全反式维甲酸诱导再分化治疗甲状腺癌的临床研究

目的评价利用全反式维甲酸(ATRA)诱导再分化甲状腺癌、提高摄碘功能的作用。方法32例经病理证实的甲状腺癌病例(24例分化型,8例失分化型)。全反式维甲酸剂量(1.0~1.5)mg/(kg·d),治疗时间6周。131I口服72小时后进行全身显像。使用美国pho/gammaHP型γ照相机,通过ROI半定量方法测定转移灶每像素的放射性计数,比较ATRA诱导前后转移灶摄取放射性变化;采用超声、X线或CT判定转移灶大小;放射免疫法测定血清TG。结果131I治疗后不同部位转移灶平均可测摄碘计数较治疗前明显降低;32例经ATRA诱导后,14例(43.8%)病灶131I摄取增高,7例(20.8%)无明显变化;6例(25%)131I摄取降低。8/27例诱导后转移灶缩小,12例无变化,7例增大。病灶摄131I的变化与病理类型无关。诱导后血清TG测定降低12例(40%),增高11例(36.7%),无变化7例(23.3%)。血清TG水平与摄碘能力改变无关。具有两项指标(病灶摄碘增高、病灶缩小和血清TG降低)及以上改变12例,占37.5%。结论初步表明ATRA治疗能够在诱导分化型甲状腺癌细胞再分化以及失分化甲状腺癌细胞的转化中产生作...     

多西紫杉醇联合希罗达治疗乳腺癌肺转移39例临床分析

目的 观察多西紫杉醇(紫杉特尔、Docetacel)联合希罗达治疗乳腺癌肺转移患者的临床疗效和不良反应,为临床治疗提供依据.方法 39例乳腺癌肺转移患者,用多西紫杉醇注射液75 mg/mz,第1天静脉滴注1小时,希罗达2 500 mg/m2,分早晚2次餐后半小时口服,第1-14天,21天为1个周期,连用4-6个周期.化疗前1天开始口服地塞米松8 mg,2次/天,连服3天,以防水钠潴留.每3周为1个周期,2个周期评价疗效.结果 39例患者完全缓解(CR)13例(33.3﹪),部分缓解(PR)14例(35.9﹪),总有效率(CR+PR)69.2﹪,稳定(SD)9例,进展(PD)3例.不良反应主要是骨髓抑制、胃肠道反应,对症治疗后均获得缓解,无化疗相关死亡.结论 多西紫杉醇联合希罗达治疗肺转移性乳腺癌有较好疗效,不良反应能耐受,是一种安全、有效的化疗方案.     

羟基喜树碱联合mFOLFOX6治疗晚期胃癌

目的:评价羟基喜树碱(HCPT)联合mFOLFOX6方案,治疗晚期胃癌的疗效.方法:27例经内镜活检或手术病理确诊且有可测量的、可评价的晚期胃癌,HCPT 10mg静滴3小时,第1-2天,奥沙利铂(L-OHP),85mg/m2(2小时静脉滴入),亚叶酸钙(CF)400mg/m2(2小时静脉滴入,第2天),5-FU 400mg/m2(静脉推注第2天),5-FU 2400mg/m2持续泵入48小时,第2天,14天重复,至少2个周期后评价疗效.结果:27例可评价疗效,完全缓解2例,部分缓解9例,总有效率40.7%,12例肝转移患者中,肝转移灶有效率50%.不良反应主要为骨髓抑制、恶心呕吐、神经毒性,无化疗相关死亡.结论:HCPT联合mFOLFOX6治疗晚期胃癌疗效好且相对安全.     

