Induction chemotherapy with docetaxel,cisplatin and fluorouracil followed by concurrent chemoradiotherapy for unresectable sinonasal undifferentiated carcinoma: Two cases of report

BACKGROUND Sinonasal undifferentiated carcinoma(SNUC) is a rare aggressive tumor that is often unresectable. Optimal treatment for patients with unresectable,locally advanced SNUC(LA-SNUC) has not been established,and the patient outcome remains poor. We report two cases of unresectable LA-SNUC in which induction chemotherapy with docetaxel,cisplatin and fluorouracil(TPF) followed by radiotherapy with concurrent cisplatin(CCRT),a standard treatment option for locally advanced head and neck cancer,demonstrated promising outcomes.CASE SUMMARY A 39-year-old man presented with tearing and pain in the right eye. A biopsy of the tumor invading the sinonasal cavities,right orbit and cranial base confirmed the diagnosis of LA-SNUC. Induction TPF chemotherapy induced remarkable tumor shrinkage and rapidly improved the symptoms. He subsequently received CCRT and achieved complete remission of the disease. The other case is a 21-year-old man who presented with worsening vision. The unresectable tumor involving the nasal septum and cranial base was pathologically diagnosed as SNUC. TPF chemotherapy followed by CCRT yielded complete remission of the disease with preserved visual function. Both patients have been disease-free for44 mo.CONCLUSION Induction TPF chemotherapy followed by CCRT may remarkably improve the outcomes in LA-SNUC patients.

Positron emission tomography complete metabolic response as a favorable prog-nostic predictor in esophageal cancer following neoadjuvant chemotherapy with docetaxel/cis-platin/5-fluorouracil

BACKGROUND 18F-fluorodeoxyglucose-positron emission tomography(PET)/computed tomography is useful in diagnosing lymph node and distant metastases of esophageal cancer.However,its value for predicting survival is controversial.AIM To evaluate the value of PET complete metabolic response(CMR)as a prognostic predictor for esophageal cancer.METHODS Between June 2013 and December 2017,58 patients with squamous cell esophageal cancer who underwent neoadjuvant chemotherapy(NAC)in Oita University were enrolled in this retrospective cohort study.Tumors were clinically staged using fluorodeoxyglucose-PET/computed tomography before and after NAC.After NAC,maximal standardized uptake value≤2.5 was defined as PET-CMR,and maximal standardized uptake value>2.5 was defined as non-PET-CMR.We compared short-term outcomes between the PET-CMR group and non-PET-CMR group and evaluated prognostic factors by univariate and multivariate analyses.RESULTS The PET-CMR group included 22 patients,and the non-PET-CMR group included 36 patients.There were no significant differences in intraoperative and post operative complications between the two groups.Five-year relapse-free survival and overall survival in the PET-CMR group were significantly more favorable than those in the non-PET-CMR group(38.6 mo vs 20.8 mo,P=0.021;42.8 mo vs 25.1 mo,P=0.011,respectively).PET-CMR was a significant prognostic factor in terms of relapse-free survival by univariate analysis(hazard ratio:2.523;95%confidence interval:1.034–7.063;P<0.041).Particularly,PET-computed tomography negative N was an independent prognostic factor of relapse-free survival and overall survival by multivariate analysis.CONCLUSION PET-CMR after NAC is considered a favorable prognostic factor for esophageal cancer.Evaluation by PET-computed tomography could be useful in clinical decision making for esophageal cancer.

Safety and Efficacy of Neoadjuvant DOF [Docetaxel, Oxaliplatin, 5-Fluorouracil] Chemotherapy Regimen in Patients with Locally Advanced Gastric and Gastro-Esophageal Junction Cancers: A Single Center Experience from India

