目的 观察消癌平注射液联合SOX化疗方案一线治疗晚期胃癌的临床疗效及不良反应.方法 选择2015年6月-2018年6月中国人民解放军总医院第七医学中心收治的晚期胃癌患者84例,采用随机数字表法分为观察组与对照组各42例.对照组予SOX方案(替吉奥+奥沙利铂)治疗,观察组在对照组SOX方案基础上联合消癌平注射液治疗.比较2组近期疗效、生活质量、治疗前后免疫功能及不良反应.结果 观察组有效率(RR)为45.24％,对照组治疗RR为40.48％,2组比较差异无统计学意义(x2 =0.194,P=0.659);观察组临床受益率(DCR)为85.71％,高于对照组的66.67％ (x2=4.200,P=0.040);观察组生活质量总改善率为80.95％,高于对照组的57.14％(x2 =5.570,P=0.018);观察组治疗前后各免疫功能指标比较差异均无统计学意义(P＞0.05),而对照组治疗后各免疫功能指标均低于治疗前(P＜0.05),且观察组治疗后各免疫功能指标均高于对照组(P＜0.05);2组非血液学及血液学不良反应发生率比较差异均无统计学意义(P＞0.05).结论 消癌平注射液联合SOX方案一线治疗晚期胃癌可提高治疗疗效,改善患者生活质量.

目的 初步评价注射用焦叶绿酸己醚(2-[1-hexyloxyethyl]-2-devinyl pyropheophorbide-a,HPPH)光动力治疗食管癌的有效性和安全性.方法 纳入诊断明确的食管癌患者18例,经标准治疗失败、缺乏或拒绝标准治疗的食管癌患者18例,其中2.5 mg/m2、3.0mg/m2、3.5 mg/m2、4.0 mg/m2和5.0 mg/m2剂量组入组病例数分别为3例、3例、4例、6例和2例受试者.用药后(48±2)h接受波长665 nm激光照射,功率密度150 mW/cm2,能量密度为150 J/cm2.结果 吞咽指数为0者3例,2例完全缓解(complete remission,CR),1例部分缓解(partial response,PR).部分梗阻性食管癌3例,1例PR、2例疾病稳定(stable disease,SD).严重梗阻性食管癌12例,28 d吞咽改善率63.6％(7/11,1例出组未评价),21 d吞咽改善率81.8％(9/11).所有受试者均未出现皮肤光毒性.发生2例严重不良反应(severe adverse event,SAE),均为气管食管瘘,判定1例可能与治疗有关,1例与治疗可能无关.发生率超过20％的不良反应有疼痛(14/18)、咳嗽(5/18)、发热(5/18).结论 HPPH光动力治疗食管癌安全有效,值得进一步深入研究.

“忌口”,让多少肿瘤患者欲罢不能. “发物”,让众多家属无所适从.对肿瘤患者来说,疾病持续不断的消耗、密集抗肿瘤治疗的实施和沉重的心理负担,都在呼唤高质量的营养支持.但在临床工作中我们发现,不少肿瘤患者对自己的饮食生活缺乏管控,导致身体吃不消;还有一些患者对自己的饮食设置了各种禁忌,结果导致营养不足,后续抗癌治疗无法顺利实施.如何合理饮食,帮助肿瘤患者顺利渡过治疗难关,尽快康复呢?

案例一:化疗是天使还是恶魔 不久前,我在肿瘤科门诊接诊了一位病人,中年男性,五十出头,大高个.人长得很精神,衣着也很得体.我们简单聊了聊,得知他是浙江人,在北京做生意,结肠癌术后半年,术后没做化疗,术后3个月复查过一次,胸腹部CT和肿瘤标志物都正常,这次想在我们医院复查.

10月11日是世界镇痛日,但你了解疼痛和镇痛治疗吗?疼痛是一种与生俱来的本能,它不会随时间迁延而减轻或适应.对于很多癌症患者来说,对疼痛的恐惧甚至大于对生命终结的恐惧. 还记得17年前,我刚刚当上医生,一天下午收治了一名晚期胰腺癌患者.老太太确诊已经一个多月,近来腰背部剧烈疼痛,让她彻夜难眠.医生也曾给她开出散利痛、曲马多等药物,效果都不理想.看着老人痛苦的样子,我给她开了一片吗啡片,再加上一片吗啡缓释片.下班前我叮嘱她的家人,如果止痛效果不佳,晚上一定要找值班医生追加药物.

