Objective To evaluate the efficacy and toxicity of nedaplatin or cisplatin combined with paclitaxel as first-line chemotherapy for patients with advanced esophageal cancer. Method A total of 80 patients with pathologi-cally confirmed and measurable lesions were enrolled and separated into either TN group (nedaplatin + paclitaxel) or TP group (cisplatin + paclitaxel) according to the respective chemotherapy regimen, and then all patients were fol-lowed up and the time to progress (TTP) and overall survival (OS) were analyzed. Result In terms of TN group (41 cases) vs TP group (39 cases), the response rate was 26.8% (11/41) vs 23.1% (10/39), with no statistical signifi-cance (P=0.603), the median TTP was significantly more in TN group as 6 months vs 5 months (P=0.003), and the median overall survival rate was also higher as 11 months vs 10 months (P=0.068); As to the most common adverse reactions, hematologic and gastrointestinal toxicities were included, however, the incidence of gastrointestinal toxicity in TP group was significantly lower than that in TN group (P=0.0001). Conclusion The combined chemo-therapy of nedaplatin + paclitaxel is as effective as the regimen of cisplatin + paclitaxel, while the TN regimen is su-perior with longer TTP and less gastrointestinal toxicity.

The UGT1A1*28 polymorphism, although closely linked with CPT-11-related adverse effects, cannot be used alone to guide individualized treatment decisions. However, CPT-11 dosage can be adjusted according to measured SN-38 pharmacokinetics. Our study is designed to investigate whether there is a relationship between SN-38 peak or valley concentrations and efficacy or adverse effects of CPT-11-based chemotherapy. We retrospectively studied 98 patients treated with advanced colorectal cancer in various UGT1A1*28 genotype groups (mainly (TA)6/(TA)6 and (TA)6/(TA)7 genotypes) treated with CPT-11 as first-line chemotherapy in Shanghai.

目的:回顾性分析2010年6月-2012年1月来自于多家医疗中心的69例进展期结直肠癌接受以伊立替康(irinotecan,CPT-11)为基础的二线联合化疗患者的尿苷二磷酸葡醛酰转移酶1A1 (uridine diphosphateglucuronosyl transferase 1A1,UGT1A1)*28基因多态性的表达情况,探讨UGT1A1*28 (TA)6/(TA)6和(TA)6/(TA)7型患者接受CPT-11治疗后的葡萄糖醛酸化SN-38(SN-38 glucuronide,SN-38G)峰浓度和谷浓度与不良反应和疗效之间的关系.方法:这是一项多中心的回顾性研究.研究对象为2010年6月-2012年1月接受以CPT-11为基础的二线联合化疗的69例进展期结直肠癌患者.化疗之前,检测UGT1A1基因多态性;在CPT-11化疗1.5和49.0 h时,应用高效液相色谱法检测SN-38血药浓度.观察近期疗效和不良反应,采用逐步回归分析法分析不同的UGT1A1*28基因型患者SN-38血药浓度与近期疗效和不良反应的关系.结果:69例患者中,(TA)6/(TA)6型45例(65.22％),(TA)6/(TA)7型24例(34.78％),未发现(TA)7/(TA)7型.CPT-11治疗后,(TA)6/(TA)7型患者的SN-38平均峰浓度和谷浓度均高于(TA)6/(TA)6型患者(P=0.001,P=0.000).逐步回归分析结果显示,(TA)6/(TA)6型患者的SN-38峰浓度与无病生存期相关,SN-38谷浓度与近期疗效相关;而(TA)6/(TA)7型患者的SN-38峰浓度与骨髓抑制相关,SN-38谷浓度与治疗后血浆总胆红素水平和迟发性腹泻相关.(TA)6/(TA)6型患者SN-38峰浓度＞43.20 ng/mL和谷浓度＞9.41 ng/mL的中位无进展生存期优于SN-38峰浓度≤43.20 ng/mL (6.0和4.6个月,x2=25.57,P=0.00)和谷浓度≤9.41 ng/mL的患者(6.0和5.2个月,x2=6.81,P=0.01).(TA)6/(TA)7型患者SN-38峰浓度＞50.60 ng/mL和谷浓度＞16.29 ng/mL的中位无进展生存期并不明显优于SN-38峰浓度≤50.60 ng/mL(7.0和6.0个月,x2=0.18,P=0.67)和谷浓度≤16.29 ng/mL的患者(6.0和7.3个月,x2=0.56,P=0.46),而骨髓抑制发生率(P=0.02,P=0.02)和迟发性腹泻发生率(P=0.04,P=0.03)较高.结论:进展期结直肠癌患者以UGT1A1*28 (TA)6/(TA)6型和(TA)6/(TA)7型占绝大多数.对于(TA)6/(TA)6型患者,如果CPT-11化疗后SN-38峰浓度≤43.20 ng/mL或谷浓度≤9.41 ng/mL,可逐步增加CPT-11剂量以提高治疗效果;对于(TA)6/(TA)7型患者,如果CPT-11化疗后SN-38峰浓度＞50.60 ng/mL或谷浓度＞16.29 ng/mL者,可适当减少CPT-11剂量以减轻不良反应,而不影响化疗效果.