Background:?The role of chemotherapy in Gastric Cancer is constantly evolving?with various neoadjuvant and adjuvant strategies. Several chemotherapeutic agents are used in the treatment of locally advanced gastric cancer (LAGC) namely Platinum based compounds (Cisplatin, Oxaliplatin), Fluoropyrimidines like 5-Flurouracil [(5-FU), Capecitabine)], Taxanes (Docetaxel) and Anthracyclines (Epirubicin). Various doublet and triplet combination chemotherapy regimens have been used for neo-adjuvant chemotherapy (NACT) in LAGCs. In this study we evaluated the safety and efficacy of docetaxel based triplet regimen DOF [Docetaxel, Oxaliplatin, 5-Fluorouracil] in LAGC. Material and methods:?50 Newly diagnosed patients of Locally Advanced Gastric Cancer (stage II or III) deemed fit to receive chemotherapy were included in our study. After 3 cycles of neoadjuvant chemotherapy, patients were assessed based on radiological and pathological response.?Results: 50 Patients were included in our study of which majority were male (32), median age at presentation was 55 years and 24 patients presented with a history of gastrointestinal reflux disease (GERD). The most common hematological toxicities observed in our study were anemia (61.2%), neutropenia (42.6%, febrile neutropenia constituted 6%) and thrombocytopenia (13.2%). The most common gastro-intestinal [GI] toxicities observed in our study included nausea (69.2%), vomiting (31.2%), diarrhea (34%), oral mucositis (14%) and constipation (6.6%). We found that safety profile of DOF regimen was favorable with majority of patients tolerating the regimen well. The Overall Response Rate (68%), Disease Control Rate (96%) and Resectability Rate (80%) were higher compared to western studies. Pathological CR (17.5%), ypN0?disease status (42.5%) and nodal down staging (52%), all showed positive correlations with survival outcomes. Conclusion:?DOF regimen is an effective and feasible option for neoadjuvant treatment of LAGC in an Indian population.

Effect of Docetaxel and Cisplatin Chemotherapy Combined with Intensitymodulated Radiotherapy in the Treatment of Postoperative Recurrence of Esophageal Cancer and Its Effect on Serum Tumor Markers

Objective: To investigate the effect of docetaxel and cisplatin combined with intensity-modulated radiotherapy in thetreatment of postoperative recurrence of esophageal cancer and the content of tumor markers in serum. Methods: According tosimple randomization method, 60 patients with postoperative recurrence of esophageal cancer admitted from February 2018 toSeptember 2019 were divided into control group (n = 30 cases) and observation group (n = 30 cases). All patients received IMRT.Fluorouracil + cisplatin was used in the control group and docetaxel + cisplatin was used in the observation group. After 2 coursesof continuous treatment, the therapeutic effect, serum tumor marker content and adverse reactions were compared between thetwo groups. Results: After treatment, the effective rate of observation group was higher than control group, and the difference wasstatistically significant (P < 0.05).The contents of carcinoembryonic antigen (CEA), squamous cell carcinoma antigen (SCC) andcarbohydrate antigen 19-9 (CA19-9) in observation group were lower than those in control group, and the difference was statisticallysignificant (P < 0.05). The incidence of adverse reactions in the observation group was lower than that in the control group, and thedifference was statistically significant (P < 0.05). Conclusion: Docetaxel and cisplatin combined with intensemodulated radiotherapyfor postoperative recurrence of esophageal cancer can improve the therapeutic effect, inhibit the malignant degree of tumor, andreduce the incidence of adverse reactions.

Docetaxel, cisplatin, and 5-fluorouracil compared with epirubicin,cisplatin, and 5-fluorouracil regimen for advanced gastric cancer:A systematic review and meta-analysis

