Clinical study on concurrent chemoradiotherapy combined with Kanglaite injection in the treatment of regionally advanced unresectable non-small cell lung cancer

Objective： To evaluate the clinical effects and toxicity of concurrent chemoradiotherapy combined with Kanglaite injection in the treatment of regionally advanced unresectable non-small cell lung cancer. Methods： 48 patients with regionally advanced unresectable non-small cell lung cancer were randomized to two groups, 25 patients in the combination group （concurrent chemoradiotherapy ＋ Kanglaite） and 23 patients in the control group （concurrent chemoradiotherapy）. The combination group received chemotherapy of vinorelbine （NVB） plus cisplatin （DDP） regimen, radiotherapy was given with conventional fraction in 2 Gy per fraction and five fractions per week concurrently. The total tumor doses were 56-60 Gy. Combined with Kanglaite injection 200 mud for twenty-one days for two courses in the combination group, the control group was chemoradiotherapy only. Effects and toxicities were evaluated according to the criteria of WHO. Results： The CR rates in the combination group and control group were 24.0% （6/25） and 13.0% （3/23）, respectively （P 〉 0.05）. Response （CR ＋ PR） rates of combination group were 76.0 % （19/25） and 69.6% （16/23） in control group, P 〉 0.05. The incidence rates of grades 3-4 leukocytopenia, grades 3-4 digestive system （nausea and vomiting） and grades 3-4 esophagitis in the combination group and control group were 40.0% （10/25）, 8.0% （2/25）, 16.0% （4/25） and 69.6% （16/23）, 34.8% （8/23）, 43.5% （10/23）, respectively （P 〈 0.05）. KPS and body weight score significantly increased in combination group after the combined treatment, P 〈 0.05. Conclusion： Concurrent chemoradiotherapy combined with Kanglaite injection can relieve side effects of chemoradiotherapy in the treatment of regionally advanced unresectable non-small cell lung cancer, and improve quality of life. Kanglaite injection may increase effective rate of regionally advanced unresectable non-small cell lung cancer combined with concurrent chemoradiotherapy.

Phase I Study to Determine MTD of Docetaxel and Cisplatin with Concurrent Radiation Therapy for Stage Ⅲ Non-Small Cell Lung Cancer

Objective： To evaluate the maximum tolerated dose （MTD） of docetaxel （DCT） and cisplatin （DDP） concurrently with three dimensional （3D） conformal radiotherapy or IMRT for patients with locally advanced non-small cell lung cancer （stage IIIa and IIIb） after 2–4 cycles of induction chemotherapy. Methods： Fourteen patients with histological/cytological proven stage III non–small-cell lung cancer were eligible. 3D or IMRT radiotherapy （60-70Gy in 30-35 fractions, 6-7weeks, 2 Gy/fraction） was delivered concurrently with cisplatin and docetaxel, 2 cycles during concurrent chemoradiotherapy （CCRT）. The level I dosage was composed of 56 mg/m2 DCT, on day 1 and 28mg/m2 DDP, on day 1 and day 2. The level II was composed of 60 mg/m2 DCT, on day 1 and 30 mg/ m2 DDP, on day 1 and day 2. The level III was composed of 64 mg/m2 DCT, on day 1 and 32 mg/ m2 DDP, on day 1 and day 2. Results： Fourteen patients were allocated and finished concurrent chemoradiotherapy. The dose-limiting neutropenia was at the dose Level III （64 mg/m2） and occurred in 2 of 5 patients. No dose limiting non-hematologic or hematologic toxicity occurred in the other patients. Conclusions： Patients with locally advanced non-small cell lung cancer may tolerate 60mg/m2 docetaxel and 60mg/m2 cisplatin for 2 cycles during concurrent radiotherapy after 2-3 cycles of induction chemotherapy.

