肿瘤晚期患者采用优质护理干预的护理效果

目的:研究对肿癌晚期患者实施优质护理干预服务的临床效果。方法:从我院肿癌晚期患者中选出64例作为受试对象,并严格遵照随机原则将其分为实验组与对照组,均为32例。安排实验组患者行优质护理干预,对照组患者行常规护理干预,比较两组患者神经功能恢复、疼痛改善及护理满意情况。结果:护理后,两组患者的神经功能量表、抑郁量表评分均明显降低,实验组降低幅度优于对照组;实验组患者轻度、中度及重度疼痛改善情况优于对照组,护理满意度(96.88%)优于对照组(81.25%)。且P<0.05,差异具有统计学意义。结论:对肿癌晚期患者实施优质护理干预,可明显改善其神经功能,降低疼痛程度,效果显著。

培美曲塞联合顺铂治疗晚期非小细胞肺癌的临床效果研究

目的:分析晚期非小细胞肺癌应用培美曲塞联合顺铂治疗的效果。方法:时间确定是2018.1~2020.3,对我院治疗的42例患者进行治疗观察,依据数字表法划分两组,即多西他赛与顺铂治疗的基础组(n=21)与培美曲塞联合顺铂治疗的实践组(n=21),观察患者治疗效果。结果:实践组NSE(15.28±2.74)ng/mL、CYFRA21-1(9.62±2.14)ng/mL、CEA(5.62±2.30)ng/mL等多项指标均优于基础组患者,基础组患者实践组NSE(18.30±3.42)ng/mL、CYFRA21-1(12.73±1.96)ng/mL、CEA(8.41±1.58)ng/mL,P<0.05;治疗过程中,实践组出现恶心症状的有2例患者、脱发症状的有1例患者,占比14.3%。较基础组不良反应产生率33.3%小,基础组患者出现恶心症状的有4例患者、脱发症状的有3例患者,P<0.05(χ^(2)=0.748)。结论:晚期非小细胞肺癌经过培美曲塞联合顺铂治疗效果显著,可更好的调整肿瘤标志物数值水平,控制患者出现不良反应,安全可靠,值得推广。

Thalidomide-based multidisciplinary treatment for patients with advanced hepatocellular carcinoma:A retrospective analysis

AIM： To evaluate the efficacy of thalidomide in com- bination with other therapies to treat patients with ad- vanced hepatocellular carcinoma （HCC）. METHODS： We performed a retrospective analysis of all patients with HCC who were treated with thalido- mide for at least two months. The medical records of patients with HCC who were treated at our institution between April 2003 and March 2008 were reviewed. Image studies performed before and after treatment, tumor response, overall survival, and the decrease in o-fetoprotein （AFP） levels were evaluated. RESULTS： A total of 53 patients with HCC received either 100 or 200 mg/d of thalidomide. The patient population consisted of 9 women and 44 men with a median age of 61 years. Thirty patients （56.6%） were classified as Child-Pugh A, and 12 patients （22.6%） were classified as Child-Pugh B. Twenty-six patients had portal vein thrombosis （49.1%）, and 25 patients had extrahepatic metastasis （47.1%）. The median duration of thalidomide treatment was 6.0 mo. Six of the 53 patients achieved a confirmed response （11.3%）, one achieved a complete response （1.9%） and 5 achieved a partial response （9.4%）. The disease control rate （CR ＋ PR ＋ SD） was 28.3% （95% CI： 17.8-42.4）, and the median overall survival rate was 10.5 too. The 1- and 2-year survival rates were 45% and 20%, respectively. Only one complete response patient showed an im- proved overall survival rate of 66.8 mo. Sixteen patients （30.2%） showed more than a 50% decrease in their serum AFP levels from baseline, indicating a better re- sponse rate （31.3%）, disease control rate （43.8%）, and overall survival time （20.7 mo）. The therapy was well tolerated, and no significant toxicities were observed. CONCLUSION： Thalidomide was found to be safe for advanced HCC patients, demonstrating anti-tumor ac- tivity including response, survival, and AFP decreases of greater than 50% from baseline.

