恶性骨肿瘤局部切除术中放疗灭活保肢的探讨

目的:探索一种既能延长生命、保住肢体,又能最大程度保留关节功能的四肢恶性骨肿瘤治疗方法.方法:1999年7月～2003年6月对9例四肢恶性骨肿瘤患者,进行局部切除术中放疗灭活保肢术前后配合化疗的治疗.结果:局部无一例复发,关节稳定,活动度均在90～135度,效果较好.结论:恶性骨肿瘤局部切除术中放疗灭活保肢的治疗方法不失为一种有效治疗方法,能较好地提高四肢恶性骨肿瘤患者的生存质量.     

恶性骨肿瘤局部切除术中放疗灭活保肢的探讨

目的：探索一种既能延长生命、保住肢体，又能最大程度保留关节功能的四肢恶性骨肿瘤治疗方法。方法：1999年7月∽2003年6月对9例四肢恶性骨肿瘤患者，进行局部切除术中放疗灭活保肢术前后配合化疗的治疗。结果：局部无一例复发，关节稳定，活动度均在90∽135度，效果较好。结论：恶性骨肿瘤局部切除术中放疗灭活保肢的治疗方法不失为一种有效治疗方法，能较好地提高四肢恶性骨肿瘤患者的生存质量。     

经左锁骨下动脉埋植药盒治疗晚期肺癌

目的：探讨经皮左锁骨下动脉穿刺埋植药盒，高位胸主动脉长期间歇灌注，治疗晚期肺癌２２例的疗效。方法：采用ＭＦＤＰ方案，即丝裂霉素－Ｃ１０ｍｇ，第１天，５－氟脲嘧啶０．５ｇ，第１～５天，吡柔比星６０ｍｇ，第５天，每３周重复一次。结果：２２例中，１３例有效，其中完全缓解２例。结论：毒副作用较静脉全身化疗轻。     

超选择性动脉内插管药物灌注治疗恶性骨肿瘤6例报告

本文报道我所1987年底—1989年收治的6例恶性骨肿瘤病例。采用以选择性动脉内插管阿霉素和顺铂局部化疗灌注术为主的治疗方法,辅以肿瘤局部刮除和其它疗法,有效地控制了局部复发和远处转移。缓解了病情,保留了患肢,提高了患者的生存质量和生存率。作者就恶性骨肿瘤的治疗问题,掌握动脉内插管化疗灌注和局部刮除的时机对预后的影响,肿瘤病理组织类型与药物敏感性、动脉内插管药物灌注治疗肿瘤疗效的评价等问题进行了讨论。     

进展期大肠癌术后早期腹腔灌洗化疗

目的了解进展期大肠癌术后早期腹腔灌洗化疗对防治腹腔内复发和肝脏转移的价值。方法选择１９９０年～１９９７年经手术及病理证实的１０２例侵及浆膜或腹腔癌胚抗原增高的大肠癌,随机分成腹腔灌洗化疗组５４例,静脉化疗组４８例。腹腔灌洗化疗组于手术当日开始用４３～４５℃的双蒸馏水１５００～２０００ｍｌ加５Ｆｕ１ｇ、ＭＭＣ１０ｍｇ行腹腔灌洗,连续应用６次;静脉化疗组用５Ｆｕ１ｇ、ＭＭＣ８ｍｇ每日静滴１次,连续６次;两组各用６次后改为口服呋喃氟脲嘧啶,总量为４０ｇ。结果静脉化疗组腹腔内复发１２例,肝脏转移６例;腹腔灌洗化疗组腹腔内复发２例,肝脏转移２例。两组未见并发症。结论术后早期腹腔灌洗化疗对防治进展期大肠癌腹腔内复发和肝脏转移有明显疗效,而且方法简单,安全、实用     

