部高频热疗联合GO方案治疗胰腺癌的临床观察

目的 探讨深部高频热疗联合GO方案治疗胰腺癌的疗效与安全性.方法 选择收治的胰腺癌患者100例.按照随机数字法分为观察组和对照组各50例.对照组患者给予GO方案化疗,观察组在对照组基础上给予胰腺区域局部深部高频热疗,首次开始于化疗用药后4h内,频率13.56MHz,温度范围41℃～43℃,连续治疗60 min,每周2次,10次1个疗程.结果 观察组患者的ORR为76.0％,DCR为86.0％,对照组患者ORR为36.0％,DCR为66.0％,观察组患者ORR和DCR均高于对照组,差异有统计学意义(P＜0.05).观察组患者疼痛症状改善有效率和体能改善有效率高于对照组,差异有统计学意义(P＜0.05).观察组4例出现Ⅰ～Ⅱ皮肤烫伤,余不良反应与对照组比较无统计学意义(P＞0.05).结论 深部高频热疗联合GO方案化疗临床疗效显著,能明显提高胰腺癌患者生活质量,且安全性较高,值得临床推广使用.     

调强适形放疗同步化疗联合热疗治疗原发性上皮性卵巢癌的疗效分析

目的 探讨调强适形放疗(IMRT)同步化疗联合热疗对原发性上皮性卵巢癌(EOC)的治疗效果.方法 回顾性分析90例原发性EOC患者的临床资料,根据治疗方式分为观察组和对照组,每组45例,对照组给予IMRT同步化疗进行治疗,观察组在此基础上给予热疗.治疗3个月后,观察两组患者的治疗效果,比较两组患者治疗前后肿瘤标志物水平、生活质量和不良反应发生情况的差异.结果 观察组患者疗效优于对照组(P﹤0.05).治疗前两组患者肿瘤标志物水平差异无统计学意义(P﹥0.05);治疗后观察组患者的癌胚抗原(CEA)、糖类抗原15-3(CA15-3)和糖类抗原125(CA125)水平均明显低于对照组(P﹤0.01).治疗前两组患者生活质量评分差异无统计学意义(P﹥0.05);治疗后观察组患者生活质量评分明显高于对照组(P﹤0.01).两组患者恶心、呕吐,肝肾功能受损,骨髓抑制及血栓性静脉炎发生情况差异无统计学意义(P﹥0.05).结论 IMRT同步化疗联合热疗对原发性EOC有较好的治疗效果,可提高患者的生活质量.     

中药联合热疗治疗晚期非小细胞肺癌32例疗效观察

目的:观察中药扶正固本汤与微波热疗联合治疗晚期非小细胞肺癌的临床近期疗效.方法:将62例患者随机分为中药扶正固本汤联合微波热疗治疗组(32例)及常规治疗联合微波热疗对照组(30例),并比较两组患者近期疗效、临床症状、生活质量、生存时间及生存率等方面的差异.结果:治疗组在临床症状、生活质量、生存时间及生存率方面优于对照组(P＜0.05);近期疗效与对照组比较无差异性(P＞0.05).结论:中药与微波热疗联合治疗晚期非小细胞肺癌对改善临床症状、生活质量及延长生存时间具有较好的疗效,值得推广.     

替吉奥联合吉西他滨治疗晚期胰腺癌的疗效观察

目的:探讨替吉奥(S-1)胶囊联合吉西他滨(GEM)化疗与吉西他滨单药治疗进展期胰腺癌的疗效.方法:对2011年5月至2013年5月收治的37例晚期胰腺癌患者的临床资料进行回顾性分析,其中18例采用替吉奥胶囊联合吉西他滨方案治疗(治疗组);19例采用吉西他滨单药治疗(对照组).采用Kaplan-Meier法分析患者的生存时间,并比较两组患者的客观缓解率、临床受益反应(CBR)、中位疾病进展时间、中位生存时间和不良反应.结果:治疗组有效率明显高于对照组(33.3％vs 21.1％),差异有统计学意义(P =0.032).治疗组疾病控制率(DCR)高于对照组(72.2％vs 63.2％),但差异无统计学意义(P =0.450).治疗组患者CBR缓解率高于对照组(71.8％ vs 45.7％),差异无统计学意义(P=0.421).治疗组的中位生存时间为10.1个月(95％CI:8.0-11.5个月),高于对照组的8.02个月(95％ CI:3.7-10.8个月),差异有统计学意义(P=0.043);两组的中位疾病进展时间分别为3.5个月和3.0个月(P=0.720).治疗组的6个月生存率(72.5％)略高于对照组(66.5％),但差异无统计学意义(P＞0.05).两组不良反应的发生率也相似(P＞0.05).结论:替吉奥胶囊联合吉西他滨治疗方案与单药治疗晚期胰腺癌相比,在客观疗效、中位生存时间方面表现出一定优势,疾病控制率及临床受益反应也有所提高,且不良反应可耐受,是晚期胰腺癌的有效治疗方案.     