Effect of Fuzheng Yiliu decoction combined with chemotherapy on patients with intermediate and late stage gastrointestinal cancer

AIM: To investigate the therapeutic effects of Fuzheng Yiliu (strengthening the body resistance to inhibit tumor) decoction combined with chemotherapy on the patients with intermediate and late stage gastrointestinal cancer. METHODS: Sixty patients were randomly divided into treatment group (chemotherapy combined with Fuzheng Yiliu decoction) and control group (chemotherapy alone). Four indexes, including the tumor recent remission rate (RR), the change of main symptoms, the toxic and side effects caused by chemotherapy and the change of performance status, were observed in the patients. Peripheral blood contents of CD3+, CD4+, CD8+ cells, CD4+/CD8+ and soluble interleukin-2 receptor (sIL-2R) were tested before and after treatment and the values were compared with those of healthy peoples. RESULTS: The improving rate of main symptoms (69.6%) and performance status (56.7%) were significantly higher in the treatment group than in the control group (34.8%, 26.7%, P<0.05). The occurrence rates of grade II toxic and side-effects on both bone marrow (13.3%) and digestive tract (30%) were lower in the treatment group compared to the control group (36.7%, 63.3%, P<0.05). Before treatment, the proportion of CD3+, CD4+ and CD4+/CD8+ decreased and the proportion of CD8+ and SIL-2R raised markedly both in the control group and treatment group as compared to the healttiy people. After treatment, that increased of CD3+, CD4+, CD4+/CD8+ increased (62.25±10.01% vs 68.31±9.72%, 36.83±10.44% vs 42.6±9.62%, 1.24±0.65 vs l.66±0.85, P<0.05) and the values of CD8+ and sIL-2R decreased obviously (33.06±7.69% vs 29.24±6.25%, 588.23±216.86 U/mL vs 475.87±211.36 U/mL,P<0.05) in the treatment group, whereas these values were opposite in the control group (64.22±6.91% vs60.63±5.75%,35.62±7.49% vs31.53±5.53%, 32.95±8.28% vs 37.14±7.48%, 1.17±0.43 vs 0.94±0.43, 573.63±214.32 U/mL vs 692.17?21.33 U/mL, P<0.05). CONCLUSION: Fuzheng Yiliu decoction can enhance therapeutic effects of chemotherapy on malignant gastrointestinal tumor, and also reduce the toxic and side effects on bone marrow and digestive tract, thereby improving the quality of life and cellular immunity in patients with malignant gastrointestinal tumor.

Clinical significance of serum vascular endothelial growth factor in advanced malignant tumors

Objective： To elucidate the clinical significance of serum vascular endothelial growth factor （VEGF） level in pa- tients with advanced cancer. Methods： Enzyme linked immunosorbent assay （ELISA） was used to determine the serum VEGF concentration in 40 patients with advanced cancer [non-small cell rung cancer （NSCLC）, esophageal cancer （EC） and nasopharyngeal carcinoma （NPC）] before and after chemotherapy and 10 healthy volunteers as control group. Results： The serum VEGF concentrations in 40 cases of advanced cancer patients were significantly higher than those of 10 healthy control cases [（477.07 ± 374.10 ） pg/mL vs （139.09 ± 133.41 ） pg/mL; P = 0.016]. The serum VEGF concentrations in patients with NSCLC, EC and NPC were （518.53 _± 378.99） pg/mL, （399.21 ± 393.69） pg/mL and （500.68 ± 348.48） pg/mL, respectively. The differences were all statistically significant as compared with healthy control group （P values were 0.011,0.044 and 0.019, respectively）. The serum VEGF concentrations of the patients in response to chemotherapy was significantly lower than those of the same patients before they undergoing chemotherapy [（400.41 ± 332.84） pg/mL vs （777.10 ± 666.01） pg/mL; P = 0.034]. Conclusion： The serum VEGF level might be a novel and promising tumor marker of advanced malignancies and a predictor of disease progression, prognosis and therapeutic efficacy,