Efficacy of concurrent chemoradiotherapy plus adjuvant chemotherapy on advanced cervical cancer

Background and Objective: Concurrent chemoradiotherapy for cervical carcinoma develops rapidly and has become a common and standard therapy in recent years. Both the local control rate and survival rate of patients were increased and the risk of death fell by 30%-50%. This study aimed to explore the efficacy of concurrent chemoradiotherapy plus adjuvant chemotherapy on and the treatment compliance of the patients with advanced cervical squamous cell carcinoma. Methods: A total of 156 patients with stage IIa-IIIb cervical squamous cell carcinoma were randomly divided into the concurrent chemoradiotherapy group (experimental group) and radiotherapy group (control group). Intracavity and external beam radiation therapy were administered. At point A, 40-48 Gy were given by 10-12 fractions; at point B, 46-50 Gy were given by 23-25 fractions. In the same time, experimental group was treated by cisplatin (DDP, 40 mg) on day 1, repeated every week. Ten days after radiation therapy, TP regimen was administered as adjuvant chemotherapy. Results: For the experimental and control groups, the objective response rates were 88.61% and 75.32%, 1-year survival rates were 88.57% and 70.77%, 1-year local control rates were 81.43% and 64.62%, 3-year survival rates were 82.14% and 57.69%, and 3-year local control rates were 75.00% and 46.15%, with significant differences (P < 0.05). Quality of life of all patients were significantly improved after treatment (P< 0.05). Conclusion: Concurrent chemoradiotherapy plus adjuvant chemotherapy for advanced cervical cancer can improve short-term and long-term survival and local control rates of patients, improve the quality of life, and the toxicity can be tolerated.

Phase Ⅰ/Ⅱ study of gemcitabine and oxaliplatin chemotherapy in combination with concurrent 3-D conformal radiotherapy for locally advanced non-small cell lung cancer

Background and objective Recent studies have showed that combination of chemotherapy and radiotherapy might result in better outcome for locally advanced non-small cell lung cancer (NSCLC). The aim of this study is to determine the maximal tolerance dose (MTD) and efficacy of full-dose gemcitabine and oxaliplatin when given concurrently with 3-dimentional radiation therapy (3D-RT) for locally advanced NSCLC. Methods Oxaliplatin was administered at a fixed dose of 130mg/m^2, and gemcitabine was administered at a starting dose of 800mg/m^2 with an incremental dose gradient of 200mg/m^2 for 3 dose levels. MTD was defined as the immediate dose level lower than the dose at which dose-limiting toxicity (DLT) occurred in more than one-third of the patients. The chemotherapy was administered at 3-week cycle. The RT was given as 3-D conformal manner at a single daily dose of 2Gy for 5 days per week. Results Twenty-two patients were evaluable and distributed to three different dose levels: 6 at level 1, 8 at level 2 and 8 at level 3. Pulmonary toxicity, esophageal and hematologic toxicity were the main DLT. Grade Ⅲ acute pulmonary toxicity occurred in one patient each at level 2 and level 3, both with V20>20%, and grade Ⅲ esophagitis in two patients at level 3. The MTD of gemcitabine in this study was 1000mg/m^2. The overall response rate was 75.0% (9/12). The 1- and 2-year survival rate was 70.0% and 30.5% respectively. The median time to progression was 8.7 months (range 5--11.8 months). Conclusion With reduced radiation volume, gemcitabine of 1000mg/m^2 in combination with oxaliplatin of 130mg/m^2 was effective and could be safely administered for NSCLC.

Initial outcome of induction chemotherapy followed by radiotherapy and concurrent weekly paclitaxel for stage Ⅲ non-small cell lung cancer

Objective： The aim of our study was to evaluate the toxicity and efficacy of induction chemotherapy （ICT） followed by three-dimensional conformal radiotherapy （3D CRT） and concurrent weekly paclitaxel on unresectable non-small cell lung cancer （NSCLC）. Methods： Stage III NSCLC patients with favorable conditions were treated with 2 to 4 cycles of carboplatin （AUC = 5-6, dl） combined with paclitaxel （175 mg/m〈 dl）, then followed by weekly paclitaxel （40 mg/m2） and concurrent 3D CRT within 3-4 weeks. The prescription dose was given as high as possible under the condition that V20 〈 31% and spinal cord dose 〈 50 Gy. Results： Thirty-one patients were enrolled. ICT was well tolerated. During the concurrent chemoradiotherapy, the treatment of 3 patients was ended ahead of the schedule because of severe pulmonary and heart toxicities; the treatment of 2 patients was delayed for 7 and 12 days because of fatigue. Myelosuppression was mild （16/31）： all were grade 1-2 except 1 was grade 3. Lymphocytopenia was more obvious （29/31, grade 3 in 21）. Three patients developed grade 3 radiation-induced esophagitis, and 2 developed grades 3-4 radiation-induced pneumonitis. Two developed grade 3 esophageal stricture. No grades 3-4 pulmonary fibrosis was observed. The overall response rate was 74.1%. The 1-, 2-, 3-year overall survival rates were 74.2%, 41.9%, and 34.6%, respectively, with the median survival time of 18.5 months. The 1-, 2-, 3-year local progression-freely survival rates were 64.5%, 32.3%, and 20.5%, respectively, with the median local progression-freely survival time of 14.3 months. Conclusion： The program of ICT followed by weekly paclitaxel and 3D CRT is accomplished in most of the favorable stage III NSCLC patients. The toxicity is tolerable, and the response rate is inspiriting.

