Ⅰ、Ⅱ期非小细胞肺癌的非手术治疗

目的：评价I期和Ⅱ期非小细胞肺癌放射治疗、化疗治疗效果。方法；将21例I期和Ⅱ期非小细胞肺癌按1997年国际抗癌联盟（UICC）分期：Ib期３例，Ⅱa期2例，Ⅱb期16例。病理组织学诊断16例，细胞学诊断5例。鳞癌18例，腺癌2例，鳞腺癌1例。全部病例行常规放疗，剂量：56Gy-70Gy。化疗：应用MVP(丝裂霉素 长春地辛＋顺铂)方案，共19例。未行化疗2例（均为鳞癌）。19例行化疗患者均于放疗结束后1-7周后进行。分别完成化疗1-5个疗程。结果：全组病例随访5年以上，五年生存率为19%。现存2例。死亡的19例中，肿瘤致死13例，均为局部复发或未控、转移死亡。非肿瘤致死亡6例。结论：早期非小细胞肺癌的非手术治疗仍是较有效的治疗手段。     

三组不同联合化疗方案治疗晚期非小细胞肺癌病例的比较

目的 比较３组不同联合化疗方案对晚期非小细胞肺癌的疗效和毒性,统计分析用ＩＶＰ方案、ＭＶＰ方案及ＣＡＰ方案治疗的９３例晚期非小细胞肺癌病例的临床资料。结果 ＩＶＰ组有效率为４８．４％,其中完全缓解２例;ＭＶＰ组有效率为４０．０％,ＣＡＰ组有效率为２８．１％,毒副反应主要为骨髓抑制及脱发。结论 以长春地辛为主的ＩＶＰ及ＭＶＰ方案为治疗晚期非小细胞肺癌较为有效而较为安全的化疗方案。     

MVP方案联合放疗治疗晚期非小细胞肺癌的近期疗效观察

目的：评价ＭＶＰ（丝裂霉素、长春地辛、顺铂）方案联合放疗治疗晚期非小细胞肺癌的近期疗效。方法：５２例晚期非小细胞肺癌患者采用ＭＶＰ方案化疗并加用＾６０Ｃｏ照射。化疗２个周期,胸部放疗总量６０Ｇｙ,远处转移灶的放疗量视病灶部位而定。结果：２５例完全缓解（ＣＲ）,１７例获部分缓解（ＰＲ）,有效率为８０．８％（ＣＲ＋ＰＲ）。对最初化疗敏感的病例疗效好,尤其ＣＲ率较高,结论：ＭＶＰ方案与放疗联用能明显提高     

含顺铂的联合化疗方案治疗晚期非小细胞肺癌的疗效观察

本文回顾分析了接受含顺铂的联合化疗方案治疗的１１２例晚期非小细胞肺癌的近期和远期疗效。结果：部分缓解２９例，有效率２５．９％；中位生存期８个月，１年、２年、３年、５年生存率分别为３４．８％、８．９％、５．４％、１．７９％。大剂量（５０ｍｇ／ｍ２～１００ｍｇ／ｍ２／次×１天）、中剂量（５０ｍｇ／次×３天）及小剂量（２０／ｍｇ～４０ｍｇ／次×３天～５天）剂量组的有效率分别为３５．１％、３１．６％及１７．９％，大、中剂量组的近期疗效明显优于小剂量组；中位生存期：大剂量组１１个月、中剂量组５个月、小剂量组８．５个月，大、中剂量两组比较差异显著（Ｐ＜０．０５）．中、小剂量组比较无明显差异；本文还提示；ⅢＢ期和Ⅳ期、鳞癌和腺癌的近期、远期疗效相同，部分缓解和稳定者的中位生存期较进展者明显延长（Ｐ＜０．０５）。     

MVP方案治疗非小细胞肺癌的疗效观察

 目的: 观察MVP方案治疗非小细胞肺癌(NSCLC)的治疗效果和毒性反应。方法: 45例非小细胞肺癌患者使用MVP(MMC +VDS +DDP) 方案治疗。结果: 45例患者中21例有效, 有效率为46.7 %。分析诸因素对疗效的影响发现病期早较病期晚疗效好。生活质量评估Karnofsky评分升高为68.9 %。骨髓抑制为剂量限制性毒性, 白细胞下降75.6 %无其他严重毒副反应发生。结论: MVP方案是治疗非小细胞肺癌有效且可以耐受的方案。     

