拓扑替康联合顺铂治疗小细胞肺癌44例疗效观察

目的：研究拓扑替康联合顺铂治疗小细胞肺癌的疗效。方法：对确诊的44例小细胞肺癌患者,应用拓扑替康联合顺铂静滴d1-d5,同时给予止吐治疗。结果：全组共化疗132个周期,44例患者中总有效率为45.5%,临床受益率81.8%,全组无治疗相关性死亡。结论：以拓扑替康联合顺铂的化疗方案对小细胞肺癌具有较好的疗效。

A randomized controlled trial of two chemotherapy regimens-paclitaxel liposome combined with platinum and paclitaxel combined with platinum in concurrent chemoradiotherapy for cervical carcinoma

Objective:The aim of the study was to compare the efficacy,side effect and influence on the survival rate of two chemotherapy regimens,paclitaxel liposome combined with platinum and paclitaxel combined with platinum,in concurrent chemoradiotherapy for cervical carcinoma.Methods:The 162 cases with primary cervical carcinoma diagnosed between January 2008 and November 2009 in Jiangxi Maternal and Child Health Hospital(China) were enrolled in this randomized controlled trial.Seventy-one cases were included in paclitaxel group and 91 in paclitaxel liposome group.And the chemotherapy doses were as follows:paclitaxel liposome and paclitaxel 135 mg/m2;cisplatin 80 mg/m2 or carboplatin AUC 4-6;then repeated every 21 days for two or three times.Radical radiotherapy was given to both groups at the same time.Efficacy was evaluated according to the tumor regression six months later and follow-up was done consistently.Results:The overall response rates of paclitaxel group and paclitaxel liposome group were 90.1% and 89 % respectively(P > 0.05).The one year cumulative survival was 91.4% for paclitaxel group and 89.2% for paclitaxel liposome group(P > 0.05).The incidence rates of adverse effects such as rash,gastrointestinal toxicity,bone marrow suppression and muscle/joint pain in paclitaxel liposome group were much lower than those in paclitaxel group(P < 0.05),while there was no difference regarding hair loss,hepatic function damage,peripheral neuritis and other aspects(P > 0.05).Conclusion:Paclitaxel liposome plus platinum is a safe and effective method for staging IIa-IV cervical carcinomas.While the long-term efficacy should be further observed.

Prediction of nephrotoxicity induced by cisplatin combination chemotherapy in gastric cancer patients

AIM:To evaluate the treatment options for nephrotoxicity due to cisplatin combination chemotherapy.METHODS:We retrospectively reviewed patients who had received cisplatin combination chemotherapy for gastric cancer between January 2002 and December 2008.We investigated patients who had shown acute renal failure(ARF),and examined their clinical characteristics,laboratory data,use of preventive measures,treatment cycles,the amount of cisplatin administered,recovery period,subsequent treatments,and renal status between the recovered and unrecovered groups.RESULTS:Forty-one of the 552 patients had serum creatinine(SCR)levels greater than 1.5 mg/dL.We found that pre-ARF SCR,ARF SCR,and ARF glomerular filtration rates were significantly associated with renal status postARF between the two groups(P=0.008,0.026,0.026,respectively).On the receiver operating characteristic curve of these values,a 1.75 mg/dL ARF SCR value had 87.5%sensitivity and 84.8%specificity(P=0.011).CONCLUSION:Cessation or reduction of chemotherapy should be considered for patients who have an elevation of SCR levels during cisplatin combination chemotherapy.

Successful treatment of multiple lung metastases of hepatocellular carcinoma by combined chemotherapy with docetaxel, cisplatin and tegafur/uracil

We report the successful treatment of multiple lung metastases after hepatic resection for hepatocellular carcinoma (HCC) with combined docetaxel, cisplatin (CDDP), and enteric-coated tegafur/uracil (UFT-E). A 68-year-old man was diagnosed with multiple lung metastases of HCC 7 mo after partial hepatectomy for HCC. Oral UFT-E was given daily and docetaxel and CDDP were given intra-arterially (administered just before the bronchial arteries) every 2 wk via a subcutaneous injection port. One month after starting chemotherapy, levels of tumor marker, protein induced by vitamin K absence(PIVKA--), decreased rapidly,and after a further month, chest X-ray and computed tomography revealed the complete disappearance of multiple liver metastases. Two years after the combined chemotherapy, HCC recurred in the liver and was treated but no pulmonary recurrence occurred. In the absence of a standardized highly effective therapy, this combined chemotherapy with docetaxel, CDDP and UFT-E may be an attractive option for multiple lung metastases of HCC.