A Case of Bilateral Secondary Pneumothorax Shortly after the Completion of Concurrent Chemoradiotherapy for Tongue Cancer

Metastatic lung tumours rarely lead to development of pneumothorax, and no case of bilateral secondary pneumothorax due to lung metastases arising from tongue cancer has been reported. Here, we report a case of a patient with tongue cancer with lung metastases complicated by bilateral secondary pneumothorax soon after the completion of concurrent chemoradiotherapy. A 39-year-old man with cervical lymph node metastases originating from pT2N0M0 tongue cancer underwent neck dissection and postoperative concurrent chemoradiotherapy. Shortly after the completion of chemoradiotherapy, he developed bilateral secondary pneumothorax. Subsequently, he underwent partial lung resection for the pulmonary fistulae for diagnostic and therapeutic purposes;nodular lesions found in both the lungs. The diagnosis of secondary pneumothorax was based on histopathological findings. Although all pulmonary fistulae disappeared after partial lung resection, he died of the primary disease despite our best efforts to control the metastatic pulmonary lesions.

Feasibility of cetuximab and chemoradiotherapy combination in Chinese patients with unresectable stage Ⅲ non-small cell lung cancer:a preliminary report

Objective： In recent years, the combination of cetuximab and chemoradiotherapy （CRT） has been used to treat stage III non-small cell lung cancer （NSCLC）; however, limited data are available for Chinese patients. Herein, we report preliminary data from a phase I/II study testing the combination of cetuximab with inductive chemotherapy, followed by concurrent CRT （CCRT） in Chinese patients with stage III NSCLC. Methods： Eligibility criteria were Zubrod performance status （PS） 0-1, forced expiratory volume in 1 second （FEV1） 〉_1.2 L and adequate organ function. Enrolled patients received weekly cetuximab （initial dose of 400 mg/m2 on day 1 of week 1 and a maintenance dose of 250 mg/m2 on week 2 to the end of CCRT） with cisplatin/vinorelbine （NP） chemotherapy （every 3 weeks for 2 cycles from week 2, followed by two cycles of concomitant NP chemotherapy and intensity-modulated thoracic radiotherapy （TRT） （60-66 Gy/2 Gy）. The primary endpoints were toxicity and feasibility. All patients received positron emission tomography- computerized tomography （PET-CT） scans within the 2 weeks prior to enrollment. Univariate analyses were used to assess the correlation between SUV-T, SUV-N, SUV-TOTAL, gender, age, histology, tumor-node- metastasis （TNM） stage, PS and smoking status and survival. Survival curves were generated for different populations using the Kaplan-Meier method and compared using a log-rank test. Results： Seventeen patients were enrolled and 16 completed the full regime. The overall response rate （ORR） was 58.8% and 82.3% after the induction and CCRT phases, respectively. With a median follow-up duration of 27.6 months, the median survival was 27.6 months [95% confidence interval （CI）： 11.3-43.9 months] with 1- and 2-year survival rates of 88.2% （95% CI, 60.6-96.9%） and 58.8% （95% CI, 60.6-77.8%）, respectively. Three patients remain progression-free to date, and the median progression-free survival （PFS） was 13.5 months （95% CI, 6.8-20.2 months）. No treatment-related death occurred; however, 76% of the patients experienced grade 3＋ adverse events （AEs）, including nansea/vomiting, intestinal obstruction, and esophagitis （〈6%）, while other AEs were mostly of hematological nature （71%）. The cut-off values for SUV-T and SUV-TOTAL were 11 and 20, respectively. Univariate analyses revealed SUV-TOTAL （P=0.027）, SUV-T （P=0.025）, and PS （P=0.006） as potential survival predictors, with a hazard ratio （HR） of 3.4, 3.7, and 9.9, respectively. Conclusions： The combination of cetuximab with induction chemotherapy followed by CCRT appears feasible and promising. Local and locoregional maximal SUVs, defined by 18F-FDG PET-CT scanning, may represent a prognostic indicator for long-term survival for these patients, which warrants further study.