Purpose: To analyze and study the short-term therapeutic effects and main adverse effects of 2 Porphyrin photosensitizer-mediated photodynamic therapy for esophageal cancer. Methods: We apply the hematoporphyrin derivative and hematoporphyrin injection produced by different manufacturers at different periods as photosensitizers in therapy of 79 esophageal cancer cases, with the administration dosage of 5 mg/kg and intravenous drip 24 hours before irradiation. We apply the gold vapor laser and semiconductor laser, respectively, as treatment light source, with the power density of 100 to 300 mW/cm2 and energy density of 100 to 300 J/cm2. After treatment for 1 to 4 sessions, we evaluate the short-term therapeutic effects as complete response, partial response, minor response, or no change, and then make comparative study on therapeutic effects and adverse effects. Results: There were 47 patients in hematoporphyrin derivative group, including 3 (6.4%) patients with complete response, 31 (66.0%) patients with partial response, 10 (21.3%) patients with minor response, and 3 (6.4%) patients with no change. The dysphagia score was reduced from 2.53 (1.16) before treatment to 1.32 (1.20; P < .01) after treatment. There were 32 patients in the hematoporphyrin injection group, including 3 (9.4%) patients with complete response, 19 (59.4%) patients with partial response, 6 (18.8%) patients with minor response, and 4 (12.5%) patients with no change. The dysphagia score was reduced from 2.41 (1.13) before treatment to 1.18 (0.99; P < .01) after treatment. The dysphagia scores of 2 groups after treatment were significantly reduced compared to those before treatment. Both groups did not display serious adverse effect. Conclusions: Two porphyrin photosensitizers in treatment of esophageal cancer at different clinical stages all had good effect with similar therapeutic effect, mild adverse effect, and good tolerance, which implies it is a preferable palliative therapy means.

Objective To study the clinical efficacy and adverse effects of the photodynamic therapy assisted respectively with two hematoporphyrin photosensitizers for upper gastrointestinal tract cancers.Methods Totally 105 patients with upper gastrointestinal cancers in different clinical stages were given photodynamic therapy.Hematoporphyrin derivative and hematoporphyrin injection were used as photosensitizers,which were given intravenously at a dose of 5 mg/kg,24 hours before the irradiation,respectively.Gold vapor laser and diode laser were used as the light source respectively.Their power density was 100 to 300 mW/cm2 and energy density 100 to 300 J/cm2.Results An evaluation of the therapeutic effect of the 67 patients given hematoporphyrin derivative showed that 5 patients (7.5％)had a complete response (CR),40 patients (59.7％) a partial response (PR),16 patients (23.9％) a mild response (MR) and 6 patients (9.0％) no response (NR).The results of the therapeutic effect of the 38 patients given hematoporphyrin injection were:4 CR (10.5％),22 PR (57.9％),7 MR(18.4％) and 5 NR(13.2％).No severe adverse effect was found with any patient in any group.Conclusions The photodynamic therapy using hematoporphyrin derivative or hematoporphyrin injection as a photosensitizer is an effective and safe palliative modality for upper gastrointestinal tract cancers.

Objective To observe the efficacy and toxicity of second-line treatment of irinotecan combined with lobaplatin for extensive small cell lung cancer ( SCLC ) . Methods 46 cases of SCLC patients were selected and given irinotecan 200 mg/m2 into the normal saline 250 mL, diluted and then intravenous dripped for 1. 5 h on the first day;lobaplatin 30 mg/m2 into 5% glucose 500 mL, diluted and then intravenous dripped for 2 h on the first day. 21 d was 1 cycle. After two cycles of treatment, the efficacy and adverse reac-tions were evaluated. Results 46 cases could be evaluated. There were 1 case of complete remission ( CR ) , 15 cases of partial remis-sion ( PR ) , 19 cases of stable disease ( SD ) , 11 cases of progressive disease ( PD );the objective response rate ( ORR ) was 34. 78%, the disease control rate ( DCR ) was 76. 09%;the median progression-free survival ( PFS ) was 4. 6 months, and the median survival ( OS ) was 7. 8 months. Adverse reactions were hematologic toxicity and gastrointestinal reactions. Conclusion Irinotecan combined with lobaplatin program for the treatment of relapsed SCLC has a good effect but also larger toxicity, which is worthy of further study.

表皮生长因子受体酪氨酸激酶抑制剂( EGFR-TKI)开启了肺癌个体化治疗的新领域,而以间变性淋巴瘤激酶( ALK )、肝细胞生长因子受体 C ( C-MET)为主要靶点的克唑替尼于2011年8月26日获得美国食品与药物管理局批准使用[1-4]。通常认为,表皮生长因子受体( EGFR)和ALK、Kirsten鼠肉瘤病毒癌基因( KRAS)在非小细胞肺癌( NSCLC)中是互斥的,但Ulivi等[5]分析252例患者的EGFR与ALK,EGFR与KRAS以及ALK 与KRAS 基因双突变概率分别为1.6%,1.1%和2.5%。本文回顾性分析诊断C-MET和ALK双驱动共存型3例患者的临床资料并复习国内外相关文献,探讨双阳性患者服用克唑替尼的疗效及预后。