BACKGROUND As the first-line regimens for the treatment of advanced gastric cancer, both docetaxel, cisplatin, and 5-fluorouracil(DCF) and epirubicin, cisplatin, and 5-fluorouracil(ECF) regimens are commonly used in clinical practice, but there is still controversy about which is better.AIM To compare the efficacy and safety of DCF and ECF regimens by conducting this meta-analysis.METHODS Computer searches in PubMed, EMBASE, Ovid MEDLINE, Science Direct, Web of Science, The Cochrane Library and Scopus were performed to find the clinical studies of all comparisons between DCF and ECF regimens. We used progression-free survival(PFS), overall survival(OS), objective response rate(ORR), disease control rate(DCR), and adverse effects(AEs) as endpoints for analysis.RESULTS Our meta-analysis included seven qualified studies involving a total of 598 patients. The pooled hazard ratios between the DCF and ECF groups were comparable in PFS(95%CI: 0.58-1.46, P = 0.73), OS(95%CI: 0.65-1.10, P = 0.21),and total AEs(95%CI: 0.93-1.29, P = 0.30). The DCF group was significantly better than the ECF group in terms of ORR(95%CI: 1.13-1.75, P = 0.002) and DCR(95%CI: 1.03-1.41, P = 0.02). However, the incidence rate of grade 3-4 AEs was also greater in the DCF group than in the ECF group(95%CI: 1.16-1.88, P = 0.002),especially for neutropenia and febrile neutropenia.CONCLUSION With better ORR and DCR values, the DCF regimen seems to be more suitable for advanced gastric cancer than the ECF regimen. However, the higher rate of AEs in the DCF group still needs to be noticed.

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.

The efficacy and toxicity of modified docetaxel,cisplatin and 5-fluorouracil combination therapy for 27 patients with advanced stage gastric adenocarcinoma

Objective: The aim of this study was to evaluate the efficacy and toxicity of modified docetaxel, cisplatin and calcium folinate (CF)/5-fluorouracil (mDCF) combination therapy for 27 patients with recurrent or metastatic gastric adeno- carcinoma (R/MGC). Methods: From May 2006 to July 2007, 27 R/MGC patients (18 were male and 9 were female) with a median age of 49 years (range19-66) were consecutively enrolled. The mDCF protocol included 50 mg/m2 docetaxel for 1 day and 25 mg/m2 cisplatin on d2-3, 200 mg/m2 CF on d2-3 and 2000 mg/m2 5-fluorouracil (5-FU) CIV (continous infusion) for 46 h on d2-3, repeated every 2 weeks. Results: Twenty-seven patients were evaluable for efficacy and toxicity. A median of 4.5 cycles was given. One complete and 12 partial responses were observed for an overall intent to treat response rate (RR) 48.1% [95% CI (confidence intervals): 32%-64%]. Median time-to-progression (TTP) was 6.2 months and overall survival (OS) was 11.8 months. Twenty-seven (100%) patients experienced bone marrow suppression, and of them 48.9% were Grade 3-4 (16.3% were Grade 4). Two patients (7.4%) ceased chemotherapy because of bone marrow suppression. WHO Grade 1-4 non-hematological toxicity, such as oral mucositis, nausea/emesia, peripheral neuropathy, liver dysfunction, diarrhea, nephrotoxicity and cardiotoxicity, occurred in 59.2%、51.9%, 48.1%, 44.4%, 25.9%, 18.5% and 11.1% patients, respectively, and most of them were Grade 1-2. No patient died due to chemotherapy toxicity. Conclusion: mDCF regimen is effective in treating R/MGC with a high RR and long TTP/OS in this trial. Despite its severe hematotoxicity, this regimen has some advantages such as no cross-resistance with paclitaxel (paclitaxel-resistant patients RR 2/6). These results suggested that the mDCF regimen worth further investigation in clinical study of R/MGC treatment.

Anti-Colorectal Cancer Chemotherapy-Induced Diarrhoea: Current Treatments and Side-Effects

Chemotherapy-induced diarrhoea (CID) is a common side-effect experienced by patients being treated with a variety of antineoplastic agents. Approximately 80% of patients undergoing chemotherapeutic treatment for colorectal and other gastrointestinal cancers present with CID;moreover, about 5% of early deaths associated with combination anti-cancer chemotherapy are due to CID. Chronic post-treatment diarrhoea amongst cancer survivors can persist for more than 10 years greatly effecting long-term quality of life. Gastrointestinal toxicities such as diarrhoea and vomiting are amongst the primary contributors to dose reductions and delays throughout anti-cancer treatment, presenting a significant hurdle in clinical management of anti-cancer regimes and often result in sub-optimum treatment. However, little is known about pathophysiological mechanisms underlying CID. This work provides a review of chemotherapy-induced diarrhoea, current management guidelines, and shortcomings of current treatments as well as emerging and already existing anti-diarrhoeal treatments potentially suitable for CID.