肝动脉化疗栓塞联合索拉非尼治疗肝细胞癌合并肺转移的临床观察

目的 评价肝动脉化疗栓塞(TACE)联合索拉非尼治疗肝细胞癌(HCC)合并肺转移的疗效和安伞性.方法 30例伴有肺转移的晚期HCC患者,于TACE治疗后3周复查,如无禁忌证即开始服用索拉非尼,400 mg/次,2次/d;不能耐受时减至200 mg/次,2次/d.每4周进行疗效评估.结果 肺部转移病灶缩小6例,病灶稳定8例;肝脏病灶稳定22例,进展8例,在服药期问行TACE1～3次.不良反应包括手足皮肤反应7例,疲乏无力18例,脱发6例,腹泻6例,贫血和骨髓抑制5例,高血压2例,消化道出血1例.结论 HCC合并肺转移时,TACE联合索拉非尼治疗可有效控制疾病进展,安伞性及患者耐受性良好.     

肝动脉化疗栓塞联合索拉非尼治疗肝细胞癌合并肺转移的临床观察

目的 评价肝动脉化疗栓塞(TACE)联合索拉非尼治疗肝细胞癌(HCC)合并肺转移的疗效和安伞性.方法 30例伴有肺转移的晚期HCC患者,于TACE治疗后3周复查,如无禁忌证即开始服用索拉非尼,400 mg/次,2次/d;不能耐受时减至200 mg/次,2次/d.每4周进行疗效评估.结果 肺部转移病灶缩小6例,病灶稳定8例;肝脏病灶稳定22例,进展8例,在服药期问行TACE1～3次.不良反应包括手足皮肤反应7例,疲乏无力18例,脱发6例,腹泻6例,贫血和骨髓抑制5例,高血压2例,消化道出血1例.结论 HCC合并肺转移时,TACE联合索拉非尼治疗可有效控制疾病进展,安伞性及患者耐受性良好.     

替吉奥联合奥沙利铂治疗晚期食管癌近期疗效观察

目的 观察替吉奥联合奥沙利铂治疗晚期食管癌的近期疗效及不良反应.方法 30例晚期食管癌均接受化疗,替吉奥80mg/(m2 ·d),分2次,餐后口服,dl-14;奥沙利铂130 mg/m2,dl,静脉滴注＞3小时,21天为1周期,2周期后行胸腹部CT及消化道钡餐造影或胃镜评价疗效,并评价不良反应.结果 30例患者均可评价疗效,完全缓解(CR)0例,部分缓解(PR) 12例,病情稳定(SD)8例,病情进展(PD) 10例,有效率(CR+ PR)为40.0％,临床获益率(CR+PR+SD)为66.7％.中位疾病进展时间5月,1年生存率63.3％.主要不良反应为血液学毒性、消化道反应、肝功能损伤、皮疹、神经毒性等.结论 替吉奥联合奥沙利铂治疗晚期食管癌疗效较好,不良反应可耐受.     

芬太尼复合丙泊酚静脉麻醉在食管癌术后吻合口瘘重症患者内窥镜诊断治疗中的麻醉效果观察

目的:观察芬太尼复合丙泊酚静脉麻醉在食管癌术后吻合口瘘重症患者内窥镜诊断治疗时的麻醉效果.方法:对26例食管癌术后吻合口瘘重症患者,在诊断与治疗过程中运用芬太尼复合丙泊酚静脉麻醉.通过胃镜或纤维支气管镜进行床旁诊断、内引流、放置空肠营养管和食管覆膜支架.治疗前静脉注入芬太尼0.4 mg/kg,后缓推丙泊酚1.5 mg/...     

沙利度胺、司坦唑醇联合泼尼松用于改善骨髓纤维化患者芦可替尼治疗相关血液学不良反应

目的 分析沙利度胺、司坦唑醇、泼尼松联合(TSP方案)治疗骨髓纤维化(MF)患者芦可替尼治疗相关血液学不良反应的效果及安全性.方法 回顾性分析2016年1月至2017年7月北京协和医院芦可替尼治疗中出现贫血和(或)血小板减少的10例MF患者临床资料,所有患者接受低剂量沙利度胺(约75 mg/d)、司坦唑醇(2 mg/次,3次/d)和小剂量泼尼松(每天0.5 mg/kg)联合治疗,评估其血液学不良反应及安全性.结果 服用芦可替尼过程中,出现贫血和血小板减少者分别为9例和7例.采用TSP方案治疗后,血红蛋白有效5例,其中1例获得完全缓解(CR);血小板有效4例,均为CR.合计血液学指标总有效7例.开始服药至起效中位时间为27 d(13～89 d).起效的7例患者中有3例疗效丧失,疗效持续中位时间为未达到(28～207 d).结论 TSP方案可以改善MF患者芦可替尼治疗中出现的贫血和血小板减少症.     