恶性骨肿瘤介入化疗的护理问题及应对策略

随着对骨肿瘤认识的不断深入，术前、术后辅助化疗的规范化应用，使恶性骨肿瘤保肢率和生存率大幅提高，越来越多的患者得以保留有用的肢体。介入化疗是经导管把化疗药物注入肿瘤供养动脉内，通过栓塞肿瘤血管抑制肿瘤生长达到对肿瘤的治疗目的。具有肿瘤局部化疗药物浓度高、外周血液浓度低、疗效高、创伤小、全身毒副作用少、还可以重复使用的优点，是骨科恶性肿瘤患者通常采用的治疗方法。我院以1998年至今，共对28例恶性骨肿瘤患者实施了介入化疗，由于我们术前对患者进行全面的健康教育，制定对策调动患者积极参与治疗，收到了满意的临床效果。     

消化道癌肝转移经皮植入药盒肝动脉内灌注化疗的临床观察

肝脏是消化道系统恶性肿瘤常见的转移部位，但许多患就诊时就已失去了手术切除机会，即或肝内肿瘤能够切除，术后仍有40％～70％肝内复发，全身静脉化疗仅对10％～20％的肝转移瘤有效，肝动脉灌注化疗较全身静脉化疗明显提高了局部有效，但其疗效与肝动脉灌注化疗方式及化疗药的药代动力学特性密切相关。     

不离体酒精浸泡灭活法治疗原发性恶性骨肿瘤

目的：推荐一种不切断骨在体内酒精灭活治疗原发性恶性骨肿瘤的方法，以缩短治疗周期，延长使用周期和减少骨愈合方面的并发症。方法：利用原发恶性骨肿瘤膝关节上、下高发的特点，解离关节，清除瘤灶，将含瘤骨段套入塑料袋中，并注入９５％ 酒精。灭活后修复缺损的骨，重建关节。共治疗８ 例。结果：获得随访的８ 例，中位时间２３ 个月（８～４２ 个月）。１ 例因软组织复发而截肢，２ 例因肺转移死亡，但无１ 例灭活骨复发，５ 例肢体功能满意。结论：体内酒精灭活治疗原发恶性骨肿瘤是一种较理想的灭活控制局部复发的方法。由于无需骨折愈合，肢体功能恢复满意     

内乳动脉置管化疗对局部晚期乳腺癌患者远期疗效的影响

目的比较术前经内乳动脉化疗和全身静脉化疗对局部晚期乳腺癌远期疗效的影响。方法随机将85例临床分期基本相同的晚期乳腺癌分为治疗组和对照组。治疗组41例行内乳动脉插管化疗，对照组44例行全身化疗，手术后再经放射治疗和全身化疗。经5年随访，对局部复发，骨、肝、胸肺转移，以及两组1、3、5年生存率进行统计分析。结果治疗组局部复发、骨转移、肝转移、胸肺转移分别为11、6、7、2例，1、3和5年存活率分别为100％、90．2％和80．5％；对照组局部复发、骨转移、肝转移、胸肺转移分别为11、5、10、10例，1、3和5年存活率分别为95．5％、77．3％和59．1％。结论内乳动脉置管化疗与全身化疗相比较，可减少晚期乳腺癌胸肺转移率并提高其5年生存率。     

周围型肺癌CT引导下经皮肺穿刺的治疗研究

１９９３～２０００年，我们对２８例周围型肺癌行全身静脉化疗加CT引导下经皮肺穿刺直接介入治疗，与单纯静脉化疗进行对照，现将其临床研究报道如下。１材料与方法１．１一般资料５０例同一时期住院患者随机分为两组，观察组（A组静脉加介入治疗）２８例，对照组（B组单纯静脉化疗）２２例，全部经细胞病理学证实为非小细胞型肺癌，且为不能手术的晚期肺癌。两组年龄、病期、病理类型、肿块大小、性别、体力评估无明显差异（P＞０．０５，详细资料省略）。１．２方法全身静脉化疗均采用CAP方案。A组：CAP化疗１个周期，加２次局部介…     

A case of gastric cancer with recurrent bone metastases successfully treated with induced hypertension chemotherapy using cisplatin]