A pharmacological review on intraperitoneal chemotherapy for peritoneal malignancy

Perioperative intraperitoneal chemotherapy in combination with cytoreductive surgery has been shown to be of benefit for treating selected patients with peritoneal surface malignancy.It has become a new standard of care in the management of diffuse malignant peritoneal mesothelioma and peritoneal dissemination of appendiceal malignancy.Numerous recent publications on carcinomatosis from colorectal cancer and gastric cancer identify groups of patients that would benef it from this local-regional approach for prevention and treatment of carcinomatosis.This review focuses on pharmacological information regarding intraperitoneal chemotherapeutic agents commonly used in gastrointestinal oncology.

Unresectable esophageal cancer treated with multiple chemotherapies in combination with chemoradiotherapy:A case report

BACKGROUND Definitive chemoradiotherapy(dCRT)using cisplatin plus 5fluorouracil(CF)with radiation is considered the standard treatment for unresectable locally advanced T4 esophageal squamous cell carcinoma(ESCC).Recently,induction chemotherapy has received attention as an effective treatment strategy.CASE SUMMARY We report a successful case of a 59-year-old female with unresectable locally advanced T4 ESCC treated by two additional courses of chemotherapy with CF after induction chemotherapy with docetaxel,cisplatin and fluorouracil(DCF)followed by dCRT.Initial esophagogastroduodenoscopy(EGD)detected a type 2 advanced lesion located on the middle part of the esophagus,with stenosis.Computed tomography detected the primary tumor with suspected invasion of the left bronchus and 90°of direct contact with the aorta,and upper mediastinal lymph node metastasis.Pathological findings from biopsy revealed squamous cell carcinoma.We initially performed induction chemotherapy using three courses of DCF,but the lesion was still evaluated unresectable after DCF chemotherapy.Therefore,we subsequently performed dCRT treatment(CF and radiation).After dCRT,prominent reduction of the primary tumor was recognized but a residual tumor with ulceration was detected by EGD.Since the patient had some surgical risk,we performed two additional courses of CF and achieved a clinically complete response.After 14 mo from last administration of CF chemotherapy,recurrence has not been detected by computed tomography and EGD,and biopsy from the scar formation has revealed no cancer cells.CONCLUSION We report successful case with tumor remnants even after DCF and subsequent dCRT,for whom a complete response was finally achieved with two additional courses of CF chemotherapy.Additional CF chemotherapy could be one radical treatment option for residual ESCC after treatment with induction DCF followed by dCRT to avoid salvage surgery,especially for high-risk patients.

THE EFFECTS OF CHINESE DRUGS FOR SUPPORTING HEALTHY ENERGY AND REMOVING BLOOD STASIS ON POSTOPERATIVE METASTASIS OF GASTRIC CARCINOMA AND ORNITHINE DECARBOXYLASE

32 postoperative cases of gastric carcinoma were treated by traditional Chinese medicine (TCM) drugs for supporting healthy energy and removing blood stasis, and their therapeutic results were compared with those in the control group treated by western medicine. After 6 months of treatment, in the TCM group, the rate of metastatic recurrence was significantly reduced, and the level of ornithine decarboxylase was also markedly lowered. Therefore, it is considered that the action of anti-metastatic recurrence of TCM drugs in postoperative cases of gastric carcinoma is probably related to the lowered activity of ornithine decarboxylase.