亚叶酸钙/氟尿嘧啶、顺铂3种方案治疗晚期胃肠道腺癌

目的 :观察两种剂量的亚叶酸钙 (CF 2 0mg/m2 ,2 0 0mg/m2 )、两种给药方法的氟尿嘧啶 (5 FU ,持续灌注和每天静滴 2小时 )与顺铂 (DDP 2 0mg/m2 )组成 3种方案分别治疗晚期胃肠道腺癌的临床疗效及不良反应。方法 :将 1999年 1月～ 2 0 0 0年 11月住院治疗的晚期胃肠道腺癌 36例患者随机分为A、B两组 ,回顾性分析 1997年 4月～ 1998年 12月住院治疗的 2 9例同种患者作为对照组C组。A组 :CF 2 0 0mg/m2 ,静滴 2小时 ,每天 1次 ,连用 5天 ;5 FU 3g/m2 ,持续静脉灌注 5天 (加入Baxter泵内 ) ,DDP 2 0mg/m2 ,静滴 2小时 ,每天 1次 ,连用 5天。B组 :CF 2 0mg/m2 ,用法同A组 ;5 FU、DDP剂量与方法同A组。C组 :CF 2 0 0mg/m2 ,用法同A、B组 ;5 FU 6 0 0mg/ (m2 ·d) ,用法同CF ;DDP方法同A、B组。以上方案每 3周为 1周期 ,连续 3个周期后评价疗效及不良反应。结果 :A组 (n =2 0 )胃癌 8例、大肠癌 12例 ,有效率 (CR +PR)分别为 5 0 %(4 / 8)、41.7%(5 / 12 ) ;B组 (n =16 )胃癌7例、大肠癌 9例 ,有效率 (CR +PR)分别为 42 .9%(3/ 7)、44 .4%(4 / 9) ;C组 (n =2 9)胃癌 14例、大肠癌 15例 ,有效率 (CR +PR)分别为 35 .7%(5 / 14)、40 %(6 / 15 )。毒副反应 :A、B两组血液毒性、胃肠道反应及肾、膀胱毒性相近     

MAAE方案治疗复发难治急性白血病25例

目的 回顾性分析MAAE方案对复发难治急性白血病(AL)的疗效及毒副作用.方法 对25例复发难治AL患者,采用米托蒽醌(MIT)、阿糖胞苷(Ara-C)、安吖啶(AMSA)和依托泊苷(VP16)组成的MAAE方案治疗.用法:第1天至第3天,MIT 10 mg/d,静脉滴注;第1天至第7天,Ara-C 200 mg/d,静脉滴注;第1天至第3天,AMSA 75 mg/d,静脉滴注;第1天至第4天,VP16100 mg/d,静脉滴注,7 d为1个疗程.WBC＜0.5×109/L时使用粒细胞集落刺激因子(G-CSF)每天5 μg/kg直至WBC＞1.0×109/L.结果 经1～3个疗程,25例患者中14例完全缓解(CR),占56%,5例部分缓解(PR),占20%,总有效率为76%.结论 MAAE方案治疗复发难治AL疗效较好,主要毒副作用为骨髓抑制.     