A sixty-eight-year-old female with bone metastases from gastric cancer successfully treated with induced hypertension chemotherapy using cisplatin is reported. She had undergone R2 curative subtotal gastrectomy in June 1985, and had orally taken tegafur 600 mg/day and then changed to doxifluridine 800 mg/day as postoperative adjuvant chemotherapy. Five months after the operation she had back pains and both 99mTc-MDP and 67Ga-citrate scintigram showed L1 vertebra and rib bone metastasis. Induced hypertension chemotherapy using cisplatin was then intermittently performed from January 1986 to September 1990, a single course of which was 25 mg/body div x 2/week for serial 4 weeks; a total of seven courses were carried out and consequently the total volume of the administered cisplatin reached 1,100 mg. Neither medullar nor renal toxicities were observed, but mild gastrointestinal symptoms were noted. The patient no longer has back pains, and no signs of bone metastases were seen on both scintigrams for two years and eight months from December 1988 to August 1991. This case is very rare because her bone metastases were successfully treated with induced hypertension chemotherapy using cisplatin. However, metastatic bone tumors from gastric cancer usually resist any treatments. It is expected that the successfully treated patients even with bone metastasis will be increasingly reported from now as various new approaches including induced hypertension chemotherapy are introduced.     

Sequential immunochemotherapy and edrecolomab in the adjuvant therapy of breast cancer: reduction of 17-1A-positive disseminated tumour cells.

BACKGROUND: The aim of our study was to evaluate the efficacy of the monoclonal antibody edrecolomab after chemo- and radiotherapy in the elimination of disseminated tumour cells in bone marrow in the adjuvant therapy of breast cancer. PATIENTS AND METHODS: The bone marrow of 25 patients with breast cancer was tested for the presence of disseminated tumour cells using the pancytoceratine antibody and the alkaline phosphatase-anti-alkaline-phosphatase (APAAP) technique. To characterize tumour cells simultaneously, immunofluorescent double labelling of pancytoceratine and epithelial cell adhesion molecule (antibody 17-1A) was performed on tumour cells after magneto bead enrichment. Patients positive for the 17-1A antigen in bone marrow after chemotherapy were treated with edrecolomab (500 mg Panorex) initially, then 100 mg/month over 4 months) and investigated for the presence of micrometastases 6 weeks after the last treatment. RESULTS: Of the 17 patients showing bone marrow micrometastases (BM-MM), 14 tested 17-1A positive before adjuvant chemotherapy. After chemotherapy, nine patients remained positive for the 17-1A antigen and were treated with edrecolomab. The final investigation after immunotherapy showed a complete elimination of the 17-1A-positive BM-MM in seven patients and a significant reduction of these cells in two patients. CONCLUSIONS: Sequential treatment of breast cancer with edrecolomab after adjuvant chemotherapy can reduce disseminated tumour cells in the bone marrow and eliminate 17-1A-positive micrometastases.     

唑来膦酸钠对绝经后乳腺癌患者骨代谢影响结果分析

目的:通过观察唑来膦酸钠对绝经后乳腺癌患者骨代谢影响,探讨唑来膦酸钠在早期预防乳腺癌患者发生骨代谢障碍及抑制骨转移中的作用。方法:85例绝经后乳腺癌患者均手术治疗,且术后常规行6个疗程的化疗,无骨转移病例。对照组:28例化疗后接受中药治疗;来曲唑组:30例化疗后继续服用来曲唑2.5mg/d;来曲唑+唑来膦酸钠组:27例患者化疗后除服用来曲唑2.5mg/d外,使用唑来膦酸钠注射液4mg+生理盐水100ml,静脉滴注15min,每4周为1个疗程。6个月后应用双能X线骨密度仪对三组乳癌患者腰椎、股骨近端骨密度(BMD)进行测定,用SPETCT行全身核素骨显像检查,使用全自动生化仪器测定血清碱性磷酸酶(ALP)、血钙(Ca)、血磷(P)等生化指标,用免疫组化方法测定雌激素(E2),对三组患者治疗前后各项指标分析比较。结果:治疗后来曲唑组与对照组病人的BMD、E2、血清Ca、P指标比较,均明显降低(P<0.05)、ALP明显上高(P<0.05);来曲唑+唑来膦酸钠组与来曲唑组比较,BMD、血清Ca、P指标明显升高(P<0.05),ALP降低(P<0.05)、E2未见明显变化(P>0.05);来曲唑+唑来膦酸钠与对照组比较,ALP、E2指标明显降低(P<0.05),BMD明显升高(P<0.05),血清Ca、P未见明显变化(P>0.05)。与对照组比较唑来膦酸钠组的骨转移发生率明显降低(P<0.05)。结论:唑来膦酸钠对接受来曲唑治疗引起的骨代谢障碍早期防治疗效明显,且对骨转移发生有明显抑制作用。     