高频通气合并化疗治疗非小细胞肺癌

肿瘤组织内乏氧细胞的存在，影响了化疗效果。为了探讨提高血氧分压合并化疗对肿瘤的治疗作用，作者采用高频通气加ＣＡＰ方案治疗晚期非小细胞肺癌３３例，能评价疗效的有２９例，其中完全缓解２例（６．９％），部分缓解１２例（４１％），总有效率４７．９％。稳定９例，进展６例。作者认为该方法有较好的近期疗效，可在临床应用。     

以诺维本为主的化疗方案治疗晚期非小细胞肺癌的疗效观察

目的：观察以诺维本为主的化疗方案对晚期非小细胞肺癌的疗效。方法：自1996年2月至1999年4月,对25例晚期非小细胞肺癌,采用以诺维本为主的化疗方案进行治疗,其中12例为两药联合（即诺维本加顺铂）,13例为三药联合（即庆维本加顺铂加异环磷酰胺或威猛）。结果：部分缓解8例,总有效率为40.0%,其中两组联合有效率为33.3%,三药联合的有效率为50.0%;中位缓解期3.3个月,中位生存期8.3个月。主要毒副反应为骨髓抑制,其中白细胞下降Ⅲ、Ⅳ度者达60%。结论：以诺维本为主的联合化疗方案治疗晚期非小细胞肺癌有效率高,三约联合有效率高于两药联合,虽毒副作用增强,但可以耐受。     

小细胞肺癌治疗进展与现状

目前恶性肿瘤的发病率和死亡率呈明显上升的趋势。在许多国家肺癌死亡占全部恶性肿瘤死亡首位。小细胞肺癌(Small cell Lung Cancer.SCLC)的发生率占所有肺癌发生率的10—25％它具有特殊的生物学特性。SCLC处于增殖期的细胞比率较高。SCLC又可分     

动脉介入健择、顺铂治疗肺癌的临床研究

背景与目的 探讨健择加顺铂通过支气管动脉灌注区域化疗,了解治疗中、晚期非小细胞肺癌的临床效果及不良反应.方法 采用seldinger技术.对38例中、晚期非小细胞肺癌进行选择或超选择性灌注健择加顺铂,观察疗效.结果 本组38例经支气管动脉灌注健择加顺铂,人均2-3个周期,经介入前后影像学、实验室检查对比,(CR+PR)总有效率达到84.2%.不良反应主要表现在血液学方面.结论 健择加顺铂通过介入的方法治疗非小细胞肺癌的近期临床效果佳,远期效果尚待观察.     

伊立替康联合顺铂一线治疗晚期非小细胞肺癌

目的:观察伊立替康(商品名开普拓)每周给药联合顺铂治疗晚期非小细胞肺癌(NSCLC)的疗效以及不良反应。方法:经病理学或细胞学确诊的初治晚期NSCLC患者13例,男性8例,女性5例,中位年龄48岁,KPS评分>70。接受顺铂60~80mg/m2联合开普拓60mg/m2第1、8、15天静脉滴注,每4周重复。至少2周期以上可评价疗效及不良反应。结果:全组PR3例,SD9例,PD1例,总有效率为23%。中位生存时间12.5个月,1年生存为率70%(7/10)。主要不良反应为延迟性腹泻和粒细胞减少。结论:开普拓每周给药联合顺铂治疗晚期NSCLC疗效确切,不良反应发生率低,耐受性较好。     

Atezolizumab Treatment Beyond Progression in Advanced NSCLC: Results From the Randomized,Phase III OAK Study

Introduction

Cancer immunotherapy may alter tumor biology such that treatment effects can extend beyond radiographic progression. In the randomized, phase III OAK study of atezolizumab (anti–programmed death-ligand 1) versus docetaxel in advanced NSCLC, overall survival (OS) benefit with atezolizumab was observed in the overall patient population, without improvement in objective response rate (ORR) or progression-free survival (PFS). We examine the benefit-risk of atezolizumab treatment beyond progression (TBP).

