经动脉灌注健择化疗联合三维适形放射治疗局部晚期胰腺癌的临床疗效分析

目的评价经动脉灌注健择化疗结合三维适形放射治疗局部晚期胰腺癌的疗效。方法51例局部晚期胰腺癌患者，其中24例采用经动脉灌注健择化疗结合三维适形放射治疗（综合治疗组），27例单纯应用经动脉灌注健择化疗（对照组）。结果综合治疗组和对照组临床获益反应有效率分别为91．7％和74．1％，两者差异有统计学意义（P〈0．01）；综合治疗组总有效率（CR＋PR）为70．8％，对照组总有效率（CR＋PR）为33．3％，两组差异有统计学意义（P〈0．01）；综合治疗组和对照组的6、12和24个月生存率分别为83．3％、62．5％、37．5％和55．6％、33．3％、11．1％，两组差异均有统计学意义（P（0．05）。结论经动脉灌注健择联合三维适形放射治疗局部晚期胰腺癌，在提高生存率、延长生存期方面优于单纯经动脉灌注健择化疗。     

吉西他宾、卡铂、顺铂联合方案、双途径化疗治疗晚期非小细胞肺癌30例

目的 评估吉西他宾（健择，gemcitabine,GEM)，顺铂（DDP）和卡铂（CBP）经不同的途径化疗治疗晚期非小细胞性肺癌（NSCLC）的疗效，耐受性和毒副反应。方法 30例晚期非小细胞性肺癌患者第1d支气管动脉介入灌注健择1000mg/m^2，卡铂200mg/m^2。第3d给予顺铂30mg/m^2静脉滴注3d，每21d-28d重复。结果 全组共完成60个周期，近期有效率73．3％，中位生存期9．9月，1年生存率56．6％。常见的毒副反应为骨髓抑制、消化道毒性和肾毒性。结论 支气管动脉介入是一种简便方法，直接支气管动脉内灌注健择联合铂类药物，再加全身静脉化疗，患者的耐受性良好，毒副反应轻，初步疗效较满意。     

健择联合奥沙利铂双周方案治疗胰腺癌作用探讨

目的：比较健择联合奥沙利铂双周化疗方案和健择单药每周方案治疗胰腺癌的疗效及不良反应方法：选择我科2003年11月至2005年1月胰腺癌患者30例．采用健择联合奥沙利铂双周化疗方案（设为A组：健择1000mg／m^2d1，奥沙利铂100mg／m^2d2，每隔14天进行1个周期）进行治疗；随机选择同时期使用健择单药方案（设为B组：健择1000mg／m^2单药，每周1次，连续3周，随后休息1周为1个周期）化疗的胰腺癌患者30例做对照,比较两方案治疗胰腺癌的疗效和不良反应的差异。结果：A组PR3例，SD21例，PD6例，1年生存率为16.7％（5／30）B组PR1例，SD14例，PD15例，1年生存率为10.0％（3／30）。化疗的主要不良反应包括：恶心、呕吐，骨髓抑制和外周神经毒性。结论：健择加奥沙利铂双周化疗方案在抑制肿瘤发展、延长生存期方面略优于传统健择单药方案，而两者不良反应大体相当，推荐临床使用。     

健择联合顺铂治疗晚期非小细胞肺癌的疗效观察

目的评价健择（GEM）联合顺铂（DDP）治疗晚期非小细胞肺癌（NSCLC）近期疗效及毒副反应。方法对64例不能手术的非小细胞肺癌患者采用健择联合顺铂化疗。健择1000mg／m^2，d1.8，顺铂20mg／m^2，d2-6，21天为一周期，完成2周期评价疗效，观察毒副反应。结果总有效率（CR＋PR）42．2％，主要毒性作用是骨髓抑制和胃肠道反应。结论健择联合顺铂治疗晚期NSCLC疗效较好，毒性作用可耐受。骨髓抑制是其剂量限制性毒性。     