Clinical observation of gemcitabine and concomitant three-dimensional conformal radiotherapy in the treatment of locally advanced non-small cell lung cancer

Objective： To evaluate the clinical effect of gemcitabine and concurrent three-dimensional conformal radiation therapy （3D-CRT） for locally advanced non-small cell lung cancer （NSCLC）. Methods： From April 2002 to June 2005, 38 patients with inoperable stage Ⅲ NSCLC were treated with gemcitabine and 3D-CRT simultaneously. Chemotherapy consisted of intravenously gemcitabine 350 mg/m^2 on days 1, 8, 15, 22, 29, 36.3D-CRT was delivered up to a total dose of 60-64 Gy with a 2.0 Gy dose fraction per day, 5 days per week. Results： The overall response rates of primary tumor and mediastinum metastatic node were 86.8% （33/38） and 90.6% （29/32） respectively, and 91.7% （22/24） and 78.6% （11/14） for squamous cell carcinoma and adenocarcinoma respectively. The acute side effects of patients were mostly myelosuppression, nausea, vomiting, radiation-induced esophagitis and pneumonitis （RTOG 1/11）, however, all of them were cured. Conclusion： Concurrent application of gemcitabine and 3D-CRT can improve the overall response rate for locally advanced NSCLC without aggravating the side effects.

Computed tomography-based delta-radiomics enabling early prediction ofshort-term responses to concurrent chemoradiotherapy for patients withnon-small cell lung cancer

Objective:To explore the potential of computed tomography(CT)-based delta-radiomics in predicting early shortterm responses to concurrent chemoradiotherapy for patients with non-small cell lung cancer(NSCLC),in order to determine the optimal time point for the prediction.Methods:A total of 20 patients with pathologically confirmed NSCLC were prospectively enrolled in this study,who did not receive surgical treatment between February 2021 and February 2022.For each case,a total of 1,210 radiomic features(RFs)were extracted from both planning CT(pCT)images along with each of the subsequent three weeks of CT images.EffectiveΔRFs were selected using intra-class correlation coefficient(ICC)analysis,Pearson's correlation,ANOVA test(or Mann-Whitney U-test),and univariate logistic regression.The area under the curve(AUC)of the receiver operating characteristic(ROC)curve was used to evaluate the potential to predict short-term responses of different time points.Results:Among the 1,210ΔRFs for 1-3 weeks,121 common features were retained after processing using ICC analysis and Pearson's correlation.These retained features included 54 and 58 of all time points that differed significantly between the response and non-response groups for the first and third months,respectively(P<0.05).After univariate logistic regression,11 and 44 features remained for the first and third months,respectively.Finally,eightΔRFs(P<0.05,AUC=0.77-0.91)that can discriminate short-term responses in both at 1 and 3 months with statistical accuracy were identified.Conclusion:CT-based delta-radiomics has the potential to provide reasonable biomarkers of short-term responses to concurrent chemoradiotherapy for NSCLC patients,and it can help improve clinical decisions for early treatment adaptation.

和胃解毒方对食管鳞癌同步放化疗病人血清肿瘤相关因子、免疫因子的影响

目的:研究和胃解毒方对食管鳞癌(ESC)同步放化疗(CRT)病人血清肿瘤相关因子、免疫因子及炎性因子的影响。方法:选取ESC同步放化疗病人84例,按照随机数字表法将病人分为观察组和对照组,各42例。对照组行CRT治疗,观察组行CRT联合和胃解毒方治疗。观察2组治疗前后血清细胞角蛋白19片段(CYFRA 21-1)、鳞状细胞癌抗原(SCC)、癌胚抗原(CEA)等肿瘤相关因子水平,血清CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)等TBNK淋巴细胞亚群水平,血清白细胞介素(IL)-6、IL-8、肿瘤坏死因子-α(TNF-α)等炎性因子水平及中医症候积分。结果:治疗后,观察组血清CYFRA 21-1、SCC、CEA水平较对照组低(P<0.01),观察组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)水平均较对照组高,CD8^(+)水平较对照组低(P<0.01)。观察组血清IL-6、IL-8、TNF-α水平明显较对照组低(P<0.01)。观察组中医症候积分较对照组低(P<0.01);结论:和胃解毒方应用于ESC CRT病人,可有效杀灭ESC细胞,降低肿瘤相关因子水平,改善免疫因子水平。