特瑞普利单抗联合顺铂及多西他赛诱导化疗局部晚期鼻咽癌的疗效分析

目的研究特瑞普利单抗联合顺铂及多西他赛诱导化疗治疗局部晚期鼻咽癌的疗效。方法非随机选取钦州市第一人民医院于2022年1月—2023年9月收治的45例局部晚期鼻咽癌患者作为研究对象,按治疗方式分为对照组(n=22,应用顺铂和多西他赛诱导化疗)和观察组(n=23,在对照组基础上联用特瑞普利单抗),比较两组的临床疗效、不良反应发生情况及T细胞亚群指标水平。结果观察组临床总客观缓解率为91.30%(21/23),高于对照组的59.09%(13/22),差异有统计学意义(χ^(2)=6.318,P<0.05)。观察组的外周血CD4^(+)、CD4^(+)/CD8^(+)高于对照组,差异有统计学意义(P均<0.05)。两组不良反应发生率比较,差异无统计学意义(P>0.05)。结论局部晚期鼻咽癌患者采用特瑞普利单抗、顺铂和多西他赛联合治疗方案可获理想疗效,且安全性较高。

西黄胶囊联合多西他赛+顺铂二线化疗在晚期非小细胞肺癌患者中的应用效果

目的探讨西黄胶囊联合多西他赛+顺铂二线化疗在晚期非小细胞肺癌(NSCLC)患者中的应用效果。方法根据治疗方案的不同将86例晚期NSCLC患者分为对照组(42例)和观察组(44例),对照组患者接受多西他赛+顺铂二线化疗,观察组患者在对照组的基础上接受西黄胶囊治疗。比较两组患者的临床疗效、肿瘤标志物[癌胚抗原(CEA)、鳞状细胞癌抗原(SCC-Ag)、细胞角质蛋白19片段抗原21-1(CYFRA21-1)]、血管生长因子[碱性成纤维细胞生长因子(bFGF)、血管内皮生长因子(VEGF)]、生活质量[肺癌患者生活质量测定量表(FACT-L)]及不良反应发生情况。结果观察组患者的客观缓解率为63.64%,高于对照组患者的38.10%,差异有统计学意义(P﹤0.05)。治疗后,两组患者血清CEA、SCC-Ag、CYFRA21-1、bFGF、VEGF水平均低于本组治疗前,FACT-L评分均高于本组治疗前,观察组患者血清CEA、SCC-Ag、CYFRA21-1、bFGF、VEGF水平均低于对照组,FACT-L评分高于对照组,差异均有统计学意义(P﹤0.05)。观察组患者消化道不适、白细胞减少发生率均低于对照组,差异均有统计学意义(P﹤0.05)。结论西黄胶囊联合多西他赛+顺铂二线化疗应用于晚期NSCLC患者中的临床疗效较好,可以有效抑制血管生成,降低肿瘤标志物水平,提高生活质量,且安全性较高。

多西他赛+顺铂化疗联合同期手术治疗冠心病合并肺癌患者的有效性及安全性探讨

目的研究多西他赛+顺铂化疗联合同期手术治疗冠心病合并肺癌患者的有效性及安全性。方法74例冠心病合并肺癌患者,根据入院编号的单双数展开分组,将37例单数患者纳入对照组,将37例双数患者设为观察组。对照组实施同期冠状动脉旁路移植术联合肺癌切除术治疗,观察组在对照组基础上联合多西他赛、顺铂化疗。对比两组的肿瘤标志物水平、T细胞亚群水平、临床疗效、并发症发生情况、生存情况。结果术后1周,两组的癌胚抗原(CEA)、糖类抗原125(CA125)、鳞状细胞癌抗原(SCC)、神经元特异性烯醇化酶(NSE)、细胞角质蛋白19片段抗原21-1(CYFRA21-1)水平均较治疗前下降,且观察组CEA(16.04±1.56)ng/ml、CA125(70.65±2.90)ng/ml、SCC(7.08±1.05)ng/ml、NSE(13.37±0.82)ng/ml、CYFRA21-1(11.53±1.68)ng/ml均比对照组的(22.56±2.37)、(83.23±4.92)、(12.09±1.43)、(16.68±1.28)、(17.41±2.62)ng/ml更低(P<0.05)。术后1周,两组的CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)均低于治疗前,但观察组高于对照组(P<0.05);两组治疗前后组内与组间的CD8^(+)比较差异较小(P>0.05)。观察组疾病总控制率78.38%较对照组的54.05%高(P<0.05)。两组术后并发症发生率相差不大(P>0.05)。观察组术后6个月、1年的生存率分别为91.89%、83.78%,均高于对照组的72.97%、59.46%(P<0.05)。结论基于同期手术对冠心病合并肺癌患者实施多西他赛+顺铂化疗安全有效,可降低肿瘤标志物水平,促进患者机体免疫功能与生存率的提高。