Successful treatment of metastatic retinoblastoma

BACKGROUND: In the past, patients with metastatic retinoblastoma have had a poor prognosis when treated with conventional modalities. In the current study, the authors evaluated the use of combined intensive conventional chemotherapy, high dose chemotherapy with autologous stem cell rescue (ASCR), and radiation therapy. METHODS: Four patients with metastatic retinoblastoma were treated. All had orbital and bone marrow metastases. In addition, three patients had bone metastases and two patients had liver metastases. None had central nervous system disease. Patients received intensive conventional chemotherapy that included vincristine, cyclophosphamide, etoposide, and either cisplatin or carboplatin. Stem cells were harvested after bone marrow disease was no longer detectable. High dose chemotherapy with carboplatin (500 mg/m(2)/day x 3 days or area under the curve = 7 via the Calvert formula) and thiotepa (300 mg/m(2)/day x 3 days) with (n = 3 patients) or without (n = 1 patient) etoposide (250 mg/m(2)/day x 3 days) was administered with ASCR. Sites that originally harbored bulky disease were irradiated after recovery from the high dose chemotherapy. RESULTS: The therapy was associated with substantial acute hematopoietic and mucosal toxicities. At last follow-up, all four patients had survived event free from 46-80 months after the diagnosis of metastatic disease. CONCLUSIONS: The treatment strategy described in the current study is effective for patients with metastatic retinoblastoma that does not involve the central nervous system. However, a multicenter trial should be considered to evaluate it in a larger group of patients.     

The effects of preoperative chemotherapy on isolated tumour cells in the blood and bone marrow of gastric cancer patients

Recent studies in breast cancer suggest that monitoring the isolated tumour cells (ITC) may be used as a surrogate marker to evaluate the efficacy of systemic chemotherapy. In the present study, we have investigated the effects of preoperative chemotherapy on ITC in the blood and bone marrow of patients with potentially resectable gastric cancer. After sorting out the CD45-positive cells, the presence of ITC defined as cytokeratin-positive cells was examined before and after preoperative chemotherapy. The patients received two courses of preoperative chemotherapy with cisplatin (100 mg m(-2), day 1) and 5-fluorouracil (1000 mg m(-2), days 1-5), administered every 28 days. Fourteen of 32 (44%) patients initially diagnosed with ITC in blood and/or bone marrow were found to be negative (responders) after preoperative chemotherapy (P<0.01). The incidence of ITC in bone marrow was also significantly (P<0.01) reduced from 97 (31 of 32) to 53% (17 of 32). The difference between patients positive for ITC in the blood before (n=7, 22%) and after (n=5, 16%) chemotherapy was statistically insignificant. The overall 3-year survival rates were 32 and 49% in the responders and non-responders, respectively (P=0.683). These data indicate that preoperative chemotherapy can reduce the incidence of ITC in patients with gastric cancer.     

Capecitabine and vinorelbine in elderly patients (> or =65 years) with metastatic breast cancer: a phase I trial (SAKK 25/99).