吉西他滨联合白蛋白结合型紫杉醇治疗晚期胰腺癌的疗效及安全性

目的 探讨吉西他滨联合白蛋白结合型紫杉醇治疗晚期胰腺癌的临床疗效及安全性.方法 根据治疗方式的不同将105例晚期胰腺癌患者分为对照组(n=49)和观察组(n=56),对照组患者采用吉西他滨治疗,观察组患者采用吉西他滨联合白蛋白结合型紫杉醇治疗.比较两组患者的临床疗效、肿瘤标志物[癌胚抗原(CEA)、糖类抗原19-9(CA19-9)、甲胎蛋白(AFP)]水平、生存情况及不良反应发生情况.结果 观察组患者的总有效率和疾病控制率分别为58.93％和78.57％,分别高于对照组的38.78％和57.14％,差异均有统计学意义(P﹤0.05);观察组中TNM分期为Ⅲ期和Ⅳ期患者的总有效率分别为61.29％和56.00％,与对照组的40.91％和37.04％比较,差异均无统计学意义(P﹥0.05);观察组中有转移和无转移患者的总有效率分别为56.52％和60.61％,与对照组的33.33％和44.00％比较,差异均无统计学意义(P﹥0.05).治疗后,观察组患者的血清CEA、CA19-9及AFP水平均低于对照组,差异均有统计学意义(P﹤0.05).观察组和对照组患者的中位生存期分别为9.9个月和8.1个月.观察组患者的9个月、12个月生存率均高于对照组,差异均有统计学意义(P﹤0.05).观察组和对照组患者的3～4级不良反应总发生率分别为26.79％和32.65％,差异无统计学意义(P﹥0.05).结论 吉西他滨联合白蛋白结合型紫杉醇治疗晚期胰腺癌患者的临床疗效及安全性均较好.     

深部热疗联合腹腔热灌注化疗治疗卵巢上皮癌腹腔转移的疗效及对生活质量的影响

目的 探讨卵巢上皮癌腹腔转移患者采用深部热疗联合腹腔热灌注化疗的临床疗效及对患者生活质量的影响.方法 将96例卵巢上皮癌腹腔转移患者按照随机数字表法分为对照组(单纯静脉化疗治疗)与治疗组(深部热疗联合腹腔热灌注化疗治疗),各48例.统计2组患者肿瘤控制情况、肿瘤指标变化、疼痛控制情况及不良反应;随访1年,统计2组患者的生活质量及生存情况.结果 治疗组肿瘤控制(CR+ PR)为54.2％(26/48),明显高于对照组33.3％ (16/48),差异具有统计学意义,P＜0.05;观察组PD为12.5％ (6/48),明显低于对照组35.4％ (17/48),差异具有统计学意义(P＜0.05).治疗后,观察组肿瘤指标CA125下降＞50％率为56.3％(27/48),明显高于对照组29.2％(14/48),差异具有统计学意义(P＜0.05).2组患者治疗后疼痛评分(VAS)均较治疗前明显下降,然观察组下降更为显著,P＜0.05.治疗期间,观察组不良反应发生率明显低于对照组,P＜0.05.随访1年,2组均无死亡病例,2组KPS评分均较治疗前明显提高,然观察组升高更为显著,P ＜0.05.结论 卵巢上皮癌腹腔转移患者采用深部热疗联合腹腔热灌注化疗的疗效显著且安全.     