化瘀通络方联合多西他赛加顺铂化疗方案治疗非小细胞肺癌的临床研究

目的观察化瘀通络方联合多西他赛加顺铂(DP)化疗方案治疗非小细胞肺癌(NSCLC)的临床疗效。方法选取2019年4月至2021年10月收治的128例NSCLC患者作为研究对象,按照随机数字表法分为2组,对照组67例予DP化疗方案治疗,治疗组61例在对照组治疗基础上联合化瘀通络方治疗。2组均治疗1个疗程后统计疗效,比较2组治疗前后中医症状(包括咳嗽咯痰、咳嗽带血、气短乏力及胸闷胸痛)评分、免疫功能指标(包括T淋巴细胞亚群CD3^(+)、CD4^(+)及CD8^(+))及肿瘤病人生活质量评分(QOL)(包括生理、情感、功能、家庭/社会以及附加关注5个维度)变化情况,比较2组治疗期间不良反应发生情况。结果治疗组总有效率81.97%(50/61),不良反应总发生率14.75%(9/61),对照组总有效率65.67%(44/67),不良反应总发生率16.42%(11/67),治疗组总有效率高于对照组(P<0.05),但2组不良反应总发生率组间比较差异无统计学意义(P>0.05)。与本组治疗前比较,2组治疗后中医症状咳嗽咯痰、咳嗽带血、气短乏力及胸闷胸痛评分均降低(P<0.05),且治疗组治疗后中医症状咳嗽咯痰、咳嗽带血、气短乏力及胸闷胸痛评分均低于对照组(P<0.05)。与本组治疗前比较,治疗组治疗后T淋巴细胞亚群CD3^(+)、CD4^(+)及CD8^(+)水平均升高(P<0.05),且治疗组治疗后T淋巴细胞亚群CD3^(+)、CD4^(+)及CD8^(+)水平均高于对照组(P<0.05)。对照组治疗前后T淋巴细胞亚群CD3^(+)、CD4^(+)及CD8^(+)水平比较差异均无统计学意义(P>0.05)。与本组治疗前比较,2组治疗后QOL量表生理、情感、功能、家庭/社会以及附加关注评分均升高(P<0.05),且治疗组治疗后QOL量表生理、情感、功能、家庭/社会以及附加关注评分均高于对照组(P<0.05)。结论化瘀通络方化瘀通络方联合DP化疗方案治疗NSCLC疗效确切,可有效改善患者中医症状,提高患者免疫功能,改善生活质量,且安全可靠。

培元抗癌汤联合多西他赛与顺铂化疗方案对晚期肺癌患者免疫功能及中医证候的影响

目的探讨培元抗癌汤联合多西他赛+顺铂(docetaxel+cisplatin,DP)化疗方案在晚期肺癌患者中的疗效。方法选取2020年3月至2021年12月中国人民解放军联勤保障部队第九七〇医院收治的86例晚期肺癌患者作为研究对象,采用随机数字表法分为观察组与对照组,每组43例。对照组采用DP化疗方案治疗,观察组在对照组基础上联合培元抗癌汤治疗。比较两组临床疗效及治疗前后免疫功能指标(CD3^(+)、CD4^(+)、CD8^(+))、中医证候积分、血清肿瘤标志物[癌胚抗原(carcinoembryonic antigen,CEA)及糖类抗原125(carbohydrate antigen 125,CA125)]和不良反应发生情况。结果观察组治疗总有效率为93.02%,高于对照组的76.74%,差异有统计学意义(P<0.05)。治疗后,两组CD8^(+)、CD3^(+)、CD4^(+)水平均低于治疗前,但观察组高于对照组,差异有统计学意义(P<0.05)。治疗后,两组咳嗽咳痰、气喘气促、痰中带血、胸胁胀满、体倦神疲积分均低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05)。治疗后,两组CEA、CA125水平均低于治疗前,且观察组低于对照组,差异有统计学意(P<0.05)。观察组不良反应发生率低于对照组,差异有统计学意义(P<0.05)。结论培元抗癌汤联合DP化疗方案在晚期肺癌患者中疗效显著,可改善其免疫功能,缓解临床症状,抑制肿瘤生长,且不良反应较少,值得临床推广应用。