BACKGROUND: Few chemotherapy regimens are suitable for the treatment of elderly patients with advanced breast cancer. With the aim of finding a regimen with a low burden of subjective non-overlapping toxic effects, vinorelbine and capecitabine were chosen to be investigated in a phase I dose-finding study. PATIENTS AND METHODS: Thirty-six patients with advanced breast cancer were stratified for the presence of bone and non-bone involvement and treated at four dose levels from capecitabine 800 mg/m2 orally days 1-14 and vinorelbine 20 mg/m2 intravenously days 1 and 8, to capecitabine 1250 mg/m2 orally days 1-14 and vinorelbine 25 mg/m2 intravenously days 1 and 8, for a maximum of six cycles. None of the patients had received prior chemotherapy for metastatic/advanced disease. Fifty-three per cent of patients with bone metastases and 67% of patients without bone metastases had visceral disease. The median age was 70 years for the 15 with bone involvement patients and 73 years for the 21 without bone involvement patients. RESULTS: Twenty-eight patients were fully evaluable for hematological dose-limiting toxicity (DLT), and all patients for other DLTs and for antitumor activity. One DLT with grade 3 venous thrombosis at dose level 2 and two dose-limiting neutropenia events at level 3 occurred in patients without bone involvement. Two dose-limiting neutropenia events were observed at dose level 2 for patients with bone involvement. Thus, the recommended dose was defined at level 1 (capecitabine 1000 mg/m2 days 1-14 and vinorelbine 20 mg/m2 days 1 and 8) for patients with bone involvement. For patients without bone involvement, the recommended dose was at level 2 (capecitabine 1250 mg/m2 days 1-14 and vinorelbine 20 mg/m2 days 1 and 8). For patients without bone involvement the overall response rate was 48% and the time to progression (TTP) was 4.5 months [95% confidence interval (CI) 3.3-6.9]. For patients with bone involvement the overall response rate was 53% and TTP was 5.3 months (95% CI 2.7-7.8). CONCLUSIONS: This regimen of capecitabine and vinorelbine is well tolerated and effective in elderly patients with metastatic breast cancer. Toxicity was mainly hematological and was observed at a lower dose in patients with bone involvement. A phase II study with the two different dose levels for elderly patients with and without bone involvement is currently being conducted.     

High-dose combination alkylating agents with bone marrow support as initial treatment for metastatic breast cancer

To evaluate the effect of high-dose chemotherapy in the treatment of metastatic breast cancer, we performed a phase II trial of a single treatment with high-dose cyclophosphamide (5,625 mg/m2), cisplatin (165 mg/m2), and carmustine (600 mg/m2), or melphalan (40 mg/m2) and bone marrow support as the initial chemotherapy for metastatic breast cancer. Twenty-two premenopausal patients with estrogen receptor negative, measurable metastatic disease were treated. Twelve of 22 patients (54%) obtained a complete response at a median 18 days. The overall response rate is 73% (complete and partial response). Median duration of response in the patients achieving complete response was 9.0 months with a median duration of survival for complete responders that is currently undefined. Relapse occurred predominantly at sites of pretreatment bulk disease or within areas of previous radiation therapy. Toxicity was frequent and five patients died of therapy-related complications. The results indicate that a single treatment with intensive combination alkylating agents with bone marrow support can produce more rapid and frequent complete responses than conventional chemotherapy when used as initial chemotherapy for metastatic breast cancer, although median disease-free and overall survival is not improved. Three patients (14%) remain in unmaintained remission beyond 16 months.     

Cyclophosphamide, methotrexate,5-fluorouracil, alternating with adriamycin and mitomycin C in metastatic breast cancer: a pilot study

To explore the clinical applicability of the Goldie and Coldman hypothesis, we treated 28 patients with metastatic breast cancer with alternating non-cross-resistant chemotherapy. The patients received cyclophosphamide, 600 mg/m2, 5-fluorouracil, 600 mg/m2, methotrexate, 40 mg/m2, alternated every three weeks with adriamycin, 60 mg/m2, and mitomycin C, 10 mg/m2. Only one patient had previously received palliative chemotherapy. Six patients had received adjuvant CMF, and 17 patients had been pretreated with endocrine therapy (13 for advanced disease, 4 as adjuvant). Fourteen patients had bone involvement, and 10 had visceral metastases. A mean of 12 cycles was given to 24 evaluable patients. The objective response rate was 67%: 11 patients (46%) achieved complete and 5 (21%) partial remission. Response rate in soft tissues was 83.3%, in bone 50%, in liver 100%, and in lung 80%. The median duration of response was 14 months, with 7 patients still in remission. No life-threatening toxicity was observed. Our preliminary results support the validity of this approach and the efficacy of this combination chemotherapy. A large-scale randomized study is warranted.     