循环肿瘤细胞上细胞程序性死亡配体1表达对宫颈癌同步放化疗预后的评估价值

目的探讨循环肿瘤细胞(CTC)上细胞程序性死亡配体1(PD-L1)表达对宫颈癌同步放化疗预后的评估价值。方法回顾性选取2021年6月至2023年12月入临汾市人民医院的60例宫颈癌患者,均经病理学确诊,CTC PD-L1经CytoSorter CTC系统测定。对宫颈癌病理特征与PD-L1^(+)CTC之间的相关性予以分析,并比较PD-L1^(+)CTC和PD-L1-CTC宫颈癌患者同步放化疗前后的无进展生存期(PFS),评估宫颈癌放化疗后PD-L1^(+)CTC数量对预后的评估价值。结果同步放化疗前后外周血CTC检出率及数量比较,差异无统计学意义(P>0.05)。较同步放化疗前,宫颈癌患者同步放化疗后PD-L1^(+)CTC检出率更低(38.33%vs.56.67%),PD-L1^(+)CTC检出数量更少[(0.77±1.20)个vs.(1.27±1.51)个],差异均有统计学意义(P<0.05)。同步放化疗前,宫颈癌患者PD-L1^(+)CTC与肿瘤直径、FIGO分期、分化程度及淋巴结转移联系紧密(P<0.05)。同步放化疗后,宫颈癌患者PD-L1^(+)CTC表达水平与肿瘤直径、FIGO分期、分化程度及淋巴结转移密切相关(P<0.05)。PD-L1^(+)CTC患者的PFS短于PD-L1-CTC患者,差异有统计学意义(P<0.05)。Cox回归分析显示,局部晚期宫颈癌患者同步放化疗前后的CTC PD-L1表达水平均可作为PFS预后因素。结论宫颈癌放同步放化疗前后测定的CTC PD-L1表达水平可作为预后评估的辅助指标。

奥希替尼联合同步放化疗治疗EGFR T790M突变的晚期非小细胞肺癌患者的临床效果

目的 探讨奥希替尼联合同步放化疗治疗表皮生长因子受体(EGFR)T790M突变的晚期非小细胞肺癌(NSCLC)患者的临床效果。方法 选取2016年3月至2018年9月本院收治的82例EGFR T790M突变的晚期NSCLC患者,采用随机数字表法将其分为对照组(41例)和观察组(41例)。对照组给予同步放化疗治疗,观察组给予奥希替尼联合同步放化疗治疗。比较两组的治疗效果。结果 观察组的疾病控制率、客观缓解率高于对照组,差异具有统计学意义(P<0.05)。观察组的Ⅰ+Ⅱ级皮疹、胃肠道反应、甲沟炎发生率高于对照组,差异具有统计学意义(P<0.05)。随访2年,观察组的无进展生存时间(PFS)为11.32(6.85,12.41)个月,长于对照组的7.29(4.91,9.32)个月(P<0.05);随访1、2年,观察组的生存率为75.61%、39.02%,高于对照组的56.10%、12.20%,差异具有统计学意义(P<0.05)。结论 奥希替尼联合同步放化疗治疗EGFR T790M突变的晚期NSCLC患者可提高近远期治疗效果,延长PFS,提升患者生存率,具有较高的临床应用价值。