TPF诱导化疗治疗局部晚期鼻咽癌的Ⅰ期临床研究

背景与目的:PF方案是治疗晚期头颈部癌包括晚期鼻咽癌的标准方案,近年发现泰素帝加PF的TPF方案可提高其疗效。本研究旨在探讨TPF诱导化疗治疗晚期鼻咽癌的剂量限制毒性(dose-limiting toxicity,DLT)和最大耐受剂量(maximum tolerated dose,MTD),同时观察疗效。方法:从2006年12月至2008年5月,共有41例初诊局部晚期(UICC分期Ⅲ、Ⅳ期)鼻咽癌患者入组,其中男性29例,女性12例,中位年龄47岁(29～60岁),ECOG体力状况评分≤2。TPF方案起始剂量为泰素帝40mg/m2d1,顺铂40mg/m2d1,氟尿嘧啶400mg/m2d1～5,每3周重复,共2个周期。泰素帝和顺铂每剂量级增加5mg/m2,氟尿嘧啶增加50mg/(m2·d)。每个剂量组至少收治6例患者,6例患者全部完成2个疗程化疗后并进行不良反应评价再进行剂量升级。第5周开始放射治疗,鼻咽原发病灶68～72Gy/34～36次,7周,颈部淋巴结阳性区60～66Gy/30～33次,6～6.5周。结果:41例患者共完成80周期化疗。40例(79个疗程)可评价疗效和不良反应。第1～4剂量组均未出现DLT;第5剂量组有3例出现DLT,包括3例持续超过1周的Ⅲ～Ⅳ度中性粒细胞减少,其中2例合并Ⅲ度口腔黏膜反应而使放疗终止超过1周;按照第5组剂量重新入组3例(第6组)并常规G-CSF支持治疗,1例出现不超过1周的短暂Ⅳ度中性粒细胞减少和Ⅲ度黏膜反应,未发现DLT;第7组4例均出现DLT,包括3例Ⅳ度中性粒细胞降低,其中1例合并发热及肺部感染,3例Ⅲ度腹泻,1例Ⅲ度黏膜反应持续10d。至此终止剂量升级,按照第5剂量组继续治疗3例(第8组)均未发现DLT。全组未出现严重肝肾功能损伤,其他严重反应包括1例Ⅲ度贫血,4例Ⅲ度呕吐,9例Ⅲ度体重下降。结论:TPF方案是治疗晚期鼻咽癌的安全有效方案,推荐剂量为泰素帝60mg/m2d1,DDP60mg/m2d1,5-FU600mg/m2d1～5。