康艾注射液联合肝动脉化疗栓塞术治疗原发性肝癌36例临床观察

目的:观察康艾注射液联合经导管动脉内化疗栓塞术(transcatheter arterial chemoembolization,TACE)治疗肝癌的临床疗效.方法:将67例患者随机分为2组,观察组36例与对照组31例,均采用相同的TACE治疗,观察组同时联合康艾注射液治疗.观察比较2组的疗效,KPS评分变化、体质量和不良反应发生情况.结果:观察组与对照组近期疗效分别为44.4%和41.9%,差异无统计学意义(P＞0.05);观察组治疗前后KPS评分值上升,经比较差异有统计学意义(P＜0.05),且对照组治疗后KPS评分值下降,治疗前后经比较差异无统计学意义(P＞0.05);2组患者治疗前后体质量均无明显变化(P＞0.05);观察组不良反应(包括白细胞减少、血红蛋白下降、肝功能损害等)发生率比对照组低,且差异有统计学意义(P＜0.05).而在血少板减少和恶心呕吐发生率及肾功能损害等不良反应的发生率方面,2组间差异无统计学意义(P＞0.05).结论:康艾注射液联合TACE治疗原发性肝癌,可以提高患者的生活质量,并减轻化疗的一些不良反应.     

吉西他滨联合康莱特治疗晚期胰腺癌的临床疗效研究

目的:探讨吉西他滨(GEM)联合康莱特治疗晚期胰腺癌的临床疗效.方法:对我院肿瘤治疗中心2002年7月至2008年9月间收治的64例晚期胰腺癌患者进行随机对照研究.32例GEM化疗病人归为A组,32例GEM化疗+康莱特治疗病人归为B组.结果:GEM组和GEM+康莱特组的临床受益率第3周期时差异无统计学意义(P＞0.05);第6周期时GEM+康莱特组显著高于GEM组,差异有统计学意义(P＜0.05).GEM+康莱特组与GEM组近期有效率差异无统计学意义(P＞0.05),但可提高总临床获益率(P＜0.05),且不良反应差异有统计学意义(P＜0.05).结论:康莱特联合吉西他滨治疗晚期胰腺癌可提高患者临床受益反应率和总临床获益率,降低化疗不良反应,提高生存质量.     

热疗辅助放化疗在晚期大肠癌的临床治疗中的应用研究

目的 探讨热疗辅助放化疗对晚期大肠癌疗效的影响.方法 选取106例晚期大肠癌患者为研究对象,分成2组.对照组53例行放化疗,观察组53例在放化疗基础上加用热疗.观察治疗前后2组相关指标的变化情况.结果 对照组有效率为52.83％,观察组有效率为69.81％,观察组显著优于对照组(P＜0.05).2组治疗后NK、CD8+、CD4+较治疗前均显著提高,治疗前后比较差异有统计学意义(P＜0.05);观察组治疗后NK、CD8+、CD4+较对照组治疗后提高更加显著,2组治疗后比较差异有统计学意义(P＜0.05).2组治疗后CEA、CA199、CA242较治疗前均显著下降,治疗前后比较差异有统计学意义(P＜0.05);观察组治疗后CEA、CA199、CA242较对照组治疗后下降更加显著,2组治疗后比较差异有统计学意义(P＜0.05).对照组治疗后躯体、社会、认知、情绪功能较治疗前无明显改善(P＞0.05),观察组治疗后躯体、社会、认知、情绪功能较对照组治疗后提高显著(P＜0.05),2组治疗后躯体、社会、认知、情绪功能等差异有统计学意义(P＜0.05).结论 热疗辅助放化疗在治疗晚期大肠癌中的疗效满意.     

紫杉醇脂联合顺铂与替吉奥联合顺铂在晚期非小细胞肺癌患者中的应用效果对比

目的 探讨紫杉醇脂联合顺铂与替吉奥联合顺铂在晚期非小细胞肺癌患者中的应用效果.方法 选取肺癌晚期患者70例,按照随机数字表法分为观察组36例,对照组34例.观察组采取紫杉醇酯联合顺铂的治疗方法,对照组采取替吉奥联合顺铂的治疗方法.对比两组患者的生存时间以及1年内的生存率、并发症发生情况以及患者治疗后的疗效.结果 观察组患者的平均生存时间为(8.2±0.3)个月,1年生存率为44.4％;对照组患者的平均生存时间为(10.3±0.5)个月,1年生存率为47.1％,差异无统计学意义(P＞0.05).观察组患者出现肾功能异常率为22.2％,血小板减少率为11.1％,严重脱发率为27.8％;对照组患者出现肾功能异常率为38.2％,血小板减少率为17.6％,严重脱发率为41.2％,观察组均低于对照组,差异有统计学意义(P＜0.05).观察组患者用药后完全缓解、部分缓解以及稳定的百分比分别为0.0％,72.2％,27.8％;对照组患者用药后完全缓解、部分缓解以及稳定的百分比分别为0.0％,41.7％,58.3％,差异具有统计学意义(P＜0.05).结论 紫杉醇脂联合顺铂治疗晚期非小细胞肺癌在降低患者并发症以及治疗效果方面优于替吉奥联合顺铂的治疗方案.     