扶正抑癌方联合化疗治疗非小细胞肺癌的近期疗效及其对免疫功能的影响

目的:观察扶正抑癌方对非小细胞肺癌(NSCLC) 化疗患者的近期疗效及其对免疫功能的影响;对中晚期非小细胞肺癌患者生存质量及机体免疫功能的影响。方法:中药治疗:扶正抑癌方辨证加减内服,每天1剂,30天为1个疗程。化疗:长春瑞滨 25mg/m2,第1、8天,顺铂20～30mg/m2,第1～3天,外周静脉滴注,21天为1个疗程。4个疗程后评价疗效。观察近期疗效、临床证候变化、治疗前后免疫功能变化及生活质量变化。结果:治疗后治疗组瘤体稳定率89.28%,显著高于对照组的71.42%(P＜0.05)。治疗组中医证候改善的总有效率(71.42%)与对照组(39.28%),差异有统计学意义(P＜0.01)。治疗组和对照组卡氏评分总有效率分别为67.85%、42.85%,差异有统计学意义(P＜0.01)。治疗组治疗后免疫指标CD3+、CD4+、CD4+/CD8+比值、自然杀伤细胞(NK细胞) 活性、治疗前后自身对照差异有统计学意义(P＜0.05)。两组治疗后比较NK、CD4+/CD8+比值升高差异有统计学意义(P＜0.05）。结论:采用扶正抑癌方联合化疗治疗中晚期非小细胞肺癌,可提高机体免疫功能,提高患者生活质量,延长生存期,是一种疗效肯定、安全性高、并发症少的综合治疗方法。     

Uptake and tolerance of adjuvant chemotherapy in early stage NSCLC patients in Alberta, Canada

Adjuvant chemotherapy for early stage non-small cell lung cancer was approved for provincial insurance coverage in Alberta, Canada in 2004. The purpose of this study was to measure factors related to uptake of chemotherapy in eligible patients and compare toxicity and survival outcomes in the Alberta population with those found in clinical trials. All Alberta residents diagnosed with stage IB-IIB NSCLC from 2004 to 2006 who had surgery and a consultation with an oncologist to discuss initial treatment were included in the study. Diagnostic, demographic, and vital statistics data were obtained from the Alberta Cancer Registry; chart reviews were conducted to identify details related to treatments discussed, refused, co-morbidities, and toxicity. Analyses were conducted to identify factors associated with discussion and receipt of chemotherapy and toxicity. Toxicity and survival were calculated and compared to clinical trial results. 226 patients were included in the study. Adjuvant chemotherapy was not recommended to 57 patients (25%) and 30 patients (13%) refused chemotherapy. Primary reasons for not recommending chemotherapy were co-morbidities and/or frailty (24 patients). Of the 139 patients who began chemotherapy, 47 (34%) stopped treatment early. Stage II patients who received adjuvant chemotherapy had over a 2-fold decrease in risk of death compared to those who did not receive chemotherapy after adjusting for age and co-morbidities. Efforts to improve uptake of adjuvant chemotherapy in patients with stage II NSCLC should be made as the survival advantage appears to be comparable to that found in clinical trials.     

非小细胞肺癌组织中p53蛋白的表达对预后以及术后化放疗疗效的影响

 目的 探讨p53蛋白表达对非小细胞肺癌术后化疗、放疗疗效的影响。方法 应用免疫组化LSAB方法检测非小细胞肺癌石蜡切片中p53蛋白的表达情况，选取18例根治术后行含铂类辅助化疗和20例根治术后行辅助放疗的Ⅲa期非小细胞肺癌，选同期单独手术的15例Ⅲa期患者作对照，应用Kaplan-Meier法和多变量Cox比例风险模型进行分析。结果 p53蛋白表达与年龄、T分期之间未发现相关性（P ＞0.05），但与组织学分级呈负相关（P＜0.05），与组织学类型呈正相关（P＜0.05）；p53蛋白表达阳性率为54.72 %，在单纯手术组、术后化疗组和术后放疗组中阳性者和阴性者生存率差异有统计学意义（P＜0.05）；Cox多因素分析结果显示p53是影响术后化疗和放疗效果的独立指标。结论 p53蛋白表达是预后较差的指标之一，p53蛋白表达阳性者较阴性者对化疗和放疗不敏感，如何提高化放疗疗效尚需深入研究。     

