外放射结合腔内照射治疗气管癌和支气管肺癌的疗效观察

目的 探讨气管癌、支气管肺癌腔内放射治疗的价值。方法 4例原发气管癌和22例原发支气管肺癌及14例(18处病变)支气管肺癌术后复发者，外放射采用6MV X射线，剂量为DT30～77Gy(平均52Gy)；腔内照射采用低剂量率^192Ir小线源(1．48BGq)，支气管黏膜参考点剂量为4～6Gy／次，总剂量10～53Gy(中位值28Gy)。结果 37例肿瘤完全消退(CR)，2例部分消退(PR)，1例轻微变化(MR)，3、5年局部控制率分别为75％和65％。23例生存时间≥3年，3年生存率为57．5％。并发症较少见。结论 外放射结合腔内照射治疗对于早期支气管肺癌、局限性气管癌和支气管肺癌术后复发者是有效的治疗手段．长期生存是可能的。     

非小细胞肺癌根治术后支气管残端复发的放射治疗

目的探讨非小细胞肺癌根治术后支气管残端复发放射治疗的疗效及毒性反应。方法21例根治术后支气管残端复发的非小细胞肺癌患者行放射治疗,19例采用体外照射,剂量为44~68Gy/22~34次/5~7周。2例行支气管腔内近距离放疗。结果33.3%(7/21)的患者肿瘤完全缓解,42.9%(9/21)的患者肿瘤部分缓解,症状缓解率为81.0%(17/21),中位生存期为22个月,1、3、5年生存率分别为66.7%、26.6%、14.2%,7例患者死于远处转移,10例患者死于局部进展。5例伴有纵隔淋巴结的残端复发癌患者均于治疗后6个月内死亡。结论非小细胞肺癌根治术后支气管残端复发行放射治疗安全有效,毒副反应可以耐受。不伴纵隔淋巴结的患者治疗后有可能长期生存。     

支气管动脉灌注化疗加放疗治疗中晚期肺癌45例疗效分析

目的　报道中、晚期肺癌经介入化疗加放疗的疗效。材料与方法　从 1997年 7月至 1999年 7月间采用经支气管动脉灌注化疗 2次 ,第 2次动脉灌注化疗后 1周加医用电子直线加速器外照射放疗 ,治疗不能手术切除的ⅢB+Ⅳ期非小细胞肺癌 45例 ,放疗剂量DT5 5～ 6 8Gy。结果　近期疗效 :CR率 2 2 2 %、PR率 6 2 2 %、显效率 (CR +PR) 84 4% ,有效缓解率 95 6 %。随访至 2 0 0 0年 7月 ,全组病例 0 5、1和 2年生存率分别为 93 3% (42例 )、6 8 8% (31例 )和 2 2 2 % (10例 )。结论　中晚期肺癌介入化疗加放疗的综合治疗可提高疗效和生存期。     

外照射加锎-252中子腔内照射治疗70例食管癌

目的:观察外照射加锎-252(252Cf)中子腔内照射治疗食管癌的疗效。方法:70例食管癌患者每周接受一次252Cf中子腔内照射,4Gy/次,总剂量16Gy/4周;中子治疗开始后第二天接受60Co外照射,4次/周,总剂量50~56Gy。结果:①近期疗效:CR87.1%,PR11.5%,NR1.4%;②1年生存率75.7%,2年生存率51.4%,3年生存率22.9%;③并发症发生率:放射性食管炎48.6%,食管溃疡7.1%,食管狭窄25.7%,食管瘘2.9%。结论:外照射加252Cf中子腔内照射治疗食管癌的近期疗效及1年、3年生存率与外照射结合192Ir腔内放疗相近,可能具有一定的应用前景。     

支气管动脉灌注化疗加放疗治疗中晚期肺癌45例疗效分析

目的：报道中，晚期肺癌经介入化疗加放疗的疗效。材料与方法：从1997年7月间采用经支气管动脉灌注化疗2次，第2次动脉主化疗后1周加医用电子直线加速器外照射放疗，。治疗不能手术切除的ⅢB Ⅳ期非小细胞肺癌45例，放疗剂量DT55－68Gy。结果：近期疗效：CR率22．2％，PR率62．2％，显效率（CR＋PR）84．4％，有效缓解率95．6％，随访至2000年7月，全组病例0．5，1和2年生存率分别为93．3％（42例），68．8％（31例）和22．2％（10例）。结论：中晚期肺癌介入化疗加放疗的综合治疗可提高疗效和生存期。     

Ⅲ期非小细胞肺癌三维适形放疗近期疗效观察

目的探讨三维适形放疗治疗Ⅲ期非小细胞肺癌(NSCLC)的疗效.方法 60例Ⅲ期非小细胞肺癌(NSCLC)经病理诊断后,进行三维适形放疗,其中,鳞癌38例,腺癌12例,腺鳞癌6例,大细胞4例,4 Gy/lf,3次/周,总剂量48 Gy～60 Gy.伴锁骨上淋巴结转移的患者用常规分割放射治疗,剂量66 Gy～70 Gy/7周.结果 60例近期疗效中,13例完全缓解(CR),28例部分缓解(PR),15例稳定(NC),4例进展.肿瘤总有效率(CR+PR)为68.3%(41/60).结论Ⅲ期非小细胞肺癌三维适形放疗近期有较好疗效,远期疗效尚需进一步观察.     