Experience with Impedance Phlebography Compared with Venography

Venography is a particularly reliable method for the diagnosis of deep venous thrombosis but is not suitable as a screening test. Impedance phlebography represents another attempt to discover a simple, non-invasive and reliable method of detecting deep venous thrombosis. It does not, however, meet these criteria.     

Compliance with guidelines and correlation with outcome in patients with advanced germ-cell tumours

PurposeTo evaluate prior compliance with guidelines in patients treated with salvage chemotherapy for advanced germ-cell tumours (GCT).Patients and methodsData concerning the initial management of patients requiring salvage chemotherapy for GCT at Institut Gustave Roussy between 2000 and 2010 were obtained and correlated with recommendations for treatment. Criteria of non-compliance were defined based on guidelines. Compliance with guidelines, predictive factors for non-compliance and the impact on outcome were analysed.ResultsAmong 82 patients treated in the salvage setting, guidelines to initial treatment were followed in only 41 cases (50%). The most common non-compliance criteria were non-adherence to the planned dose (16%), an inappropriate interval between first-line chemotherapy cycles (16%), the lack of post-chemotherapy surgery (16%) and a long interval to post-chemotherapy surgery (48%). Compliance with standard care was better in cancer centres than in other hospitals (private or public) (Odd Ratio (OR): 6.9, P = 0.001). A poor-risk status according to the International Germ Cell Cancer Collaborative Group (IGCCCG) was also predictive of compliance in univariate but not in multivariate analysis. No significant difference in outcome after salvage chemotherapy was observed. Patients relapsing after non-compliant first-line therapy tended to be more easily salvaged, which is consistent with the fact that their initial treatment was inadequate. Some of these relapses were therefore probably not due to true biologically refractory disease.ConclusionGuidelines for first-line treatment are adhered to in only half the patients requiring salvage chemotherapy. As the only predictive factor for non-compliance was the treating centre, centralisation of patients with GCT in well-trained hospitals should be recommended.     

Treatment with methylnaltrexone is associated with increased survival in patients with advanced cancer

BackgroundMethylnaltrexone (MNTX), a peripherally acting μ-opioid receptor (MOR) antagonist, is FDA-approved for treatment of opioid-induced constipation (OIC). Preclinical data suggest that MOR activation can play a role in cancer progression and can be a target for anticancer therapy.Patients and methodsPooled data from advanced end-stage cancer patients with OIC, despite laxatives, treated in two randomized (phase III and IV), placebo-controlled trials with MNTX were analyzed for overall survival (OS) in an unplanned post hoc analysis. MNTX or placebo was given subcutaneously during the double-blinded phase, which was followed by the open-label phase, allowing MNTX treatment irrespective of initial randomization.ResultsIn two randomized, controlled trials, 229 cancer patients were randomized to MNTX (117, 51%) or placebo (112, 49%). Distribution of patients' characteristics and major tumor types did not significantly differ between arms. Treatment with MNTX compared with placebo [76 days, 95% confidence interval (CI) 43–109 versus 56 days, 95% CI 43–69; P = 0.033] and response (laxation) to treatment compared with no response (118 days, 95% CI 59–177 versus 55 days, 95% CI 40–70; P < 0.001) had a longer median OS, despite 56 (50%) of 112 patients ultimately crossing over from placebo to MNTX. Multivariable analysis demonstrated that response to therapy [hazard ratio (HR) 0.47, 95% CI 0.29–0.76; P = 0.002) and albumin ≥3.5 (HR 0.46, 95% CI 0.30–0.69; P < 0.001) were independent prognostic factors for increased OS. Of interest, there was no difference in OS between MNTX and placebo in 134 patients with advanced illness other than cancer treated in these randomized studies (P = 0.88).ConclusionThis unplanned post hoc analysis of two randomized trials demonstrates that treatment with MNTX and, even more so, response to MNTX are associated with increased OS, which supports the preclinical hypothesis that MOR can play a role in cancer progression. Targeting MOR with MNTX warrants further investigation in cancer therapy.Clinical trials numberNCT00401362, NCT00672477.     