安罗替尼联合信迪利单抗同步放化疗治疗驱动基因阴性非小细胞肺癌临床研究

目的探讨安罗替尼联合信迪利单抗同步放化疗一线治疗驱动基因阴性非小细胞肺癌(NSCLC)的临床疗效和安全性。方法选取苏州大学附属张家港医院2021年3月至2022年3月收治的驱动基因阴性NSCLC患者80例,按随机数字表法分为观察组和对照组,各40例。对照组患者给予NP化疗方案(顺铂30 mg/m^(2)+长春瑞滨25 mg/m^(2))+肺内原发灶和区域淋巴结放射治疗,观察组患者在对照组基础上加用安罗替尼联合信迪利单抗200 mg/m^(2)(第1天)。两组患者均以21 d为1个周期,共治疗4个周期。结果观察组客观缓解率和疾病控制率分别为72.50%和85.00%,均显著高于对照组的37.50%和52.50%(P<0.05)。治疗后,两组患者血清癌胚抗原(CEA)、糖类抗原125(CA125)、细胞角质蛋白19片段抗原21-1(CYFRA21-1)水平均显著降低(P<0.05),生活质量调查核心问卷(QLQ-C30)和肺癌专用问卷(QLQ-LC13)评分均显著升高(P<0.05),且观察组均显著优于对照组(P<0.05)。观察组和对照组患者Ⅲ级及以上不良反应发生率相当(62.50%比52.50%,P>0.05)。所有患者的中位随访时间为15个月(12~24个月),失访3例。观察组中位无进展生存期(PFS)和中位总生存期(OS)分别为6.9个月和12.6个月,均显著长于对照组的4.3个月和8.9个月(Log-rankχ2=13.760,31.830,P<0.05)。结论安罗替尼联合信迪利单抗同步放化疗可提高驱动基因阴性NSCLC患者的临床疗效,改善生活质量,降低血清肿瘤标志物水平,延长生存时间,且安全性高。

同步放化疗期间头颈癌病人症状群与生活质量的相关性研究

目的:调查头颈癌病人同步放化疗期间症状群及生活质量,并分析两者之间的相关性。方法:采用一般资料调查表、安德森症状评估量表-头颈部模块、头颈癌生活质量量表,对安徽省某三甲医院134例同步放化疗期间头颈癌病人进行调查。结果:通过因子分析提炼出头颈放疗特异性症状群、进食障碍症状群、病感行为症状群、心理情绪症状群、胃肠道症状群5组症状群,累积方差贡献率达72.21%,其中头颈放疗特异性症状群尤为严重;病人生活质量总分为(82.95±9.01)分,处于较低水平;5组症状群与生活质量总分均呈负相关关系(P<0.05~P<0.01);回归分析显示,除胃肠道症状群外,其余4组症状群均为生活质量的负向预测因素(P<0.05~P<0.01)。结论:头颈癌病人同步放化疗期间存在多个影响生活质量的症状群,医护人员应及时准确识别并干预,尤其是头颈放疗特异性症状群,从而提高病人的生活质量。

卡瑞利珠单抗联合吉西他滨联合顺铂方案同步放化疗治疗鼻咽癌的临床研究

目的观察卡瑞利珠单抗联合吉西他滨联合顺铂(GP)方案同步放化疗治疗鼻咽癌(NPC)的临床疗效,并分析联合治疗对NPC患者生存期的影响。方法选择2018年3月至2020年3月西安市北方医院收治的120例NPC患者作为研究对象,根据治疗方法分为观察组与对照组,各60例。对照组给予GP方案同步放化疗治疗,观察组给予卡瑞利珠单抗联合GP方案同步放化疗治疗。治疗4个周期后,比较2组患者肿瘤缓解情况;全部患者均于治疗4个周期后随访2年,记录2组患者总生存期、无远处转移生存期、无局部复发生存期;并记录患者治疗期间不良反应发生情况。结果治疗4个周期后,观察组总缓解率高于对照组(82%和63%),差异有统计学意义(χ^(2)=5.058,P<0.05);2组随访2年期间,观察组病死3例(5%),远处转移6例(10%),局部复发9例(15%),对照组病死10例(17%),远处转移12例(20%),局部复发17例(28%);观察组总生存期、无局部复发生存期高于对照组,差异有统计学意义(P<0.05);2组各级不良反应比较,差异无统计学意义(P>0.05)。结论卡瑞利珠单抗联合GP方案同步放化疗能够有效提升NPC患者临床治疗效果,延长生存期,且不会增加不良反应发生风险。