健择联合顺铂方案治疗晚期胰腺癌的疗效观察

目的：观察GP（健择 DDP）方案治疗晚期胰腺癌的近期疗效与不良反应。方法：将20例晚期胰腺癌给予GP方案化疗2个周期，按WHO标准评定疗效和不良反应。结果：有效率（CR PR）为35%，不良反应主要为骨髓抑制物胃肠道反应，结论：健择加顺铂是治疗晚期胰腺癌的一种安全有效的化疗方案。     

健择联合顺铂治疗晚期非小细胞肺癌临床观察

目的观察健择（GEM）联合顺铂（DDP）治疗晚期非小细胞肺癌（non-small cell lung csneer,NSCLC）的疗效和毒性反应。方法50例晚期非小细胞肺癌患者应用GP联合方案化疗,健择1000ms／m^2,静滴30min,第1,8天;顺铂25mg／m^2,静滴1h,第1—3天,每21d为1周期,至少2周期。结果全组完全缓解（CR）1例,部分缓解（PR）21例,总有效率为44．0％。中位生存期为11个月,1年生存率为40．0％。Ⅲ度和Ⅳ度白细胞减少症和血小板减少症发生率分别为18．0％和16．0％。结论健择联合顺铂治疗晚期NSCLC有较好的疗效,且安全耐受性较好。     

健择联合顺铂方案治疗晚期胰腺癌的疗效观察

目的 :观察GP (健择 DDP)方案治疗晚期胰腺癌的近期疗效与不良反应。方法 :将 2 0例晚期胰腺癌给予GP方案化疗 2个周期 ,按WHO标准评定疗效和不良反应。结果 :有效率 (CR PR)为35 % ,不良反应主要为骨髓抑制和胃肠道反应。结论 :健择加顺铂是治疗晚期胰腺癌的一种安全有效的化疗方案。     

吉西他宾、卡铂、顺铂联合方案、双途径化疗治疗晚期非小细胞肺癌30例

目的　评估吉西他宾 (健择 ,gemcitabine,GEM) ,顺铂 (DDP)和卡铂 (CBP)经不同的途径化疗治疗晚期非小细胞性肺癌 (NSCLC)的疗效 ,耐受性和毒副反应。方法　 30例晚期非小细胞性肺癌患者第1d支气管动脉介入灌注健择 10 0 0mg/m2 ,卡铂 2 0 0mg/m2 。第 3d给予顺铂 30mg/m2 静脉滴注 3d ,每 2 1d～2 8d重复。结果　全组共完成 6 0个周期 ,近期有效率 73 3% ,中位生存期 9 9月 ,1年生存率 5 6 6 %。常见的毒副反应为骨髓抑制、消化道毒性和肾毒性。结论　支气管动脉介入是一种简便方法 ,直接支气管动脉内灌注健择联合铂类药物 ,再加全身静脉化疗 ,患者的耐受性良好 ,毒副反应轻 ,初步疗效较满意。     

健择单药联合伽玛刀治疗18例晚期胰腺癌疗效观察

[目的]观察健择单药联合伽玛刀治疗不能手术胰腺癌的疗效。[方法]18例晚期胰腺癌患者均采用健择1000mg/m^2,第1、8天静脉输注,21天为1个周期,治疗6个周期。第1个周期化疗的第2天行伽玛刀治疗,等剂量曲线为55%～70%,肿瘤≤5cm的单次周边剂量4.0Gy～5.5Gy,肿瘤〉5cm的单次周边剂量3.0Gy～4.0Gy,治疗总剂量为32Gy～48Gy,治疗次数8～12次,6次/周。[结果]全组18例共完成96个周期化疗,3个月CT检查,CR3例（17%）,PR4例（22%）,NC10例（56%）,PD1例（5%）,中位生存期11.8个月,临床受益反应17/18（94%）。主要毒副反应是白细胞、血小板下降。[结论]健择单药联合伽玛刀治疗不能手术的晚期胰腺癌具有较好的耐受性和疗效。     