Living with secondary breast cancer: coping with an uncertain future with unmet needs

JOHNSTON S.R.D. (2010) European Journal of Cancer Care 19 , 561–563 Living with secondary breast cancer: coping with an uncertain future with unmet needs     

奥沙利铂联合羟基喜树碱治疗晚期胃癌临床分析

背景与目的体外及体内的临床研究显示,奥沙利铂(L-OHP)对多种肿瘤有显著抑制作用并与绝大多数抗癌药物具有相加或协同细胞毒作用.本文旨在观察L-OHP联合羟基喜树碱(HCPT)治疗晚期胃癌的近期疗效和患者耐受性,并与传统的化疗方案进行对比.方法采用非随机的分组方法将43例晚期胃癌患者分为L-OHP+HCPT方案组(治疗组)与Vp-16+CF+5-FU(ELF)方案组(对照组),其中男性28例,女性15例,中位年龄59岁,KPS评分≥60,观察两组的近期疗效和患者耐受性.结果治疗组24例有效率58.3%(14/24),对照组19例有效率42.1%(8/19).治疗组有效率高于对照组,两组差异有显著性(P<0.05).两组不良反应主要是骨髓抑制、恶心、呕吐、口腔炎、周围神经炎、静脉炎、脱发等,均在Ⅰ、Ⅱ度范围内.结论L-OHP联合HCPT方案治疗晚期胃癌疗效较好,不良反应可以耐受.     

Varicella-Zoster Virus Prophylaxis with Low-Dose Acyclovir in Patients with Multiple Myeloma Treated with Bortezomib

BackgroundVaricella-zoster virus (VZV) reactivation is a common complication in patients with multiple myeloma (MM) treated with bortezomib, with an incidence rate of 10%-60%. The aim of our study was to analyze the effect of acyclovir prophylaxis in this patient population.Patients and MethodsWe studied 98 consecutive patients with relapsed MM treated with bortezomib. Bortezomib 1.3 mg/m² was given on days 1, 4, 8, and 11 of a 21-day cycle. At first, patients did not receive any VZV prophylaxis, but because of the high incidence of VZV reactivation, VZV prophylaxis with acyclovir was implemented subsequently.ResultsA total of 11 patients treated with bortezomib did not have any VZV prophylaxis, and 4 of these 11 patients (36%) developed VZV reactivation in the form of herpes zoster. No VZV reactivations were observed in the 32 patients who received acyclovir 400 mg 3 times daily or the 55 patients who received acyclovir in a dose reduced to 400 mg once daily during bortezomib treatment.ConclusionVaricellazoster virus reactivation is a common and serious adverse effect of bortezomib treatment. Acyclovir 400 mg once daily is sufficient to protect from VZV reactivation in patients with MM treated with bortezomib.     

Costs associated with complications are lower with capecitabine than with 5‐fluorouracil in patients with colorectal cancer

BACKGROUND:

Capecitabine, an oral alternative to 5‐fluorouracil (5‐FU) in patients with colorectal cancer (CRC), has equal clinical efficacy and a favorable safety profile; however, its use may be limited because of unit cost concerns. In this study, the authors measured the cost of chemotherapy‐related complications during treatment with capecitabine‐ and 5‐FU–based regimens.

METHODS:

Patients with CRC who received at least 1 administration of capecitabine or 5‐FU during 2004 and 2005 were identified from the Thomson MarketScan research databases. Monthly frequency and cost for 23 complications were recorded. Logistic regression was used to predict complication probability. General linear models were used to predict monthly complication cost and total monthly expenditure.

RESULTS:

In total, 4973 patients with CRC met the inclusion criteria for this analysis. Although the most frequently observed complications were the same between capecitabine and 5‐FU (nausea and vomiting, infection, anemia, neutropenia, diarrhea), each was observed with greater frequency in 5‐FU–based regimens. The mean predicted monthly complication cost was significantly higher (by 136%) with 5‐FU monotherapy than with capecitabine monotherapy (difference, $601; 95% confidence interval [95% CI], $469‐$737). In addition, the mean predicted monthly complication cost for 5‐FU+oxaliplatin was higher than the cost with capecitabine plus oxaliplatin (difference, $1165; 95% CI, $892‐$1595). When acquisition, administration, and complication costs were taken into consideration, there were no significant differences in the total cost between capecitabine regimens and 5‐FU regimens.

CONCLUSIONS:

Capecitabine compared well with 5‐FU–based therapy in patients with CRC and was associated with lower complication rates and associated costs. Cancer 2009. © 2009 American Cancer Society.