Prognostic relevance of circulating CK19 mRNA in advanced malignant biliary tract diseases

AIM: To determine the role of circulating tumor cells (CTCs) in prediction of the overall survival of patients with advanced malignant biliary tract obstruction. METHODS: We investigated the prognostic value of CTCs by examining two markers, cytokeratin (CK) 19 and human telomerase reverse transcriptase (hTERT) mRNA, in 40 patients diagnosed with advanced malig- nant biliary tract diseases. Quantitative real-time re- verse transcription polymerase chain reaction was used to detect CK19 and hTERT mRNA in the peripheral blood of these patients. Overall survival was analyzed using the Kaplan-Meier method and Cox regression modeling.RESULTS: Positive CK19 and hTERT mRNA expression was detected in 45% and 60%, respectively, of the 40 patients. Univariable analysis indicated that positive CK19 mRNA expression was significantly associated with worse overall survival (P = 0.009). Multivariable analysis determined that positive CK19 mRNA expres- sion, patient's age and serum bilirubin were each inde- pendently associated with overall survival. CONCLUSION: CK19 mRNA expression levels in pe- ripheral blood appear to provide a valuable marker to predict the overall survival of patients with advanced malignant biliary tract obstruction.

Application of stilamin on advanced gastrointestinal carcinoma patients complicated with malignant bowel obstruction

Objective： To investigate the effectiveness of stilamin in malignant bowel obstruction （MBO） due to advanced gastrointestinal carcinoma patients. Methods： 62 patients with MBO due to gastrointestinal carcinoma were randomly divided into two groups： routine therapy group （control group 30 patients） and stilamin group （32 patients）. Stilamin group received routine therapy combined with stilamin （6 rag/d） by 24 hours continuous infusion for three to twelve days. The curative effectiveness was observed and compared between the two groups. Results： After treatment, the clinical symptoms of abdominal distention and abdominal pain were relieved significantly in stilamin group compared with the control group （84.4% vs 57.6%; P 〈 0.05）. The exhaust of anus was more earlier （62.1% vs 25.6%; P 〈 0.05）, and the average volume of gastrointestinal decompression reduced more rapidly in stilamin group compared with the control group [（216 ± 158） mL/d vs （522 ± 184） mL/d; P 〈 0.001）, smaller and less fluid-air in the intestinal and in the colon at the 81.3% of patients plain abdominal radiography were observed in stilamin group. Quality of life, evaluated with Karnofsky score （57 ±7 vs 45 ±9; P 〈 0.01）, was improved significantly. Conclusion： The administration of stilamin, in combination with routine treatment can be very effective in the management of MBO. It can effectively relieve the symptoms of MBO and improve the quality of life in patients.

Tumor size as a prognostic factor in patients with advanced gastric cancer in the lower third of the stomach