健择与顺铂联合去甲斑蝥酸钠治疗晚期NSCLC疗效观察

目的：观察健择和顺铂联合去甲斑蝥酸钠治疗晚期（ⅢB和IV期）非小细胞肺癌（non-smallcelllungcancer,NSCLC）的临床疗效和不良反应。方法：选择2010—01—01—2012—02—28在莱芜市中医院住院治疗的晚期（ⅢB和Ⅳ期）NSCLC患者180例,患者均经胸部CT和病理学确诊,KPS评分均≥70。180例患者随机抽样分为治疗组和观察组,每组90例,进行病例对照研究。治疗组顺铂30mg／m2＋NS250mL,静脉滴入,dl～d3;健择1000mg／m2＋NS250mL,静脉滴入,30min,d1,d8,dl5;去甲斑蝥酸钠注射液250mL,静脉滴入,d1～d2;28d为1个周期。对照组顺铂30mg／m2＋NS250mL,静脉滴入,d1～d3;健择1000mg／m2＋NS250mL,静脉滴入,30min,d1,d8,d15;28d为1个周期。两组患者于治疗3个周期后进行疗效评价。结果：治疗组有效率为80．OO％,对照组有效率为55．56％,两组差异有统计学意义,x2=11．253,P=0．0067。化疗后治疗组白细胞下降发生率为46．67％,对照组为85．56％,两组差异有统计学意义,x2=33．1593,P=0．007;治疗组血小板下降发生率为50．00％,对照组为84．44％,两组差异有统计学意义,x2=28．644,P=0．008;治疗组转氨酶升高发生率为24．44％,对照组为51．1l％,两组差异有统计学意义,P=0．0472;治疗组血清尿素氮升高发生率为11．11％,对照组为15．56％,两组差异无统计学意义,P=0．7981。治疗组恶心和呕吐不良反应率为18．9％,对照组为20％,两组差异无统计学意义,P〉0．05;治疗组皮肤改变发生率为3．3％,对照组为4．4％,两组差异无统计学意义,P〉0．05。结论：治疗组较对照组有效率明显提高;部分化疗毒副作用明显减轻,提高了患者对化疗的耐受性。健择与顺铂联合去甲斑蝥酸钠治疗晚期NSCLC的方案值得在临床推广应用。     

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.     

再放疗并同步使用Docetaxel在鼻咽癌放疗后复发病人中的应用

目的:不能手术切除的鼻咽癌放疗后再复发的病人,其治疗困难,化疗疗效差,而单独再放疗只能挽救一小部分病人,本文探讨再放疗并同步使用多西紫彬醇(Docetaxel)在鼻咽癌首次放疗后复发病人中可行性及毒副反应,并评价其疗效。方法:对11例鼻咽癌足量放疗后经组织病理学证实复发、而无法行手术及腔内放疗的患者进行了同步放化疗。放疗采用三维适形放疗,外照射鼻咽部,分次量为1.8Gy,总剂量为36Gy-39.6Gy。化疗采用Docetaxel,15mg/m2,每周一次,静脉滴注。结果:10%、33%的患者分别出现Ⅲ度、Ⅳ度皮肤反应,18%、10%的病人分别出现Ⅲ度、Ⅳ度黏膜反应,18%患者出现Ⅲ度恶心呕吐,27%的患者出现Ⅲ度-Ⅳ度白细胞下降,10%患者出现Ⅲ度血小板下降。1例患者因严重的黏膜反应致使治疗延迟2周。治疗结束后,9例(82%)患者达到CR,2例(18%)达到PR,反应率为100%。结论:对于放疗后局部复发的鼻咽癌患者,采用同步放化疗,3D-CRT同时每周使用Docetaxel是可行的,其毒性反应在可以接受的范围内,短期疗效显著。     

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.     

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.