Docetaxel and cisplatin combination chemotherapy in anthracyclines-resistant advanced breast cancer

Objective： To observe the effect and toxicity of docetaxel with cisplatin in anthracyclines-resistant advanced breast cancer. Methods： Forty-five female patients received docetaxel 60 mg/m^2 on dl and cisplatin 30 mg/m^2 on d1-d3 of every 28 days. Every patient was treated with at least 2 cycles and a median of 3 cycles （2-6 cycles ）. Results： Five patients achieved complete response （11.1%） and 18 partial response （40.0%）, 10 stable disease （22.2%）. The overall response rate was 51.1%. The clinical disease control rate was 73.3%, median time to tumor progression （TTP） was 7.8 months （1.0-34.5 months）, median survival time was 17.6 months （range 1.9-48.0 months）, and one year survival rate was 65.2%. The main side effect was marrow suppression. The treatment was well tolerated with grades Ⅲ and Ⅳ leukopenia in nine （20%） and ten （22.2%） patients. Conclusion： Combinative chemotherapy of docetaxel and cisplatin has a good anti-tumor activity on refractory advanced breast cancer with manageable toxicity.

Influence of tumor response on the survival of patients with extensive-stage small-cell lung cancer treated with the etoposide plus cisplatin chemotherapy regimen

Objective In this study, we evaluated the difference of progression-free survival （PFS） and overall survival （OS） between extensive-stage small-cell lung cancer （ES-SCLC） patients who acquired partial response （PR） or complete remission （CR） after two cycles of first-line chemotherapy with the etoposide plus cisplatin （EP） regimen and those who acquired PR or CR after four or six cycles. Methods A total of 106 eligible patients treated with the EP chemotherapy regimen for two to six cycles, at The General Hospital of Shenyang Military Region （China） between November 2004 and Way 2011, were enrolled in this study. RECIST version 1.1 was used for the evaluation of chemotherapy efficiency. We followed up all eligible patients every 4 weeks. All statistical data were analyzed by using SPSS 21.0 statistical package for Windows. Results After a median follow-up of 293 days （range, 62-1531 days）, all patients had died by the cutoff date. Fifty-one patients acquired PR or CR after two cycles of chemotherapy; the median PFS reached 6.0 months （95% CI, 5.1-6.9）, and the median OS was 10.5 months （95% CI, 8.6-12.4）. Twenty-eight patients acquired PR or CR after four or six cycles; the median PFS was 4.8 months （95% CI, 4.4-5.2）, and the median OS was 7.5 months （95% CI, 6.8-8.2）. Both PFS and OS showed a statistical difference between the two groups. Conclusion ES-SCLC patients who acquired PR or CR after two cycles of the EP regimen as first-line therapy had longer PFS and OS than those who acquired PR or CR after four or six cycles.

Clinical analysis of preoperative induction chemotherapy with gemcitabine combined with cisplatin for locally advanced non-small cell lung cancer

Objective:The purpose of this study was to assess the curative effect and adverse reaction of preoperative induction chemotherapy with gemcitabine combined with cisplatin for locally advanced non-small cell lung cancer(NSCLC).Methods:This prospective randomized controlled trial included 115 patients with locally advanced NSCLC were randomly divided into experimental and control groups and were treated from January 2007 to January 2010.The experimental group of 63 cases was treated with two cycles of induction chemotherapy before operation,radical surgery had been performed about three weeks after completion of chemotherapy,followed by received two cycles of chemotherapy.And the control group(52 cases) was treated at first with radical surgery,then treated with four cycles of chemotherapy.Two groups of the cases received routine thoracic radiotherapy with a total dose of 45 Gy.One cycle of gemcitabine combined with cisplatin regimen included gemcitabine 1000 mg/m2 on day 1 and day 8 and cisplatin 25 mg/m2 on day 1,day 2 and day 3 by intravenous infusion,with 21 days as one cycle.The tumor recurrence was evaluated by chest CT and abdominal B-ultrasound.Efficacy and toxicity results were compared by two groups.Results:All patients were followed up for three months to two years.The surgical stage of the experimental group reduced,two-years disease-free survival and postoperative recovery in the experimental group were better than in the control group,the difference was statistical significant.Toxicity and side effect after chemotherapy were mainly bone marrow suppression and gastrointestinal reactions,other complications included thrombocytopenia,leukopenia,anemia,liver and kidney dysfunction were no significant difference in two groups.Conclusion:Preoperative induction chemotherapy with gemcitabine combined with cisplatin for locally advanced lung cancer can reduce the surgical staging and extend the postoperative disease-free survival.