Objective To investigate the radiosensitizing effect of docetaxel on gastric cancer xenograft in nude mice and the induction of apoptosis by docetaxel combined with radiotherapy.Methods The animal models of xenotransplanted human gastric cancer cell line AGS was set up in 28 nude mice which were divided into 4 groups at random.:the control group,radiation group,docetaxel group and docetaxel plus radiation group.The tumor mass volume was observed in all the groups and the inhibition rate for tumor growth calculated.The effect of radiation enhancement of docetaxel was assessed.The specimens obtained from the nude mice were then detected by optical microscope and TdT-mediated dUTP nick end labeling(TUNEL).Results The mass of gastric tumor was formed in all the nude mice,and none of the mice died.The difference in the volume of tumor formation was significant between the groups,P0.01.The rate of tumor inhibition in the radiation group,docetaxel group and docetaxel plus radiation group were 36.4%,44.2%,86.9%,respectively.EF(enhancement factor)was 1.5 in the docetaxel plus radiation group.The average apoptosis index(AI)in the docetaxel plus radiation group was(15.6±2.3)%,which was higher than the other groups(P0.01).Conclusions Docetaxel has an evident radiosensitizing effect on gastric cancer xenograft in the nude mice.As compared to docetaxel alone or radiation alone,docetaxel combined with radiotherapy is more efficient in inducing tumor cell apoptosis.

Purpose To explore the prognostic factors of the extrahepatic bile duct carcinoma.Methods Sixty-eight patients with extrahepatic bile duct carcinoma were followed up.Univariate survival analysis and Cox multivariate regression were used to analyze prognostic factors from these clinical data.Results The median overall survival(OS)of the patients that received radical resection,simple resection and palliative draining operations were 27 months,16 months and 6 months,respectively(P=0.001),and the median OS of the patients with Ⅲ～Ⅳ stage extrahepatic bile duct carcinoma and those with Ⅰ～Ⅱ stage were 16 months and 37 months,respectively(P=0.015).Cox model found surgical procedure(P=0.001)and clinical stage(P=0.037)were independent prognostic factors of OS.Median relapse free survival(RFS)in the patients with Ⅰ～Ⅱ stage extrahepatic bile duct carcinoma was significantly longer than that with Ⅲ～Ⅳ stage(21 months vs.11 months,P=0.003),and median RFS of the patients with adjuvant chemotherapy was significantly longer than that without(19 months vs.11 months,P=0.046).Cox model confirmed that clinical stage(P=0.033)and post-surgical adjuvant chemotherapy(P=0.038)were independent prognostic factors of RFS.Conclusion Surgical modality and clinical stage were independent factors affecting OS,while clinical stage and adjuvant chemotherapy were independent prognostic factors affecting RFS of extrahepatic bile duct carcinoma.

目的:比较早期隔上霍奇金淋巴瘤(HD)斗篷野与累及野放疗联合化疗的疗效.方法:对35例早期HD患者,先予化疗4个疗程,然后随机分为常规斗篷野放疗(20例)或累及野放疗(15例),剂量为大野30Gy,局部肿块区加至40Gy,放疗后再化疗2个疗程.结果:中位随访58个月.3年总生存率为94.3%.无复发生存率为80.0%.两组3年总生存率及无复发生存率无明显差异.结论:早期隔上HD在化疗基础上,累及野与斗篷野放疗疗效相似,并发症较低.

目的:分析直肠癌根治术后局部复发的类型、综合治疗的疗效及预后.方法:对直肠癌术后局部复发、以往未接受过放疗的66例病人进行疗效分析.原手术方式为经腹直肠切除术45例(Dixon术40例,Parks术5例),腹会阴直肠切除术21例.经腹直肠切除术后复发以吻合口为主(37/45,82.2%),腹会阴直肠切除术后复发则以盆腔或会阴为主(19/21,905%).复发后盆腔放疗中位剂量为40(20～64)Gy,临床症状缓解中位剂量26(10～52)Gy.其中26例在放疗过程中或之后接受过中位7个(2～12)疗程以5-FU为主的化疗.有22例放疗后获补救手术机会.结果:全组中位生存期24个月.Kaplan-Merier法计算生存率,放疗后1、3年总生存率分别为72.2%、17.9%.单因素分析并Log-rank检验生存率差异,显示生存率与原发病变的期别、术后复发时间、复发部位及是否加用化疗无关,而仅与是否再次行补救手术有关.放疗后加用补救手术者3年生存期明显较长,为36.0%比8.8%(P=0.016).结论:直肠癌根治术后局部复发者,放疗具有良好的姑息减症的作用;对部分经腹直肠切除术后的复发病例,放射治疗加补救手术能明显延长生存期.

Objective:　To evaluate and compare the effects of pre- and postoperative radiotherapy on rectal cancer. Methods:　One hundred and seventy-six cases of histologically proved rectal cancer admitted from February 1988 to February 1995, were divided into 3 groups. Group one: 38 patients(T2:68.4%) were treated with a single fraction preoperative radiotherapy, with a tumor dose of 5 Gy; operation was performed within 48 hours. Group two: 43 patients(T3～4:60.5%) were treated by the conventional preoperative radiotherapy regimen with a median tumor dose of 40Gy in 20 fractions, with a daily dose of 1.8～2Gy, followed by surgery within 4 weeks. Group three: 95 patients(T3～4:62.1%,T2～4N＋:81.1%) underwent postoperative radiotherapy with a median tumor dose of 54Gy in 30 fractions, with a daily dose of 1.8Gy, 3～4 weeks after surgery. Results:　The 3-yr and 5-yr survival rates were: 78.9% and 50.0% in group one, 67.4% and 51.1% in group two, 58.9% and 43.1% in group three. Local recurrence rates were:13.1% and 23.6% , 11.6% and 27.9%, 23.1% and 28.4% in the 3 groups, respectively. Only the 3-yr local recurrence rate of the two preoperative radiotherapy groups were significantly lower than those of the postoperative radiotherapy group (P<0.05). Conclusions:　Compared with the postoperative radiotherapy regimen, preoperative radiotherapy with a proper dosage had better local control and fewer complications.