局部后程加速超分割放疗同期配合长春瑞滨加顺铂治疗Ⅲb期非小细胞肺癌

目的 :探讨Ⅲb期非小细胞肺癌 (NSCLC)局部小野放疗与长春瑞滨加顺铂联合化疗 (NP方案 )同步进行的临床疗效、生存质量和毒副反应。方法 :1996年 6月～ 1999年 3月 ,2 3例Ⅲb期NSCLC患者行同步放、化疗。化疗方案 :长春瑞滨 (NVB) 2 5mg/M2d1,d8;顺铂 (DDP) 30mg/M 2d1- 3,2 8天为一周期。放疗采用针对局部病变小野放疗 ,后程加速超分割方式 ,总剂量达 6 1～ 70Gy。结果 :全组病例总有效率达 86 96 % ,中位生存期 (MST) 16个月 ,1、3、5年生存率分别为 6 5 2 2 %、30 4 3%、4 35 %。骨髓抑制是主要的限制性毒副作用 ,放疗前后检测肺功能无明显改变。结论 :NP方案联合化疗加同期局部小野放疗治疗Ⅲb期NSCLC可提高疗效 ,延长中位生存期而不降低生存质量。     

NP方案联合局部放疗治疗鼻咽癌骨转移

目的：观察NP方案联合局部放疗治疗鼻咽癌骨转移的疗效。方法：60例鼻咽癌骨转移患者随机分为单放组和放化综合组各30例,单放组针对骨转移疼痛最剧烈处照射,行局部小野照射或适当扩大照射野。对于多发性骨转移患者,则着重选择2—3个疼痛最明显的部位放疗,总剂量30—46Gy／3—4．5周。放化疗综合组化疗采用NP方案,长春瑞滨（NVB）25mg／m^2,d1、d3,顺铂（PDD）20mg／m^2,d1-d4,21天至28天为1个周期。在放疗前行第2周期化疗,在化疗间歇期开始放疗,放疗方法与单纯放疗组相同,所有患者均行4周期化疗。结果：近期疗效：单放组和综合治疗组有效率（CR＋PR）分别为83．3％（25／30）和80．0％（24／30）,两组疗效无显著性差异（P〉0．05）,但是CR综合组（26．7％）高于放疗组（13．3％）。治疗后中位生存时间（MST）：单放组为5．3个月,综合组为7．6个月;1年生存率：单放组10．0％（3／30）,综合组23．3％（7／30）,差异有显著性（P〈0．05）。疼痛改善情况：单放组和综合治疗组疼痛缓解有效率分别为96．7％（29／30）和93．3％（28／30）,差异无显著性（P〉0．05）。结论：NP方案联合化疗加局部小野姑息性放疗对鼻咽癌骨转移是较好的治疗方法。     

58例含长春瑞滨方案治疗(蒽环类/紫杉类治疗后)复发转移乳腺癌的临床观察

目的：观察含长春瑞滨方案对蒽环类/紫杉类药物治疗后复发转移性乳腺癌的有效性和安全性。方法：蒽环类/紫杉类药物治疗后复发转移性乳腺癌患者61例,其中58例可评价疗效;长春瑞滨联合顺铂（NP）41例,长春瑞滨25mg/m^2,第1天和第8天,静脉滴注;顺铂75～80mg/m^2,静脉滴注,分割为2～5天,3周为一周期;长春瑞滨联合卡培他滨或替加氟（NF）17例,长春瑞滨用法同NP组,卡培他滨800～1000mg/m^2,分早晚两次服用,第1～14天,或替加氟600mg/m^2,第2～6天,3周为一周期。化疗过程中注意观察不良反应,根据不良反应的程度调整药物用量。每两周期评价疗效。结果：长春瑞滨联合顺铂（NP）组,CR2例（4.9%）,PR23例（56.1%）,SD14例（34.1%）,PD2例（4.9%）,有效率为61.0%;长春瑞滨联合卡培他滨或替加氟（NF）组,CR1例（5.9%）,PR8例（47.1%）,SD7例（41.2%）,PD1例（5.9%）,有效率52.9%。常见的不良反应主要为骨髓抑制、胃肠道反应、手足综合症、神经毒性等。结论：含长春瑞滨方案治疗蒽环类/紫杉类药物治疗后复发转移乳腺癌疗效确切,毒性可耐受,是治疗复发转移性乳腺癌的较好方案。     