AIM: To explore the impact of tumor size on outcomes in patients with advanced gastric cancer in the lower third of the stomach. METHODS: We retrospectively analyzed the clinical records of 430 patients with advanced gastric cancer in the lower third of the stomach who underwent distal subtotal gastrectomy and D2 lymphadenectomy in our hospital from January 1998 to June 2004. Receiver-operating characteristic (ROC) curve analysis was used to determine the appropriate cutoff value for tumor size, which was measured as maximum tumor diameter. Based on this cutoff value, patients were divided into two groups: those with large-sized tumors (LSTs) and those with small-sized tumors (SSTs). The correlations between other clinicopathologic factors and tumor size were investigated, and the 5-year overall survival (OS) rate was compared between the two groups. Potential prognostic factors were evaluated by univariate KaplanMeier survival analysis and multivariate Cox's propor-tional hazard model analysis. The 5-year OS rates in the two groups were compared according to pT stage and pN stage. RESULTS: The 5-year OS rate in the 430 patients with advanced gastric cancer in the lower third of the stomach was 53.7%. The mean ± SD tumor size was 4.9 ± 1.9 cm, and the median tumor size was 5.0 cm. ROC analysis indicated that the sensitivity and specificity results for the appropriate tumor size cutoff value of 4.8 cm were 80.0% and 68.2%, respectively (AUC=0.795, 95%CI: 0.751-0.839, P=0.000). Using this cutoff value, 222 patients (51.6%) had LSTs (tumor size ≥ 4.8 cm) and 208 (48.4%) had SSTs (tumor size<4.8 cm). Tumor size was significantly correlated with histological type (P=0.039), Borrmann type (P=0.000), depth of tumor invasion (P=0.000), lymph node metastasis (P=0.000), tumor-nodes metastasis stage (P=0.000), mean number of metastatic lymph nodes (P=0.000) and metastatic lymph node ratio (P=0.000). Patients with LSTs had a significantly lower 5-year OS rate than those with SSTs (37.1% vs 63.3%, P=0.000). Univariate analysis showed that depth of tumor invasion (c 2=69.581, P=0.000), lymph node metastasis (c 2=138.815, P=0.000), tumor size (c 2=78.184, P=0.000) and metastatic lymph node ratio (c 2=139.034, P=0.000) were significantly associated with 5-year OS rate. Multivariate analysis revealed that depth of tumor invasion (P=0.000), lymph node metastasis (P=0.019) and tumor size (P=0.000) were independent prognostic factors. Gastric cancers were divided into 12 subgroups: pT2N0; pT2N1; pT2N2; pT2N3; pT3N0; pT3N1; pT3N2; pT3N3; pT4aN0; pT4aN1; pT4aN2; and pT4aN3. In patients with pT2-3N3 stage tumors and patients with pT4a stage tumors, 5-year OS rates were significantly lower for LSTs than for SSTs (P<0.05 each), but there were no significant differences in the 5-year OS rates in LST and SST patients with pT23N0-2 stage tumors (P > 0.05). CONCLUSION: Using a tumor size cutoff value of 4.8cm, tumor size is a prognostic factor in patients with pN3 stage or pT4a stage advanced gastric cancer located in the lower third of the stomach.

Endostar combined GC in the treatment of advanced non-small cell lung cancer:a case report

A 43-year-old female with a 3-month history of paroxysmal irritating cough presented progressive chest tightness and shortness of breath.Laboratory data showed elevated carcino-embryonic antigen(CEA).Further imaging studies revealed a soft tissue mass shadow was in right middle lobe lung with mediastinal and sub-carinal lymph nodes enlarged.Biopsy diagnosis:moderately and poorly differentiated adenocarcinoma of the lung.Clinical diagnosis:central non-small cell lung cancer(NSCLC) of right middle lobe(CIVT4N2M1),lung adenocarcinoma G2-3,malignant pleural effusion,pericardial effusion,hilar and mediastina lymph node metastases.After 4 cycles of endostar plus GC therapy,imaging studies revealed showed soft tissue mass in right middle lobe disappeared,and evaluation of short-term result was complete remission(CR).PFS has been seven months till now.Therefore,this report provided strong evidence that endostatin combined GC treatment for advanced NSCLC is safe and effective,which can prolong survival and improve quality of life.

Recent achievements and acute toxicity after TP concurrent chemoradiotherapy for the advanced cervical cancer