Fluorescence detection of photosensitizer photoditazin in the tissue of benign prostatic hyperplasia

The authors present pilot experience in investigation of accumulation, distribution and elimination of photosensitizer photoditazin from hyperplastic tissue of human prostate. Fluorescent spectroscopy showed that 2-24 hours after intravenous injection of photoditazin in a dose 1 mg/kg, it is detected in hyperplastic tissue of human prostate with maximal accumulation 3 hours after introduction. Exogenic fluorescence of photoditazin lowered 12 and 24 hours after injection this indicating its elimination. The results favor use of photoditazin for photodynamic treatment of patients with benign prostatic hyperplasia.     

PHOTOFRIN光动力治疗晚期梗阻性支气管肺癌

目的 探讨内镜下光动力治疗晚期梗阻性支气管肺癌以观察其疗效和不良反应。方法 28例晚期梗阻性支气管肺癌患者均经过化疗、放疗或其他方法治疗无法消除肿瘤,光敏剂为PHOTOFRIN,按2mg/kg体重静脉滴注,48h后经内镜导入光导纤维给以630nm（DIOMED半导体激光治疗仪）激光照射治疗,72h后经内镜清除坏死组织并对原有病灶和新发现病灶给以复照,之后根据具体情况对患者的病灶部位清除坏死组织。结果光动力治疗后晚期梗阻性支气管肺癌PDT治疗总有效率为85.8%,气道梗阻缓解率为90.0％,KPS评分也较治疗前有明显改善。结论 光动力治疗晚期梗阻性支气管肺癌能够有效的解除腔道梗阻,患者耐受性好,能明显改善患者的生存质量,不良反应轻,光动力治疗对晚期梗阻性支气管肺癌不失为一种好的姑息治疗手段。     

Fluorescence detection of chlorine E6 based photosensitizer in urinary bladder tumors

The authors present pilot experience with accumulation and distribution of chlorine E6 based photosensitizer in unaffected mucosa and tumor of human urinary bladder (UB). Local fluorescence spectroscopy in vivo has shown that 2-3 hours after intravenous injection of the photosensitizer in a dose 1 mg/kg its exogenic fluorescence is detected in the tumor but not in unaffected UB mucosa. This indicates selective accumulation of the sensitizer in UB tumors. Thus, chlorine E6 based photosensitizer can be used for fluorescence-based diagnosis of UB cancer and treatment of such patients with photodynamic therapy. Application of local fluorescence spectroscopy allows monitoring of photobleaching in the course of treatment session.     

Gastric cancer treated by hematoporphyrin derivative(HPD)-laser--histopathological study of 10 gastrectomy specimens

10 patients with gastric carcinoma treated by HPD-laser preoperatively are reported. The gastric lesions were irradiated with laser beam delivered by a quartz fibre through the fiberoptic gastroscope 48-72 hours after intravenous injection of HPD (5.0 mg/kg) about 2 weeks before operation. In the resected specimens, the histological changes following HPD-laser therapy were studied. The cancer cells in the irradiated areas showed degeneration and necrosis in varying degrees. Because of the fact that the light spots were small and the penetration not deep enough, the cancer cells beyond the irradiated area and those infiltrating more deeply or beyond the gastric wall did not show any evident changes while metastatic cancers in the lymph nodes showed no changes at all. These facts may suggest that the HPD-laser therapy should not be used as the main therapeutic method to replace operation, radiotherapy or chemotherapy for gastric cancers in either advanced or early stage.     

Concurrent low-dose cisplatin/5-FU chemotherapy and radiation for the recurrent gastric carcinoma--case reports