长春瑞滨剂量强度对晚期非小细胞肺癌一线化疗影响分析

目的：分析长春瑞滨＋顺铂方案（NP方案）中不同剂量强度[mg／（m^2·w）]长春瑞滨对晚期非小细胞肺癌（NSCLC）一线化疗疗效的影响。方法：回顾分析2003年6月-2004年6月共71例接受NP方案作为一线化疗的Ⅳ期NSCLC患者，以长春瑞滨剂量25mg／m^2为标准，按照剂量强度分为两组，分别为≥16．67mg／（m^2·w）和〈16．67mg／（m^2·w）。分析两组患者在缓解率、1年生存率、中位生存期上的差别以及血液学毒性等不良反应方面的差异。结果：两组3年生存率分别为15．27％和8．56％，中位生存期分别为421天和303天（P=0．09）；男性患者中，长春瑞滨≥16．67mg／（m^2·w）组中位生存期优于〈16．67mg／（m^2·w）组（553天 vs．302天，P=0．041）。两组缓解率（CR＋PR）分别为37．03％和48．84％，疾病控制率（CR＋PR＋SD）为66．67％和67．44％，均未达到统计学差异。长春瑞滨≥16．67mg／（m^2·w）组的静脉刺激发生率高于长春瑞滨〈16．67mg／（m^2·w）组（P=0．002），但两组患者在血液学毒性、胃肠道反应方面无显著统计学差异。结论：对于接受NP方案作为一线化疗的晚期NSCLC患者，长春瑞滨按推荐剂量足量给与可能为患者带来获益。剂量较高时应注意静脉刺激的发生。     

铂类为基础的三种化疗方案治疗晚期非小细胞肺癌的临床研究

目的：观察紫杉醇（paclitaxel，Taxel）、长春瑞滨（vinorelbine，NVB）、吉西他滨（gemcitabine，GEM）分别联合顺铂（cisplatin，DDP）方案对晚期非小细胞肺癌（non—small cell lung cancer，NSCLC）的疗效及毒副反应。方法：93例晚期非小细胞肺癌患者随机分为TP组（紫杉醇＋顺铂）32例、NP组（长春瑞滨＋顺铂）31例、GP组（吉西他滨＋顺铂）30例。给药方法：紫杉醇135mg／m^2，第1天；长春瑞滨25mg／m^2，吉西他滨1000mg／m^2，均在第1、8天使用；顺铂80mg／m^2，分2天使用。统计各组有效率（CR＋PR）、中位生存期（median duration of survival）、1年生存率（1year survival rate）。结果：TP组有效率（CR＋PR）为43．8％，中位生存期为8．6月，1年生存率为32．1％；NP组有效率为38．7％，中位生存期为8．4月，1年生存率为26．5％；GP组有效率为36．7％，中位生存期为9．4月，1年生存率为38．1％，三组间疗效无显著差异（P〉0．05）。主要不良反应为骨髓抑制、消化道反应，均可耐受。11P组骨髓抑制发生率相对较高，NP组静脉炎发生率高于TP、GP组，有显著性差异（P〈0．05）。结论：三种联合化疗方案对晚期NSCLC疗效确切，三种方案间无显著差异，均可作为一线化疗方案在临床应用。     

长春瑞滨加顺铂治疗晚期非小细胞肺癌26例

  目的 观察长春瑞滨（国产）与顺铂联合化疗治疗晚期非小细胞肺癌的疗效。方法 NP方案：长春瑞滨25 mg／m2第1、8天加顺铂40 ~ 50 mg第1 ~ 3天，治疗期非小细胞肺癌26例。结果 部分缓解（PR）8例，稳定（NC）14例，进展（PD）4例，总有效率30.8 %，初治有效率46.7 %，复治有效率9.1 %。主要毒副作用为白细胞减少。结论 长春瑞滨与顺铂联合化疗治疗晚期非小细胞肺癌是一个疗效好，毒性中等的一线方案。     

NP方案联合三维适形放疗治疗局部晚期非小细胞肺癌疗效分析

目的：探讨长春瑞滨、顺铂同期联合三维适形放疗治疗不能手术的局部晚期非小细胞肺癌的疗效及患者耐受性。方法：对68例经病理或细胞学确诊的不能手术选择的局部晚期非小细胞肺癌患者随机分为A、B两组。A组35例给长春瑞滨联合顺铂方案诱导化疗2周期后,从第3周期第1天开始施行同步放化疗,放疗期间继续原方案化疗2周期。B组33例给长春瑞滨联合顺铂方案第1周期化疗第1天开始实行放疗,放疗期间化疗2周期,同步放化疗结束后即第3周期开始予原方案巩固化疗2周期。两组化疗方案均采用长春瑞滨联合顺铂方案化疗（长春瑞滨25mg／m2,第l、8天;顺铂25mg／m2,第1、2、3天,28天重复）。放疗采用6MV—X射线,前程普通照射,后程三维适形放疗,常规剂量分割,普通外照射DT40Gy后缩野,改用三维适形放疗技术,追加剂量至DT60—66Gy。结果：所有患者均顺利完成治疗。A组有效率48．6％（CR3例,PR18例）,1,2年生存率分别为51．4％和34．3％;B组有效率75．8％（CR5例,PRl9例）,1,2年生存率分别为78．8％和65．6％,两组间差异有显著性。不良反应主要是白细胞减少,恶心、呕吐,放射性食道炎及肺炎。发生率以诱导化疗组高,但差异无显著性,严重不良反应少。结论：长春瑞滨联合顺铂方案同步放化疗治疗不能手术的局部晚期非小细胞肺癌近期疗效较理想,不良反应轻,患者能耐受。同步放化疗后巩固化疗效果较诱导化疗后同步放化疗提高了生存率,两种治疗方法的不良反应无较大区别。     