Objective： The aim of our study was to investigate the early outcome of the taxotere and cisplatin chemora- diotherapy to the advanced cervical cancer. Methods： Fifty-six cases with cervical cancer （FIGO lib to IVa） were divided randomly into two groups in the oncology hospital of Jingzhou from September 2009 to October 2010, radiotherapy alone （28 cases） and radiation plus chemotherapy （TP） group. There was no difference of radiotherapy between the two groups, the RT ＋ C cases who accepted TP regimen during the radiation, and DDP once weekly injection of vain, according to 20 mg/m2 and taxotere once weekly i.v. according to 35 mg/m2. These regimen were given for 4-5 weeks, and some medicine for vomit- ing was given to the RT ＋ C cases. Two groups were received an oral medicine MA 160 mg every day during the treatment. Results： The early outcome： the complete remission rate was 64.3% and partial remission rate was 35.7% in RT ＋ C. The complete remission rate was 32.1% and partial remission rate was 39.3% in RT. The total response rate and complete remis- sion of RT ＋ C group was higher than that of the RT group. There was significant difference between the two groups. In RT ＋ C group, 1-year survive rate was 100.00% （28/28）; in RT group, 1-year survive rate was 85.71% （24/28）. There was significant difference between the two groups （X2 = 4.31 〉 3.84, P 〈 0.05）. Conclusion： The taxotere and cisplatin chemoradiotherapy can improve the early outcome of the advanced cervical cancer, and the adverse effect are raised, but that can be endured.

Pharmacokinetic comparison between ultraselection of uterine artery and peripheral vein chemotherapy of carboplatin in cervical cancer

Objective:The present study is to compare pharmacokinetics difference of carboplatin by using ultraselection uterine artery with by using peripheral vein in cervical cancer.Methods:Thirteen patients with locally advanced cervical cancer who had been proved by pathobiology were randomly divided into two groups:the ultraselection uterine artery group(group A, n = 6) and the peripheral vein(group B, n = 7).Carboplatin was administered by infusing into artery or vein in both groups at the dosage of 300 mg/m2.Tissues from the cervical tumor were collected at different times after infusion in both groups and then analyzed.Results:The peak concentration of platinum in tumor tissue was about 2.79 times higher in group A than that of group B(P < 0.05).The platinum concentrations in tumor in group A reached its peak levels immediately after infusion.But, group B had delayed time.While, for the time point of 0 min, when the administration finished immediately, the platinum concentration in tumor was significantly higher when compared with group B(P < 0.05).The tumor tissue area under the concentration(AUC) of carboplatin was about 2 times higher in group A than that of group B(P < 0.05).Conclusion:We observed the pharmacological advantages of chemotherapy by using ultraselection uterine artery administration of chemotherapeutic agent carboplatin in tumor tissue which provided theoretical basis and laboratory parameters of the intra-arterial chemotherapy for gynecologic malignancy.

Therapeutic options for intermediate-advanced hepatocellular carcinoma

Hepatocellular carcinoma (HCC) is one of the most common malignancies, ranking the sixth in the world, with 55% of cases occurring in China. Usually, patients with HCC did not present until the late stage of the disease, thus limiting their therapeutic options. Although surgical resection is a potentially curative modality for HCC, most patients with intermediate-advanced HCC are not suitable candidates. The current therapeutic modalities for intermediate-advanced HCC include: (1) surgical procedures, such as radical resection, palliative resection, intraoperative radiofrequency ablation or cryosurgical ablation, intraoperative hepatic artery and portal vein chemotherapeutic pump placement, two-stage hepatectomy and liver transplantation; (2) interventional treatment, such as transcatheter arterial chemoembolization, portal vein embolization and image-guided locoregional therapies; and (3) molecularly targeted therapies. So far, how to choose the therapeutic modalities remains controversial. Surgeons are faced with the challenge of providing the most appropriate treatment for patients with intermediate-advanced HCC. This review focuses on the optional therapeutic modalities for intermediateadvanced HCC.