不同放疗剂量在局部晚期肺癌中的应用及其安全性分析

目的探讨不同放疗剂量在局部晚期肺癌中的应用及其安全性。方法回顾性选择2023年3月至12月在本院放疗科接受治疗的局部晚期肺癌患者75例进入试验,根据患者的耐受情况分为高剂量组和低剂量组,其中低剂量组(38例,放疗剂量45 Gy),高剂量组(37例,放疗剂量65 Gy),对比分析2组患者的临床疗效、疾病控制率、生存率、复发率、血清指标、毒副作用以及免疫因子水平。结果治疗后,高剂量组临床治疗有效率97%,低剂量组87%(χ^(2)=1.545,P>0.05);高剂量组和低剂量组的疾病控制率(86%和66%)、复发率(68%和89%)和生存率(18%和3%)比较有统计学意义(P<0.05);2组血清指标水平均下降,且高剂量组血清癌胚抗原(CEA)、糖类抗原(CA)125、CA19-9、细胞角蛋白19片段(CYFRA21-1)水平高于低剂量组(P<0.05);高剂量组的恶心呕吐、肝肾功能异常等5项毒副反应发生率高于低剂量组(P<0.05);治疗后,高剂量组的CD8^(+)(35.7±4.3)%高于低剂量组(30.3±4.8)%、且高剂量组的CD4^(+)(31.3±4.7)%和CD4^(+)/CD8^(+)(0.89±0.18)分别低于低剂量组的CD4^(+)(37.9±4.82)%和CD4^(+)/CD8^(+)(1.22±0.34),差异有统计学意义(P<0.05)。结论高剂量放疗在局部晚期肺癌疾病控制中的效果优于低效量放疗,复发率低,但低剂量安全性更高。

舒格利单抗辅助同步放化疗对晚期肺癌患者肿瘤控制及预后的影响

目的:探究同步放化疗联合舒格利单抗对晚期肺癌患者肿瘤控制及预后的影响。方法:选取2022年1月至2023年1月于我院进行就诊的82例晚期肺癌肿瘤患者为研究对象,根据随机抽签法,分为对照组和实验组,各41例。对照组给予常规同步放化疗治疗(顺铂+依托泊苷)方案,实验组给予舒格利单抗辅助同步放化疗治疗方案。治疗6 w后使用实体瘤疗效评定标准和功能状态评分观察两组患者治疗后的短期疗效,使用流式细胞术观察T淋巴细胞亚群水平,采用Log Rank χ^(2)检验比较两组患者的半年生存率。结果:治疗6 w后,实验组的客观缓解率为65.85%,明显高于对照组的29.26%(P<0.05)。而实验组的疾病控制率为92.86%,较对照组的75.60%略高(P>0.05)。治疗结束后,实验组患者的生存质量稳定改善率为87.81%,高于对照组的41.46%(P<0.05)。治疗后,实验组CD3^(+)、CD4^(+)、CD4^(+)/CD8^(+)高于对照组(P<0.05);实验组CD8^(+)水平低于对照组(P<0.05)。随访6 m内,对照组患者病死率14.63%,实验组病死率4.88%,两组患者预后病死率差异有统计学意义(χ^(2)=4.203,P=0.040)。结论:同步放化疗联合舒格利单抗可提高晚期非小细胞肺癌的近期疗效及预后,改善患者免疫状态,提高生存质量,具有较好的临床应用价值。

常规放疗加每周紫杉醇治疗局部晚期鼻咽癌的临床Ⅰ期试验

目的 :评价常规放疗的同时每周 1次紫杉醇持续 3小时滴注治疗局部晚期鼻咽癌的剂量限制性毒性(dose-limitingtoxicity ,DLT ) ,确定此治疗模式下紫杉醇的最大耐受剂量 (maximaltolerantdose,MTD)。方法 :局部晚期鼻咽癌患者随机进入前瞻性临床I期试验。急性毒性按常见毒性评价标准 (CommonToxicityCriteria:Ver sion 2 .0 ,CTC 2 .0 )分级 ,紫杉醇MTD定义为≥ 2 / 6患者出现DLT剂量水平的下一级剂量。紫杉醇每周 1次 ,持续静滴 3小时 ,开始剂量 2 0mg/m2 ,每个剂量水平治疗 3例 ,如无DLT发生则逐次递增 10mg/m2 。放疗每周 5次 ,每次 2Gy ,总剂量 6 8～ 70Gy。结果 :2 0 0 0年 12月～ 2 0 0 1年 6月 ,16例患者按计划完成了治疗。在 2 0mg/m2剂量水平未发生DLT ,30mg/m2 水平 1/ 3患者发生Ⅲ级口咽部粘膜炎并持续 5周 ,再以此剂量治疗的 3例未发生DLT。 4 0mg/m2 水平的 3例中 1例发生Ⅲ级粘膜炎并持续 4周 ,1例发生Ⅲ级皮肤损伤并持续 4周。为增加试验的可靠性 ,再以 30mg/m2 治疗了 4例患者 ,未有DLT发生。按照计划试验到此停止。中位随访 12个月后 ,1例放疗后 6个月死于多发性骨转移 ,1例右上颈淋巴结足量照射后残留 ,观察至 3个月时 ,淋巴结开始增大 ,予以手术摘除。其余 14例均无瘤生存。结论