长春瑞滨联合铂类治疗中晚期子宫内膜癌

目的：比较长春瑞滨和紫杉醇分别与铂类联合治疗中晚期子宫内膜癌的近期疗效及毒副反应。方法：33例晚期子宫内膜癌，治疗组（NP方案组）21例，长春瑞滨＋顺铂或卡铂化疗，长春瑞滨25mg／m^2，静注d1、8；顺铂25mg／m^2，静注d1～3，或卡铂（300mg／m^2或者AUC4～5）静脉滴注d1。对照组（TP方案组）12例：紫杉醇135～150mg／m^2，静注d1；顺铂或卡铂用法同前。结果：全组均完成2周期以上化疗，其中CR4例．PR14例，NC10例，PD5例。有效率（CR＋PR）54．54％。NP方案组，CR2例，PR9例，有效率（CR＋PR）52．38％；TP方案组，CR2例，PR5例，有效率（CR＋PR）58．33％，两组间无统计学差异（P〉0．05）。副反应主要为骨髓抑制、白细胞、血小板减少，Ⅲ～Ⅳ度发生率，NP组为71．43％，TP组为75．0％（P〉0．05）。结论：长春瑞滨＋铂类联合与紫杉醇＋铂类联合化疗治疗中晚期子宫内膜癌有相同的疗效且毒副反应可以耐受。     

赫赛汀联合长春瑞滨治疗晚期乳腺癌疗效观察

目的：评价赫赛汀和长春瑞滨联合化疗在治疗晚期乳腺癌中的疗效和不良反应。方法：将50例晚期乳腺癌患者分为两组。26例患者采用赫赛汀联合长春瑞滨方案治疗：赫赛汀静脉滴注,首次4mg／kg,其后每周1次,2mg／kg,连续使用;长春瑞滨25mg／m2静脉滴注,d1,8;每3周为1周期。24例患者采用长春瑞滨和顺铂方案（NP方案）治疗：长春瑞滨40mg／天,d1,8;顺铂25mg／m2,d1,3,每3周为1周期。结果：赫赛汀联合长春瑞滨方案有效率为65．4％,NP方案有效率为54．2％,（P〈0．05）。结论：赫赛汀联合长春瑞滨治疗晚期乳腺癌是有效且安全的治疗方案,不良反应可耐受,可作为晚期乳腺癌一线方案应用。     

长春瑞滨+顺铂方案同期放化疗治疗晚期鼻咽癌35例

[目的]评价长春瑞滨＋顺铂方案（NP）联合同期放化疗治疗鼻咽癌的疗效。[方法]35例晚期（Ⅲ、Ⅳ期）鼻咽癌患者随机进入本研究,给予鼻咽及颈部淋巴引流区照射,放射治疗总剂量7000cGy／35次,同期给予NP方案化疗2个周期,测量病灶大小变化,观察疗效及毒副反应。随访34-64个月,统计生存期。[结果]35例晚期（Ⅲ、Ⅳ期）鼻咽癌患者经治疗后有效率为77．14％,其中T晚期者有效率为94.29％,N晚期者为81．82％,3年无进展生存率为71．43％,3年总生存率为85．71％。毒副反应主要表现为中性粒细胞缺乏的血液系统反应,恶心、呕吐等消化道反应和静脉炎。[结论]同期放、化疗和／或联合辅助化疗可以降低鼻咽癌的远处转移率．提高患者生存期。     

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.     

Pseudomembranous colitis associated with chemotherapy with 5-fluorouracil

Pseudomembranous colitis is frequently associated with antibiotics and more rarely with chemotherapeutic agents such as 5-fluorouracil. The objective of this study is to show that it is possible to confuse this infection with chemotherapy associated toxicity. We present a 54 year old woman who underwent surgery for colorectal cancer and in the first cycle of chemotherapy with 5-fluorouracil developed pseudomembranous colitis. We detected the toxin B of Clostridium difficile in stools and we began early antibiotic treatment. Thus, in patients with post chemotherapy neutropenia and diarrhoea that develop negatively, we have to rule out this infection.