Efficacy of transcatheter arterial chemoembolization combined with ganfule on advanced hepatocellular carcinoma

Objective： The aim of this study was to evaluate the efficacy of transcatheter arterial chemoembolization （TACE） combined with a Chinese compound preparation of ganfule on advanced hepatocellular carcinoma （HCC）. Methods： The study population consisted of 132 advanced HCC patients with Child-pugh NB. Tumor in all patients was involved with main trunk of portal vein and/or inferior vena cava, or local lymph node metastasis, or distant metastasis. TACE combined with ganfule were performed in 65 patients with advanced HCC （interventional treatment group）, 67 patients were treated with traditional Chinese herbal drug alone （Chinese herb group）. The prime end point was overall survival （OS）, and prognostic factors were analyzed. Results： The median OS was 205 days [95% confidence interval （CI）, 155-255 days] in interventional treatment group and 127 days （95% CI, 70-184 days） in Chinese herb group （P 〈 0.05）. The 6-month, 1-year, and 2-year OS rates were 58.9%, 29.1%, 7.7% in interventional treatment group, and 33.3%, 12.3%, 1.8% in Chinese herb group, respectively. The portal vein thrombosis, ECOG performance status （PS） were independent prognostic factors for OS. Conclusion： Ttranscatheter arterial chemoembolization combined with a Chinese compound preparation of ganfule could greatly prolong the OS of advanced HCC patients. The portal vein thrombosis and ECOG PS were independent prognostic factors for OS.

Epinephrine use during chemotherapy to treat severe tracheal stenosis secondary to advanced esophageal cancer:A case report and review of the literature

Dyspnea from tracheal stenosis due to compression by a tumor is an emergency that complicates therapy in oncology.We report a case of advanced esophageal cancer in a 56-year-old male who developed severe dyspnea due to airway compression by mediastinal lymph node enlargement.We used epinephrine by subcutaneous injection and aerosol inhalation to temporarily relieve dyspnea while the patient received bevacizumab and chemotherapy.The dyspnea had subsided considerably after 5 days,and the mediastinal lymph nodes were significantly reduced after 2 cycles of chemotherapy.However,the patient died of massive tracheal hemorrhage 2 months later.

Therapy Response of Chinese Herbal Medicine in Advanced Liver Cancer： A Retrospective Observational Clinical Trial

Aiming at starting the ball rolling and contributing humble effort to promote CTM （Chinese traditional medicine）, we performed the present study to assess the therapy response of Chinese herbal decoction compared to conventional therapy on critical ill patients of advanced liver cancer. A total of 6 patients （1 female and 5 males） with histologically confirmed liver cancer were included in this retrospective observational clinical trial. We administered Chinese medicine （Gan Decoction, mixed with a variety of effective herbal components） to help them to recover from poor condition. In the meantime, conventional treatment of surgical resection and artery catheterization chemotherapy was applied in cases compared. In 3 cases of CTM combined treatment, the tumor marker level decreased. Residual intrahepatic metastatic sites reduced according to ultrasonography/CT imaging, and the patients felt free from the complaint of abdominal discomfort. The quality of life has been improved, we managed to have prolonged the PFS （Progression-Free-Survival） and TTP （Time-to-Progression） from the onset to date. While in 3 cases with conventional treatment only of surgical resection and artery catheterization chemotherapy, we were not able to decrease the level of tumor marker, metastatic lesions increased according to ultrasonography/CT imaging, and the patient＇s condition worsen more. We failed in having prolonged the PFS and TTP in the compared cases of conventional treatment only. The retrospective clinical study showed no OS （overall survival） benefit for liver cancer patients treated with Gan Decoction, while the QOL （quality of life） evaluation seemed to predict survival better. Chinese herbs might be an additional choice with its better benefits and tolerability in the treatment of primary liver cancer.

Capecitabine plus cisplatin treatment in patients with advanced hepatocellular carcinoma