We report two postoperative cases of recurrent gastric carcinoma successfully treated with concurrent low-dose cisplatin/5-FU chemotherapy and radiation therapy. Case 1: A 74-year-old man underwent total gastrectomy and splenectomy for advanced gastric carcinoma followed by a local recurrence at the anastomotic site 6 months after surgery. Case 2: A 75-year-old man underwent total gastrectomy and splenectomy for advanced gastric carcinoma followed by multiple lymph node swelling along the abdominal aorta one year after surgery. We employed concurrent radiation therapy and low-dose CDDP/5-FU therapy for the recurrent gastric carcinoma tumor which consisted of 5-FU (125-250 mg/body/day, as a 24-h intravenous injection for 4 weeks) and low-dose cisplatin (10 mg/body on day 1, 8, 15, 22). X-ray radiation was delivered to the target tumor in a daily fraction of 1.8 Gy, 6 days/week, with a total dose of 50.4 Gy. PR and CR were obtained after the therapy. Grade 3 leucopenia was observed in Case 1,which was successfully treated with G-CSF injection. The concurrent low-dose cisplatin/5-FU chemotherapy and radiation therapy could be an effective treatment modality for the recurrent tumors of gastric carcinoma after surgery.     

Chemotherapy Targeting Regional Lymph Nodes by Gastric Submucosal Injection of Liposomal Adriamycin in Patients with Gastric Carcinoma

We investigated the delivery of adriamycin (ADR) to the regional lymph nodes of the stomach following the gastric submucosal injection of liposomal adriamycin (Lipo-ADR) in 34 gastric carcinoma patients, as well as following intravenous administration of free ADR (F-ADR) in another 18 patients. Prior to radical gastrectomy, Lipo-ADR was endoscopically injected into the gastric submucosa adjacent to the primary tumor via a needle-tipped catheter. After Lipo-ADR injection, the ADR concentration in the primary and secondary drainage lymph nodes was higher than in the other regional lymph nodes. Thus, the regional nodes more susceptible to metastasis showed higher levels of ADR. In contrast, the intravenous administration of F-ADR produced a similar and far lower ADR concentration in all the nodes. Delivery of ADR to the primary drainage lymph nodes following injection of 5 ml of Lipo-ADR was compared with delivery to the left gastric artery lymph nodes after intravenous administration of an equal dose of F-ADR. The ADR levels (μg/g) after gastric submucosal injection were 15.1±8.30 on day 1 (n = 4); and 11.9±4.80 on day 4 (n = 6). Those after intravenous administration were 0.29±0.10 on day 1 (n = 4); and 0.36±0.0 on day 4 (n = 2). The differences between the two groups were significant (P<0.05). The ADR levels after the gastric submucosal injection were far higher than those after intravenous administration. These findings indicate that the gastric submucosal injection of Lipo-ADR can specifically deliver ADR to the regional lymph nodes at high concentrations. Such preoperative adjuvant chemotherapy targeting the regional lymph nodes may be useful for preventing the lymph node recurrence of gastric carcinoma.     

EOS 方案与 FOLFOX4 方案治疗晚期胃癌的疗效比较简

目的：比较EOS方案与FOLFOX4方案治疗晚期胃癌的疗效和毒副反应。方法：将60例经病理证实的晚期胃癌随机分为2组,A组给予EOS方案化疗,表阿霉素50mg／m^2静注d1＋奥沙利铂135mg／m^2静滴d1＋替吉奥胶囊40mg／m^2口服d1-14,3周重复,共完成4周期;B组给予FOLFOX4方案化疗,奥沙利铂85mg／m^2静滴2小时d1＋亚叶酸钙200mg／m^2静滴2小时d1-2＋氟尿嘧啶400mg／m^2静注d1-2＋氟尿嘧啶600mg／m^2持续静滴22小时d1-2,2周重复,共完成6周期。结果：A组患者生活质量改善率为70％,近期有效率为63．3％,中位疾病进展时间为6．9个月,中位生存时间为11．6个月。B组患者分别为43．3％、36．7％、4．8个月和8．2个月。A组均显著优于B组。两组患者化疗毒副反应无差异。结论：EOS方案疗效优于FOLFOX4方案,且耐受性好,值得临床进一步研究。     