同步放化疗和单纯放疗治疗ⅡB～ⅢB期宫颈癌的疗效比较

背景与目的:同步放化疗已成为局部晚期宫颈癌的标准治疗模式,但对于放疗联合何种方案的化疗效果最佳,目前尚无一致意见。本研究中我们比较同步放化疗与单纯放疗,以及同步放化疗不同化疗方案的疗效及毒副反应。方法:2003年1月至2004年12月江西省妇幼保健院收治的符合入组标准的ⅡB～ⅢB期宫颈癌患者285例,按住院序号随机分为单纯放疗组142例,同步放化疗组143例。同步放化疗组又按化疗方案不同分为:BP(博来霉素+顺铂)方案同步放化疗51例,TP(紫杉醇+卡铂)方案同步放化疗47例,FP(氟尿嘧啶+顺铂)方案同步放化疗45例。比较单纯放疗组与同步放化疗组患者的3年生存率和不良反应,同时对同步放化疗三种不同化疗方案组的3年生存率及不良反应进行比较。结果:全组中位随访时间为42个月,单纯放疗组与同步放化疗组的3年生存率分别为65%和75%,两组比较差异有统计学意义(P=0.042)。单纯放疗组Ⅲ～Ⅳ度急性毒副反应低于同步放化疗组(P<0.001),迟发性毒副反应两组差异无统计学意义(P=0.613)。同步放化疗组BP方案、TP方案、FP方案的3年生存率分别为74%、80%和71%,三组间比较差异无统计学意义(P=0.792)。三组Ⅲ～Ⅳ度急性及迟发性毒副反应发生率相似。结论:与单纯放疗相比,同步放化疗可明显提高ⅡB～ⅢB期宫颈癌患者的疗效。在同步放化疗三种不同的化疗方案中,紫杉醇联合卡铂方案组患者3年生存率略高于其他两种化疗方案,毒副反应可耐受,值得进一步研究。

紫杉醇联合卡铂三周方案同步胸部放疗治疗不宜手术的局部晚期非小细胞肺癌疗效和安全性研究:一项来自单中心的回顾性研究

背景与目的对于局部晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)同步放化疗是推荐的标准治疗。理想的化疗方案并未确立。本研究拟回顾性分析紫杉醇/卡铂(paclitaxel/carboplatin,PC)三周方案同步胸部放疗治疗局部晚期NSCLC的疗效和安全性,并与标准的依托泊苷/顺铂(cisplatin/etoposide,PE)方案进行比较。方法回顾性分析北京协和医院2012年1月-2014年6月收治的局部晚期NSCLC患者共43例,其中15例接受PC三周方案同步胸部放疗,28例接受PE方案同步胸部放疗。比较两组患者的临床特征、疗效和不良反应。结果全组患者:客观缓解率(objective response rate,ORR)为41.9%,疾病控制率(disease control rate,DCR)为90.7%,中位无疾病进展生存时间(progression-free survival,PFS)为10.6个月(95%CI:7.4-13.8),中位总生存期(overall survival,OS)为19.2个月(95%CI:15.3-23.1)。PC组和PE组在疗效上无统计学差异(ORR:33.3%vs 46.4%,DCR:86.7%vs 92.9%,P=0.638;PFS:6.6个月vs 12.2个月,P=0.389;OS:16.1个月vs 22.1个月,P=0.555)。不良反应可处理,两组均未发生治疗相关死亡。结论PC三周方案同步胸部放疗治疗局部晚期NSCLC与标准PE方案疗效相似,不良反应可接受,在临床中可采用。