Objective： Hepatocellular carcinoma （HCC） is the sixth most common cancer in the world and the third leading cause of cancer related death globally. Parentral treatment of Egyptian patients of bilharziasis contributed to the high incidence of viral hepatitis, and subsequently liver cirrhosis and HCC. CapecJtabJne plus cJsplatJn protocol was evaluated regarding the efficacy and safety in patients with advanced HCC as first line chemotherapy. Methods： One hundred patients with advanced HCC were randomized to receive either capecitabine （1000 mg/m2） twice daily for fourteen days plus intravenous cisplatin （60 mg/m2） on day one to be repeated every three weeks with a maximum of six cycles or placebo （phase III trial）. Results： Baseline characteristics were comparable in both groups. According to Barcelona Clinic Liver Cancer Staging System, stage C was the most predominant （82% vs. 75%） in both groups. Median OS was 12 months versus 10 months in favor of the treated group （P value 〈 0.05）. Median TTP was significantly higher in the chemotherapy group （7 months vs. 4.5 months） as well as disease control rate （40% vs. 29%）, no patient had achieved complete response. Grade 3 toxicity was more pronounced in the treatment group, as regards vomiting and diarrhea （10% vs. 2%）, neurotoxicity （6% vs. 2%）, elevation of aminotransferase and bilirubin （9.8% vs. 4.9%）, hand and foot syndrome reaction was recorded only in chemotherapy group. Conclusion： Capecitabine plus cisplatin regimen showed modest antitumor activity with tolerable toxicity in patients with advanced HCC. Moreover, because of the significantly prolonged time to progression, we demand further attention to this convenient, outpatient, and economic profile based chemotherapy protocol.

Evaluation of the effect of neoadjuvant chemotherapy on tumor and axillary lymph nodes in locally advanced breast cancer: a study of 50 patients

Objective： The purpose of the study was to correlate between effect of pre-neoadjuvant chemotherapy （NACT） and post-NACT clinical, sonographic and pathologic features of the tumor and axillary lymph nodes （ALNs） and to raise the possibility of applying the concept of sentinel lymph node biopsy （SLNB） in patients with initially positive ALNs before NACT. Methods： A prospective study of 50 female patients with locally advanced breast cancer （LABC） with clinically palpable.and cytologically （under ultrasonographic guidance） positive ALNs. All patients received NACT and then referred for ultrasono- graphic assessment of the axilla regarding any detectable sonographic criteria of metastatic deposits in ALNs as well as the tumor size in relation to its prechemotherapy size, All patients were then subjected either to modified radical mastectomy or breast conserving surgery. The clinical, sonographic and pathological response of the tumor and the ALNs were documented, classified and correlated with each other. Results： Patients＇ mean age was 47.7±9.1 years. The mean clinical tumor size was 6.7 ± 1.4 cm; stage IliA that was presented in 32 patients （64%） and IIIB was presented in 18 patients （36%）. Chemotherapy was given for a median of 4 cycles, there was reduction of the mean clinical tumor size from 6.7 ± 1.4 cm to 4.3 ± 2.7 cm （P 〈 0.001）. Clinical response was complete in 5 （10%） tumors, complete pathological tumor response （post-neoadjuvant） was detected in 6 （16%） of patients. Complete clinical nodal response （post-neoadjuvant） in 23 （46%） axillae, on sonographic assessment of the axilla, response was complete in 17 （34%） axillae. Complete pathological nodal response occurred in 16 （32%） axillae. Out of 17 axillae that showed complete sonographic response 11 axillae showed complete pathological nodal response （P 〈 0.001）. Conclusion： Formal axillary lymph node dissection can be avoided and replaced by SLNB post NACT in patients with LABC with metastatic ALNs if there were complete clinical and sonographic criteria of nodal response as well as complete pathological tumor response.

Gefitinib in the treatment of 41 cases with refractory non-small cell lung cancer