目的:评估甲地孕酮在晚期恶性肿瘤患者化疗期间的应用价值.方法:入组105例患者先接受1周期单独化疗,随后第2周期化疗开始前2d连续应用甲地孕酮14d,检测并分析患者两周期主要营养指标和恶心/呕吐的差异.结果:应用甲地孕酮后食欲改善率达到58.1％;KPS评分得到提升(79.0分vs76.0分,P=0.002);体重明显增加(60.7 kg vs 59.9 kg,P=0.016);血清白蛋白(36.7 g·L-1 vs 35.9g·L-1,P=0.007)和血清前白蛋白(234.5mg·L-1 vs221.7mg·L-1,P=0.007)均有改善;但血红蛋白和恶心/呕吐无改善.KPS评分＜80分患者多项指标改善更为显著.结论:甲地孕酮可以显著改善晚期恶性肿瘤患者化疗期间多项营养指标,减轻化疗对机体的不利影响,增加患者对化疗的耐受性和顺应性且安全性良好.

阿片类药物是治疗慢性疼痛的重要药物,总体安全可靠.阿片类药物相关便秘是常见的消化道不良反应,在应用阿片类药物后随时可能发生,且不会逐渐耐受.近年来,国内镇痛治疗取得了很大进步,阿片类药物的处方量逐年增加,阿片类药物相关便秘的诊断和治疗更显重要.常规缓泻药治疗阿片类药物相关便秘疗效不甚满意.一些新靶点治疗药物,包括鲁比前列酮、复方羟考酮纳洛酮缓释片、甲基纳曲酮、纳洛醇醚等的应用,显示出对阿片类药物相关便秘良好的治疗效果,值得关注.处方阿片类药物的临床医师及时诊断并合理治疗阿片类药物相关便秘,是镇痛治疗的重要工作内容.

Naloxone is a synthetic pan-opioid receptor competitive antagonist of the opioid receptors inside and outside the cen-tral nervous system. After systemic administration, it reverses almost all opioid effects. Systemically administered naloxone is used to reverse the life-threatening opioid toxicity. A number of studies have analyzed the importance of oral naloxone as a peripheral opioid an-tagonist in cancer patients. Naloxone has shown satisfactory efficacy for opioid-induced constipation (OIC). Ultra-low dose of naloxone has been reported to enhance the anti-nociceptive effect of morphine and reduce morphine consumption. We summarize the results from current studies of naloxone administration in cancer pain management.

Objective To analyze the treatment parameters adopted in curing upper gastrointestinal tract cancer with photodynamic therapy and the clinical characteristics thereof. Methods Five patients with upper gastrointestinal tract cancer in early stage were treated with photodynamic therapy.HpD and porfimer sodium(Photofrin) were used as photosensitizers,which were given intravenously in doses of 5 mg/kg and 2 mg/kg respectively 24-72 hours before irradiation.Gold vapor laser and diode laser were used as light source for the irradiation respectively at a power density of 100 to 200 mW/cm2 and an energy density of 100 to 200 J/cm2. Results Of the five patients cured of upper gastrointestinal tract cancer,three were healed with one course of photodynamic therapy.One patient with gastric antrum cancer was cured with one course of photodynamic therapy and the cancerous change to his corpus ventriculi,found 4 years later,was also healed after another course of photodynamic therapy.Another patient,whose cancer focus had invaded the shallow layer of intrinsic muscle,was cured after two courses of photodynamic therapy.Neither relapse nor metastasis of cancer occurred to any of the five patients in the follow-up period of 2 to 8 years.In general,the adverse effects were mild,and only one patient developed esophagus cicatricial stenosis after the therapy. Conclusions Photodynamic therapy can safely cure certain types of early-stage upper gastrointestinal tract cancer with mild adverse effects,and it is worth furthering the exploration and research in this area

Objective: To observe and analyze adverse effects related to two different FOLFIRI regimens in patients with advanced colorectal cancer.Methods: A total of 121 patients with advanced colorectal cancer were assigned to receive two FOLFIRI regimens.The incidence of adverse effects was recorded.The correlation between clinical characteristics of the adverse effect development and chemotherapy regimens was analyzed.Results: Delayed-onset diarrhea(43.8%) and neutropenia(42.1%) were major dose-limited toxicity.Five patients with severe diarrhea and 4 patients with serious myelosuppression were withdrawn from the study.Cholinergic symptoms were more common in senior patients(75.0% vs 54.3%,P = 0.028) and nausea / vomiting were more common in female patients(68.8% vs 49.3%,P = 0.024).Other adverse effects of modified FOLFIRI were similar to those of classic FOLFIRI,except for mucocitis(47.1% vs 27.5%,P = 0.028).Conclusion: Both different FOLFIRI regimens can be safely used for treating advanced colorectal cancer and the modified FOLFIRI can be a suitable substitute for classic FOLFIRI.