Total lymphoid irradiation, high-dose chemotherapy and autologous bone marrow transplantation for chemotherapy-resistant Hodgkin's disease

Seventeen patients with advanced stage Hodgkin's disease who relapsed or failed to respond to multiple regimens of combination chemotherapy (mostly Mechlorethamine, Vincristine, Procarbarzine, Prednisone and Adriamycin, Bleomycin, Vinblastine, Dacarbazine) were treated with accelerated hyperfractionated total lymphoid irradiation (TLI) and high-dose chemotherapy followed by autologous bone marrow transplantation (AuBMT). Candidates for the protocol did not have prior radiation therapy and had no evidence of bone marrow involvement. Their bone marrow was initially harvested and cryopreserved. The treatment protocol consisted of reinduction with conventional doses of combination chemotherapy followed by boost local field irradiation to areas of residual disease (1500 cGy within 5 days) and total lymphoid irradiation (2004 cGy given in 12 fractions of 167 cGy each t.i.d. delivered within 4 days). The patients were treated with Etoposide (250 mg/m2/day I.V. X 3 days) and high-dose Cyclophosphamide (60 mg/kg/day I.V. X 2 days). Cryopreserved (unpurged) autologous bone marrow was infused 48 hr after completion of chemotherapy. Of the 17 patients treated, four were in relapse and 13 refractory to multiple regimens of combination chemotherapy. Four patients died during the immediate peritransplant period (2--septicemia, 2--pulmonary complications). Of the 13 surviving patients, 12 entered a complete remission and one had a partial remission and died of disease 6 months later. One patient relapsed 5 months after treatment and is currently alive with disease. Eleven patients (65%) are alive with no evidence of disease 4-35 months (median 20 months) following completion of therapy. Treatment with this protocol results in a high rate of complete remission and a potential for long-term disease-free survival in previously unirradiated patients with advanced stage refractory or relapsed Hodgkin's disease who have exhausted conventional modes of chemotherapy.     

核素骨显像在多发性骨髓瘤疗效评价中的应用

Objective:To investigate the value of radionuclide whole-body bone imaging on monitoring chemotherapeutic effects for multiple myeloma(MM).Methods:Sixty patients were included.Twenty nine cases received CTD(thalidomide 100-200 mg/d;cyclophosphamide 200-300 mg/m2/d,1-4 days,every 4 weeks;and dexamethasone 20-40 mg/d,1-4 days,every 4 weeks);Thirty cases received VAD(vincristine 0.4 mg/d,1-4 days,every 4 weeks;adriamycin 10 mg/d,1-4 days,every 4 weeks;dexamethasone 40 mg/d,1-4 days,every 4 weeks).Radionuclide bone imagings were performed in all patients before chemotherapy,six months,twelve months and eighteen months after chemotherapy.The correlation of chemothera-peutic effects between CTD and VAD were analyzed.Results:One hundred and seventy nine bone lesions were visualized by bone scintigraphy before CTD treatment.Eighteen months after CTD chemotherapy,it was observed by bone scintigraphy that 39/179(21.78%) lesions disappeared,112/179(62.57%) improved,and 28/179(15.64%) had no change.One hundred and ninety one bone lesions were showed by bone imaging before VAD treatment,36/191(18.84%) lesions disappeared,eighteen months after chemotherapy,103/191(53.92%) improved,and 52/191(27.22%) had no change.The significant difference was observed in locations of MM induced bone lesions treated with CTD(H = 8.23,P < 0.05) and VAD(H = 11.18,P < 0.05).A significant chemotherapeutic sensitivity in detecting MM induced lesions in ribs was found compared with other bone lesions.The chemotherapeutic effect of CTD was statistically significant than that of VAD(U = 2.17,P < 0.05).Conclusion:Radionuclide whole-body bone imaging has great value in monitoring chemotherapeutic effects for MM.