泰素帝联合顺铂(TP)与顺铂联合5-FU(PF)方案治疗局部晚期鼻咽癌的比较

背景与目的:泰素帝、顺铂是治疗头颈部肿瘤有效的单药,泰素帝+顺铂(TP)方案联合放疗用于头颈部肿瘤的治疗已完成Ⅱ～Ⅲ期临床试验。本研究通过对比顺铂联合氟尿嘧啶(5-FU)(PF)方案与TP方案对鼻咽癌患者的反应率和毒副反应,探讨局部晚期鼻咽癌患者同期化疗新的化疗方案。方法:自2005年10月1日至2006年3月31日中山大学肿瘤防治中心放疗科二区鼻咽癌住院患者符合入组标准的20例进入试验组(TP组)。自2004年3月至2005年9月30日期间符合入组条件的PF方案诱导+同期放化疗的45例病例中随机抽取20例作为对照组(PF组)。分别比较两组患者诱导化疗与同期放化疗的近期疗效和不良反应。结果:与PF方案相比,TP方案诱导+同期放化疗实施的平均化疗周期数多(3.85vs.2.75,P=0.000)。诱导化疗后,TP组鼻咽病灶部分缓解(partialremission,PR)18例,稳定(stable disease,SD)2例;颈淋巴结完全缓解(complete remission,CR)7例,PR11例,SD2例。PF组鼻咽病灶PR17例,SD3例;颈淋巴结CR2例,PR15例,SD1例。两组对比差异无统计学意义(P>0.05)。同期放化疗结束后评价,试验组鼻咽灶均达CR,对照组18例达CR;颈淋巴结试验组19例CR,对照组15例CR,残留病灶经进一步处理后无增大或复发。试验组和对照组诱导化疗Ⅲ度及Ⅲ度以上中性粒细胞减少的发生率分别为40.5%和0%;同期放化疗Ⅲ度及Ⅲ度以上中性粒细胞减少的发生率分别为40.5%和10.2%,两组比较差异有统计学意义(P<0.05),但贫血与血小板减少发生率低(P<0.05)。两者在抗生素使用及静脉营养支持上差异皆无统计学意义(P>0.05)。结论:TP方案治疗鼻咽癌的近期疗效与PF方案相似,不良反应可耐受,远期疗效与毒性尚需进一步研究。

DC方案与PF方案化疗与同步放疗治疗中晚期食管鳞癌

目的观察多西紫杉醇加顺铂化疗(DC)同步放疗与顺铂加氟尿嘧啶(PF)化疗同步放疗中晚期食管癌的疗效和毒副反应。方法将48例食管鳞癌患者随机分成多西紫杉醇加顺铂化疗同步放疗组(DC组)和顺铂加氟尿嘧啶化疗同步放疗顺6组0(铂GP yF2/53组0m)f各g/6/㎡周24iv。例d结1。-果3D、氟C两组尿组采嘧近用啶期多疗50西效0紫m比g杉较/㎡醇无,7连统5用计mg学5/㎡d意,i2义v8(d d1Z为,=+1 1顺.1周0铂6期,2P,5共=m04.g2周/6㎡9)期。iv。Dd两1C-组3组,放2和8疗PdF为方组一法的周相3期同年,,中共采位用4周生普期存通。时放P间疗F分组总别采剂用为量26个月(95%CI∶24.579～27.421)、23个月(95%CI∶21.896～24.104),log rank test差异无显著性(χ2=3.4041,P=0.065)。DC组与PF组的放射性食管炎比较有统计学意义(P=0.049),而骨髓抑制、胃肠道反应方面比较无统计学意义。结论多西紫杉醇加顺铂同步放化疗可用于治疗中晚期食管鳞癌且安全可靠。

顺铂和5-氟尿嘧啶/醛氢叶酸双周疗法治疗鼻咽癌初步报道

目的:观察顺铂(cisplatinDDP),5-氟尿嘧啶5fluorouracil5FU/醛氢叶酸(leucovorinLV)双周疗法治疗鼻咽癌的疗效及其毒性。方法:病理明确的20例鼻咽癌患者进入研究组。包括:1)初诊时即有远处转移的病人;2)放疗后发生远处转移的病人;3)初诊时局部晚期的病人;4)放疗后局部复发的病人。治疗方案:LV200mg/m2静脉输注2h,后接5FU375mg/m2静脉推注10min,再接5FU3.0g/m2,用输液泵连续静脉输注48h,以上治疗每两周一次。DDP80mg/m2用时水化,28天1次。所有病人至少接受2疗程的治疗。结果:经过两个周期的化疗,完全缓解completeremissionCR2例(10%),部分缓解prtialremissionPR12例(60%),6例病人稳定(30%),治疗中无疾病进展无治疗相关的死亡。恶心、呕吐、静脉炎为主要的不良反应毒性相对较弱。结论:当前研究的数据表明,大剂量DDP合并5FU/LV双周疗法治疗复发转移或局部晚期的鼻咽癌病人,缓解率较高,毒性相对较低。