10.3969/j.issn.1000-8179.2013.12.011

脑胶质细胞瘤是成年人中最常见的原发中枢神经系统恶性肿瘤,占总数的50％～60％,其中以胶质母细胞瘤恶性程度较高[1].脑胶质瘤发病率虽仅占全身恶性肿瘤的3％～5％,但因治疗手段有限、肿瘤生物学行为多样且呈浸润性生长,预后差、平均生存期短.

目的:观察和分析伊立替康治疗结直肠癌相关胆碱能综合征的发生情况.方法:应用2种FOLFIRI方案治疗转移性结直肠癌患者89例,观察和记录胆碱能综合征发生情况,并将其与患者临床资料、其他不良反应和所应用的治疗方案进行相关性分析.结果:53例（59.6%）患者发生胆碱能综合征,中位发生时间为伊立替康开始滴注后150min（30min-25h）,绝大多数在用药后24h内逐渐消退,预防性应用阿托品可以有效预防胆碱能综合征发生;≥60岁老年患者胆碱能综合征明显高发（75.9%vs51.7%,P=0.029）,未发现其与性别、ECOG评分等临床特征有关;出现胆碱能综合征患者迟发性腹泻有减少趋势（52.8%vs34.0%,P=0.077）,未发现胆碱能综合征与其他不良反应相关;采用高剂量氟尿嘧啶治疗方案患者黏膜炎明显高发（50.0%vs27.5%,P=0.029）.结论:伊立替康相关胆碱能综合征高发,应引起临床医生重视;胆碱能综合征对后续可能发生的迟发性腹泻和/或骨髓抑制无预测作用.

目的:调查了解某边防部队士兵的心理健康水平.方法:采用症状自评量表(SCL-90)对某边防部队士兵273例进行心理健康水平测评,并与中国军人常模比较.结果:本次共筛查出阳性27例,阳性率为9.9％.某边防部队士兵躯体化因子分值非常显著高于中国军人常模(P＜0.01),而人际关系敏感、抑郁、偏执和精神病性因子分值显著或非常显著低于中国军人常模(P＜0.05,P＜0.01);SCL-90总分和其他因子分值与中国军人常模比较,差异不显著(P＞0.05).城镇士兵SCL-90总分、抑郁、恐怖、偏执和精神病性因子分值显著或非常显著高于农村士兵(P＜0.05,P＜0.01);其他各因子分值比较,差异不显著(P＞0.05).城镇独生子女士兵SCL-90总分、躯体化、强迫症状、抑郁、焦虑、恐怖、偏执和精神病性因子分值显著高于非城镇独生子女士兵(P＜0.05);其他各因子分值比较,差异不显著(P＞0.05).结论:某边防部队士兵整体心理健康水平较好,但部分城镇独生子女士兵心理健康水平不理想,应进行有针对性的心理干预.

[目的]探讨西妥昔单抗联合卡培他滨和顺铂一线治疗晚期胃癌的疗效与相关基因多态性的关系.[方法]分别应用PCR-限制性片段长度多态性法、PCR-直接测序法和SNPstream基因分型系统分析20个位点基因多态性,并分析其与TTP和临床疗效相关性.[结果]TS基因3RG携带者较非3RG携带者TTP有明显优势(6.1个月vs 3.0个月,P=0.024).VEGF C936T多态性的T/T基因型患者TTP明显较C/T及C/C基因型患者短(分别为2.0、5.2和5.4个月,P=0.014).EGF A61G多态性的G/G基因型中位TTP较A/G基因型有延长趋势(5.3个月vs 2.7个月,P=0.159).[结论]TS基因5’-UTR串联重复序列多态性、VEGF C936T多态性和EGF A61G多态性可能与西妥昔单抗联合卡培他滨/顺铂方案一线治疗晚期胃癌临床疗效相关.

Objective To investigate gene mutations of the epidermal growth factor receptor of tumor tissue and peripheral blood in non-small-cell lung cancer, and to compare the consistency of EGFR mutations in tumor tissue and peripheral blood, fluorescence quantitive polymerase chain reaction (FQ-PCR) was performed according to standard procedure. Methods 112 peripheral blood and 87 tumor tissue of NSCLC were detected by FQ-PCR, among which 45 cases were analyzed using peripheral blood-tumor tissue matched samples. The relationship between clinical efficacy and EGFR mutations Was analyzed. Results Our results showed that there is 32 mutations in EGFR in 112(28.6%)of the patients'peripheral blood samples and 27 mutations in EGFR in 87(31.O%)tumor tissue. EGFR mutations were mainly found in adenocarcinoma and non-smokers in NSCLC (P<0.05). The consistency of EGFR mutation between tumor tissue and peripheal blood reached 71.4%. The clinical outcome of mutations Was significantly effective(P