Combination of radiotherapy and chemotherapy in locally advanced NSCLC

The combination of radiotherapy and chemotherapy is considered to be a standard approach for patients with locally advanced, stage III non-small-cell lung cancer. The current state of the art of combined radiochemotherapy supported by evidence-based data is presented. As shown in the meta-analyses, the concurrent radiochemotherapy gives a superior outcome in terms of survival compared with sequential delivery of both modalities. This is obtained at the expense of higher toxicity, which makes further intensification of radiochemotherapy challenging. Eligibility of patients with non-small-cell lung cancer for such an approach is limited. The new methods to improve treatment results, such as selection of proper strategies, incorporation of molecular agents into combined treatment and radiotherapy technique modifications are discussed.     

Advanced NSCLC: from cytotoxic systemic chemotherapy to molecularly targeted therapy

Approximately a third of non-small cell lung cancer patients present with disseminated disease at the time of diagnosis. For these patients, as well as those with recurrent disease, chemotherapy remains the mainstay of treatment. For several decades, researchers have attempted different combinations of drugs in search for the ‘best’ chemotherapy regimen. Despite the emergence of newer, ‘third-generation’ cytotoxic agents, success is still modest at best. Fortunately, new insights in tumor biology, leading to the design of molecularly targeted drugs, are opening a new era in cancer treatment. These novel agents target molecular pathways specifically found in cancer cells, thus maximizing the antitumor effect while minimizing toxicities on normal cells.     

易瑞沙(Iressa)在非小细胞肺癌的研究进展

分子靶向治疗是近年随着肿瘤基础研究及分子生物学的进展而出现的一种全新的治疗领域,它是根据肿瘤组织有别于正常组织的一些生物学特性,特异的作用于和肿瘤组织发生、发展密切相关的一些受体,蛋白激酶,信号传导系统从而达到阻断其增殖、转移、血管生成、促进细胞凋亡。Iressa即是通过抑制表皮生长因子受体-酪氨酸激酶EGFR-TK来达到治疗非小细胞肺癌(NSCLC)的目的,也是第一个被国内外正式批准用于治疗NSCLC的分子靶向药物。本文将对此药的临床研究及进展作一综述。     

PD-(L)1 inhibitors vs. chemotherapy vs. their combination in front-line treatment for NSCLC: An indirect comparison

We comprehensively compared the therapeutic effects and safety of PD-1/L1 antibodies (I), chemotherapy (C) or their combination (I + C) as first-line treatments for advanced NSCLC. Online databases were searched to identify RCTs. Survival outcomes and safety events were pooled by indirect treatment comparison. Main subgroup analyses were conducted according to PD-L1 expression. A total of 11 RCTs involving 6,731 patients were included. Overall, PD-1/L1 inhibitors showed no difference to chemotherapy in PFS (HR 0.90, 0.65–1.24) and OS (HR 0.84, 0.64–1.09), while I + C was superior to chemotherapy both in PFS (HR 0.64, 0.58–0.71) and OS (HR 0.74, 0.62–0.89). I + C also showed advantages over PD-1/L1 in PFS (HR 0.71, 0.51–0.99) but not OS (HR 0.88, 0.64–1.22). In the PD-L1 < 1% subgroup, I + C was beneficial both in OS (HR 0.78, 0.67–0.90) and PFS (HR 0.72, 0.65–0.80) than chemotherapy. In PD-L1 ≥ 50% population, PD-1/L1 had longer OS than chemotherapy (HR 0.71, 0.60–0.84); I + C also had longer OS (HR 0.61, 0.49–0.77) and PFS (HR 0.41,0.34–0.49) than chemotherapy. In indirect analysis (PD-L1 ≥ 50%), I + C was superior to PD-1/L1 in terms of PFS (HR 0.54, 0.35–0.82), but not OS (HR 0.86, 0.65–1.14). Both treatment-related and immune-mediated adverse events occurred most frequently in the combination therapy group. We suggest that a combination regimen is preferable as first-line treatment for NSCLC patients with different PD-L1 expression, in the meanwhile, in cautious of side effects.