Objective： We observe the curative effect, median survival time, time to progression, quality of life and adverse effect of patients with advanced refractory non-small cell lung cancer （NSCLC） after gefitinib （Iressa） treatment. Methods： Forty-one patients with grade Ⅲb to Ⅳ NSCLC previously treated with two chemotherapy including 85.4% of patients after second line therapy were chosen. The regimen was oral intake of gefitinib 250 mg once daily until the disease progression or toxic reaction has become intolerable. The patients were required to receive tumor evaluation before the treatment, one month, two month and every three months after Iressa administration. Results： All of 41 patients were evaluable for therapeutic effect. Without complete regression being observed, partial response rate （PR）, stable disease （SD） and progression of disease （PD） were 43.9% （18/41）, 34.1% （14/41） and 22.1% （9/41）, respectively. The overall response rate was 43.9% （18141） and disease control rate （PR ＋ SD） was 78% （32/41）. The response rate in male was 42.1%, while it in female was 45.5% （P 〉 0.05）. Twenty-two of them （53.7%, 22/41） were still alive with 10.1 months of MST when the follow-up ended in November 2006. TTP and MST of patients who died was 2.7 and 5.0 months, respectively. The rate of symptom improvement was 78% of all patients with 13 months of MST of PR patients. The Karnofsky enhanced 20 ＋ 5 after 28 days treatment without 3-4 degree of reactive toxicity. Conclusion： Iressa has significant antitumor activity in advanced NSCLC patients who have previously failed in second or third line chemotherapy. Iressa is effective and safe for patients with poor performance status.

The short-term efficacy of icotinib on the treatment of advanced non-small-cell lung cancer

Objective： The aim of the study was, （1） to observe the short-term efficacy and adverse reactions of icotinib hydrochloride on the treatment of advanced non-small cell lung cancer （NSCLC）; （2） to explore whether there is difference in the efficacy of icotinib hydrochloride among the subgroups of sex, age, smoking history, classification of CEA, histological type, multi-line treatment and PS score. Methods： The study was conducted to collect 138 patients taking icotinib hydrochloride with advanced non-small cell lung cancer in hospitals of Dalian （China） from September 1st 2011 to June 14th 2012. All patients had taken icotinib hydrochloride （125 mg three times a day） until the disease was progressed or the adverse reactions could not be tolerated. During the period of taking it, other anti-tumor treatments were forbidden. We observed the symptoms, such as cough, short breath, hemoptysis, pain. The objective efficacy was evaluated by RECIST criteria, and the adverse reactions related to the treatment was assessed on the basis of NCl-CTC 3.0. Results： Of all patients, CR was 1 （0.7%）, PR was 59 （42.8%）, SD was 37 （26.8%）, PD was 41 （29.7%）. And ORR was 43.5% （60/138）, DCR 70.3% （97/138）. The DCR of females was 83.5% （71/85） versus 49.1% （26/53） of males. The difference of ORR and DCR between the two subgroups had statistical significance （X2 = 8.065, P = 0.05; X2 = 18.577, P = 0.000）. The difference of ORR and DCR between the subgroups of patients after or before 70 years old had no statistical significance. The difference of ORR and DCR between the subgroups of smoking and non-smoking had statistical significance （X2 = 8.492; X2 = 13.602）. The difference of ORR and DCR between the CEA subgroups had statistical significance （X2 = 14.141; X2 = 14.160）, showed 81 patients with abnormal CEA before the treatment with ORR 56.8.0% （46/81）, DCR 81.5% （66/81）; 57 patients of normal CEA before the treatment with ORR 24.6% （14/57）, DCR 52.6% （30/57）. The 36 patients （26.1%） using icotinib hydrochloride as the first-line treatment, 78 patients （56.5%） using icotinib hydrochloride as the second-line, 20 patients （14.5%） using icotinib hydrochloride as the third-line, and 4 patients （2.9%） with tyrosine kinase inhibitor （TKI） resistance, there was statistical difference of DCR among the multi-groups above （~2 = 11.734, P = 0.008）. ORR was 31.1% （14/45） versus DCR 53.3% （24/45） in 45 patients with PS 3-4 points, and ORR was 49.4% （46/93） versus DCR 78.5% （73/93） in 93 patients with PS 0-2 points, and there was statistical difference （X2 = 4.156; X2 = 9.149）. The main adverse reactions were rash （26.8%）, diarrhea （13.8%）, mild liver function abnormal （10.9%）. Conclusion： The short-term efficacy of icotinib hydrochloride on the treatment of advanced NSCLC is positive, and the relevant adverse reactions are mild. The efficacy is better when the patient is female, non-smoker, treated as first-line, with higher CEA before treatment and lower PS scores.