Effects of gemcitabine and cisplatin chemotherapy in advanced non-small cell lung cancer patients with RRM1 low protein expression

Objective： The aim of this study was to observe the efficacy of gemcitabine combined with cisplatin （GP） in advanced non-smaU cell lung cancer （NSCLC） patients with low expression of ribonucleotide reductase 1 （RRM1） protein using immunohistochemistry. Methods： RRM1 protein expression in tumor tissue was detected by streptavidin-peroxidase （SP） method of immunohistochemistry. GP regimen （gemcitabine 1000-1250 mg d1, d8, cisplatin 75 mg/m2） was given to advanced NSCLC patients with low expression of RRM1 protein. Results： In the total of 40 patients, these patients with RRM1 low expression performing GP chemotherapy had a good response rate, the objective response rate （ORR） was 47.5% （95% CI, 32.02%- 62.98%）, and the disease control rate （DCR） was 72.5% （95 % CI, 65.44%-79.56%）. ORR is 45.45% （5/11） in the squamous cell carcinoma patients while 48.15% （13/27） in the adenocarcinoma patients. Conclusion： Supedor ORR and DCR were found in advanced NSCLC patients with low expression of RRM1 protein expression performing GP regimen.

中晚期宫颈癌顺铂加一体化后装腔内放疗的临床观察

目的：探讨顺铂加一体化后装腔内放疗在中晚期宫颈癌治疗中的临床应用价值。方法：将126例中晚期宫颈癌患者随机分为顺铂加一体化后装治疗纽（A组64例）和一体化后装治疗组（B组62例）。A组于后装治疗的前4～6h给予顺铂30mg／m^2，静脉滴入，两组后装与体外放疗方案相同，观察两组患者的治疗效果及不良反应。结果：A组和B组的近期有效率均为100％，其中CR率分别为96．88％和95．16％。A组和B组1、2和3年累积生存率分别为100％、97．30％、92．43％和100％、93．89％、74．41％，A组3年累积生存率与B组比较差异有统计学意义，χ^2=1．56，P〈0．05。A组和B组的局部复发率分别为4．69％和16．13％，差异有统计学意义，P=0．035；远处转移率分别为3．13％和14．52％，两纽比较差异有统计学意义，P=0．024。对两组患者的毒副反应进行比较，上消化道反应与白细胞下降A组与B组，差异无统计学意义，P〉0．05。结论：顺铂加一体化后装治疗中晚期宫颈癌有较好的临床疗效，可降低局部复发率和远处转移率，提高3年累积生存率，毒副反应可耐受。

每周紫杉醇和顺铂同步三维适形盆腔放疗原发宫颈癌的Ⅰ期临床研究

目的同步放化疗是局部进展期宫颈癌和无法手术切除早期宫颈癌的标准治疗，紫杉醇（PTx）联合顺铂（DDP）是同步放疗常用的化疗方案。本研究通过药物剂量递增试验，明确原发宫颈癌每周PTX和DDP同步三维适形盆腔放疗的最大耐受剂量（maximum tolerated dose，MTD）。方法选取2008-10-18-2013-05-15北京大学第三医院经病理学确诊的FIGO分期为ⅠB1-ⅣA的腹主动脉旁淋巴结阴性的初治原发宫颈癌患者18例。盆腔采用6、10MVX射线，4个野三维适彤外照射，照射剂量为50-50．4Gy／25-28次，其中在36-40Gy予盆腔中央挡铅，根据病情继续予宫旁加量10～20Gy／5～10次；192Ir高剂量率腔内照射，A点剂量为6Gy／次，共6～8次。化疗DDP剂量为每周40mg／m。保持不变，PTX分为每周10、20、30、40和50mg／m2 5个剂量组，共6个周期。每组3例患者，第5剂量组为剂量限制性不良反应（does-limiting toxicity，DLT）组，共6例患者。结果18例患者中位年龄46．5岁（32-66岁），均在8周内完成外照射和腔内照射。在前4个剂量组中，1例（第1剂量组）在拟行第6个周期化疗前1d出现2级非粒细胞减少性发热（菌血症性发热），伴3级恶心呕吐和电解质紊乱停化疗，完成5个周期化疗；其余11例完成6个周期化疗。在第5剂量组的6例患者中，1例出现4级白细胞减少，另外3例均因为出现3级白细胞减少无法恢复至正常导致化疗延迟2周以上中断化疗，仅有1例按时完成6个周期的化疗。结论原发宫颈癌三维适形盆腔照射联合每周PTx和DDP化疗的最大耐受剂量为6个周期的每周PTX40mg／m2和DDP40mg／m2，该方案具有安全性和可行性。