PHOTOFRIN光动力治疗晚期鼻咽癌疗效观察

目的:探讨PHOTOFRIN光动力治疗晚期鼻咽癌的近期疗效及毒副反应。方法:30例肿瘤患者均属于临床Ⅳ期,随机分为光动力治疗组和化疗组两组,光动力治疗组光敏剂为PHOTOFRIN,按2mg/kg体重静脉滴注,48小时后经内镜导入光导纤维给以630nm的激光照射,48h后经内镜清除坏死组织并对原有病灶和新发现病灶给以复照,之后根据具体情况给患者的病灶部位清除坏死组织;化疗组给以常规顺铂和氟尿嘧啶化疗。结果:光动力组总有效率(78·6%)和腔道梗阻的缓解率均明显高于化疗组,KPS评分也有明显差异。结论:与常规化疗相比光动力治疗晚期鼻咽癌能够有效的解除腔道梗阻,毒副反应轻,耐受性好,明显改善患者的生存质量,对晚期鼻咽癌不失为一种较好的姑息治疗手段。     

Experimental study on abdominal arterial infusion of anti-cancer agents

The distribution of Adriamycin (ADM), Mitomycin C (MMC) and 7-N-(p-Hydroxyphenyl)-Mitomycin C (KW 2083) in various organs inclusiding plasma level after intraarterial or intravenous infusion was determined in mongrel dogs and experimental dogs. Similar plasma time-course of ADM was obtained with both routes, showing the maximum level at 5 minutes after infusion. The maximum level with intravenous infusion was twice as highs as that with intraarterial administration. High levels of ADM were encountered in the liver, gallbladder and kidney after proper hepatic arterial infusion, in the angular region of the stomach after left gastric arterial infusion and in the gastric antrum after right gastroepiploic arterial infusion (0.8 mg/kg). There was no significant difference in plasma levels of MMC (0.2 mg/kg) and KW 2083 (1.0 mg/kg) between intraarterial and intravenous infusion. It was of interest that MMC was hardly measurable in the liver after proper hepatic arterial infusion of 0.4 mg/kg. On the other hand, rather high level of KW 2083 was observed in the liver, gallbladder and pancreas after proper hepatic arterial infusion of 1.0 mg/kg. Hepatic necrosis around the central hepatic vein noted at the histological examination seems to be due to infusion of above-mentioned anticancer agents. It is worth mentioning that the concentration of KW 2083 in tumor tissue of the stomach of experimental dog after right gastroepiploic arterial infusion was twice as high as that in intact gastric wall. Grade IIA histological alterations of tumor cells by Oboshi and Shimosato's Classification such as vacuolation of cytoplasm and pyknosis of nuclei were noted after KW 2083 infusion.     

Photodynamic therapy in the management of resistant lower urinary tract carcinoma

Twenty-three patients with resistant transitional cell carcinoma (TCC) of the bladder and posterior urethra had photodynamic therapy (PDT). Seventy-two hours after an intravenous injection with 2 mg/kg of the photosensitizer dihematoporphyrin ether (DHE) (Photofrin II, Photomedica, Raritan, NJ), each patient received cystoscopic light treatment. The light dose to the whole bladder using the bulb diffuser ranged from 5 to 60 J/cm2; power density ranged from 9 to 22 mW/cm2. The focal light dose ranged from 100 to 200 J/cm2 at a power density from 100 to 200 mW/cm2. To treat the urethra, a diffuser fiber was used to deliver 200 to 400 J/linear cm at a power of 110 to 300 mW/cm. In the 19 of 23 patients who were treated for resistant superficial TCC, 83.3% of the tumors had responded at the initial follow-up evaluation. Seven patients had a complete response and 10 had a partial response. Three of 19 patients who received inadequate light treatment failed to respond. Control of intractable gross hematuria was the only benefit for patients with locally invasive disease (greater than or equal to T2). Irritating lower urinary tract symptoms that varied in severity and duration occurred in all patients. Four patients experienced bladder shrinkage, which did not resolve. Although the light and drug doses remain to be determined, a whole bladder light dose of 15 to 20 J/cm2 with a drug dose of 2 mg/kg seems to be effective enough without producing permanent adverse effects in the bladder.