125I放射性粒子植入联合三维适形放疗治疗局部非小细胞肺癌的疗效

目的:探讨125I 放射性粒子(125I 粒子) 植入联合三维适形放疗治疗非小细胞肺癌的放射剂量、安全性和近期疗效.方法:对经病理学确诊的16例非小细胞肺癌病人(均为周围型,腺癌9 例,鳞癌7例) 予外照射(8MV的X线常规放疗) 治疗,60-66Gy/(30-33) 次.1-2个月左右复查胸部CT,观察肿瘤退缩情况,并开始应用125I 粒子.术前经三维立体定向125I 粒子植入放射治疗计划系统(TPS) 制定治疗计划,根据TPS 结果计算所需125I 粒子数和布源方法.在CT 引导下经皮穿刺组织间植入125I 粒子,内照射剂量为90-120Gy.术后应用TPS 进行剂量验证.结果:125I 粒子植入术后每3 个月左右复查胸部CT,肺部肿瘤完全消退者4例,部分退缩者12例.16例病人接受植入术中发生少量气胸者2 例;4 例出现咳血痰,给予止咳和止血药物后1-2d 症状消失.结论:125I 粒子植入联合外照射治疗非小细胞肺癌是一种有效的方法,且肺放射性损伤程度低,值得进一步研究.     

^125I放射性粒子植入联合三维适形放疗治疗局部非小细胞肺癌的疗效

目的：探讨^125I放射性粒子（^125I粒子）植入联合三维适形放疗治疗非小细胞肺癌的放射剂量、安全性和近期疗效。方法：对经病理学确诊的16例非小细胞肺癌病人（均为周围型,腺癌9例,鳞癌7例）予外照射（8MV的X线常规放疗）治疗,60-66Gy/（30-33）次。1-2个月左右复查胸部CT,观察肿瘤退缩情况,并开始应用^125I粒子。术前经三维立体定向^125I粒子植入放射治疗计划系统（TPS）制定治疗计划,根据TPS结果计算所需^125I粒子数和布源方法。在CT引导下经皮穿刺组织间植入^125I粒子,内照射剂量为90-120Gy。术后应用TPS进行剂量验证。结果：^125I粒子植入术后每3个月左右复查胸部CT,肺部肿瘤完全消退者4例,部分退缩者12例。16例病人接受植入术中发生少量气胸者2例;4例出现咳血痰,给予止咳和止血药物后1-2d症状消失。结论：^125I粒子植入联合外照射治疗非小细胞肺癌是一种有效的方法,且肺放射性损伤程度低,值得进一步研究。     

Ⅲ期大体积非小细胞肺癌三维适形放疗尝试

目的探讨以三维适形放疗(3DCRT)技术提高Ⅲ期大体积非小细胞肺癌的局控效果的可行性。方法回顾分析应用3DCRT技术治疗的52例瘤体直径≥8 cm的Ⅲ期非小细胞肺癌病例的治疗结果。42例行根治性放疗,BED 72~112 Gy;10例行姑息性放疗,BED 48~70 Gy。结果44例临床状况明显改善。总的肿瘤局部控制有效率(CR PR)69.3%;根治病例为76.2%。无2级以上急性及晚期放射损伤(RTOG/EORTC分级标准)。结论3DCRT是治疗Ⅲ期大体积非小细胞肺癌的安全有效的方法之一,可以提高肿瘤局控率。     

外照射结合锎-252中子腔内照射治疗食管癌的临床观察

观察锎252(252cf)中子腔内照射结合外照射治疗食管癌的疗效,对70例食管癌患者每周予以252cf中子4Gy腔内照射1次,共4次。中子治疗后第2天予以60Co外照射,食管靶区每次剂量2Gy,4次/周,总剂量50～56Gy。近期疗效CR61例,PR8例,NR1例;1、3和5年生存率分别为75.7%、28.9%和22.5%。并发症发生率放射性食管炎48.6%、食管溃疡7.1%、食管狭窄25.7%和食管瘘2.9%。初步研究结果提示,外照射加252cf中子腔内照射治疗食管癌的疗效较理想,有一定的应用前景。     

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.     

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     

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.     

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.     

Protothecosis successfully treated with amikacin combined with tetracyclines

Summary We report a case of protothecosis in an 18-year-old female student caused by Prototheca zopfii successfully treated with amikacin combined with tetracyclines. Zusammenfassung Es wird über eine Protothecose, verursacht durch Prototheca zopfii, bei einer 18-j?hrigen Studentin berichtet, die erfolgreich mit Amikacin in Kombination mit Tetracyclinen behandelt wurde.