腹腔,动脉双途径化疗晚期卵巢癌：附13例报告

晚期卵巢癌应用腹腔、动脉双途径化疗共13例。合并腹水者11例,全部得到控制。肿块除2例无变化外,11例均有不同程度缩小,有效率为84.6％。化疗后开腹9例,证明7例母瘤缩小,周围坏死,转移灶坏死变性,容易剥离和摘除。采用术前化疗,可以提高手术彻底性。     

Progress and Challenges in Chemotherapy for Loco-Regionally Advanced Nasopharyngeal Carcinoma

Incidence rates of nasopharyngeal carcinoma are high in Indonesia, Singapore and South-Eastern China.Chemoradiotherapy has been the standard regimen for locally advanced nasopharyngeal carcinoma accordingto guidelines from the National Comprehensive Cancer Network. Recently, advances in the management ofnasopharyngeal carcinoma have transferred into better treatment outcomes. Most phase III clinical trials supportthe addition of concurrent chemotherapy to radiotherapy for the initial treatment of these patients. Studiesevaluating effects and toxicity of concurrent chemotherapy with different regimens have been reported. However,the status of adding adjuvant chemotherapy or induction chemotherapy remains controversial. Recent studieshave shown that adjuvant chemotherapy with two or three cycles may improve survival for nasopharyngealcarcinoma with stage N2-3 disease or with persistently detectable plasma EBV DNA after radiotherapy. Thisreview examines the pertinent issues and latest studies concerning the management of loco-regionally advancedNPC, regarding concurrent chemotherapy, adjuvant chemotherapy, and induction chemotherapy in decades.     

恶性腹水双途径联合化疗的临床疗效评价

目的：评价双途径联合化疗治疗恶性腹水的临床疗效及不良反应。方法：根据瘤细胞类型选择药物，静脉与腹腔联合用药。结果：本方法治疗食管癌、胃癌、原发性肝癌、大肠癌、卵巢癌所致恶性腹水的总有效率依次为‘76．9％、85.l％、27.3％、75.l％和88．9％，腹水平均控制时间分别为46．3、5l.2、60．6、53．7和48．9天，平均生存期分别为13．4、10．8、5.2、ll.6和12.7个月。不良反应发生率，中、高度发热为35．5％，恶心呕吐为100％，轻、中度腹痛为77．7％；白细胞普遍下降，肝肾功能损害不显著。结论：双途径联合化疗是目前治疗恶性腹水有效、可行的一种方法。     

局部晚期宫颈癌新辅助化疗不同给药途径的疗效分析

目的探讨局部晚期宫颈癌新辅助化疗的最佳给药途径。方法对124例局部晚期宫颈癌患者,采用不同给药途径化疗（65例行静脉化疗,59例行动脉插管化疗）,比较其近远期疗效。结果静脉化疗和动脉插管化疗的总有效率、症状缓解率、骨髓抑制发生率、神经毒性发生率、手术切除率、出血量、1年无瘤生存率、5年存活率比较均无统计学差异;静脉化疗的胃肠道反应发生率、2年无瘤生存率高于动脉插管化疗;从开始化疗到手术历经时间静脉化疗长于动脉插管化疗,但住院总费用少于动脉插管化疗。结论局部晚期宫颈癌静脉给药新辅助化疗的近远期疗效好,操作方便,经济实用。值得推广。     

Influence of surgical resection before and after chemotherapy on survival in small cell lung cancer

We attempted to define the role of surgery in the treatment of small cell lung cancer (SCLC). Of 81 patients with clinically localized SCLC, 36 underwent surgical resection: 19 underwent initial resection with postoperative chemotherapy, while the remaining 17 were treated initially with chemotherapy, then resection. The remaining 45 patients were treated with a combination of chemotherapy and radiotherapy. The 5-year survival for the 36 surgical patients was 38%; median survival time (MST) was 33 months. Nineteen patients treated with postoperative chemotherapy showed a 42% 5-year survival, while 17 patients treated with preoperative chemotherapy showed a 33% 5-year survival. This difference was not significant. However, stage III survival tended to be better in patients with preoperative chemotherapy (MST, 29 months) than in those who had had postoperative chemotherapy only (MST, 17 months). Although survival of the 45 nonsurgical patients was poor, stage I and II patients, or those with complete remission showed a 25% 5-year survival with an MST of 33 months, and a 21% 5-year survival with an MST of 25 months, respectively. We thus concluded that initial resection combined with postoperative chemotherapy is beneficial for patients with stage I, and probably stage II disease. For resectable stage III, particularly in patients with N2 disease, adjuvant resection after chemotherapy may be a favorable choice in the management of SCLC. For advanced stage III, complete remission by chemotherapy should be attempted in combination with radiotherapy.     

胃肠道癌术后早期腹腔化疗的临床分析

为防止胃肠道癌术后腹腔内复发和肝转移，探讨切实有效的辅助治疗措施。对５０例胃肠道癌根治术后行卡铂、５－Ｆｕ、ＩＬ－２腹腔内灌注，与５０例根治术后单用静脉化疗相比较。腹腔化疗组５年复发率（３２％）明显低于静脉化疗组（６２％）；５年生存率（７２％）明显高于静脉化疗组（４４％）。腹腔化疗组全身毒副反应明显低于静脉化疗组。腹腔热灌注化疗对胃肠道癌术后腹腔内复发及肝转移的预防和治疗颇有意义     

可切除胃癌术后辅助化疗现状

世界范围内,胃癌发病率和死亡率占所有癌症的第2位.在中国胃癌占发病和死亡的第1位.5年生存率低.手术是惟一可根治的方法.术后辅助化疗在提高生存率方面的作用尚有争议.本文综述胃癌根治术后辅助化疗方面的现状.     

Prednisone, etoposide, procarbazine, and cyclophosphamide (PEP-C) oral combination chemotherapy regimen for recurring/refractory lymphoma: low-dose metronomic, multidrug therapy

BACKGROUND: Many patients with recurrent lymphoma are unable to tolerate intensive therapies, or have disease that is refractory. Metronomic chemotherapy offers a novel, potentially less toxic yet effective treatment strategy. METHODS: An analysis was performed on 75 lymphoma patients who were treated with the PEP-C regimen at a single institution. The program consisted of oral prednisone 20 mg after breakfast, cyclophosphamide 50 mg after lunch, etoposide 50 mg after dinner, and procarbazine 50 mg at bedtime with an oral antiemetic. All medications were administered daily until the white blood cell count fell to less than 3.0 x 10(9)/L, whereupon treatment was withheld until recovery from the nadir. Therapy was then reinstituted on a daily, alternate day, or fractionated weekly basis (eg, 5 of 7 days), depending on patient tolerance. Doses given per day were held constant. RESULTS: Eighty percent of patients had previously received 2 or more treatments. Overall, 69% achieved an objective response after PEP-C treatment, with 36% complete responses and 33% partial responses. Subjects with indolent histologies had superior overall responses, complete responses, and time on therapy relative to those with aggressive histologies. The regimen was generally well tolerated. CONCLUSIONS: Metronomic therapy with low-dose oral agents administered in combination for continuous, prolonged periods with minimal drug-free intervals represents a novel, active, easily tolerated approach to management of patients with recurrent lymphoma, particularly those with indolent histologies.     

围抗癌化疗期几组止吐药物效果的比较

目的从几组化疗止吐剂中筛选一帖经济有效、便于推广应用的抗癌止吐处方。方法胃复安为对照组；利多卡因、恩丹西酮、综合防治用药为观察组进行自身前、后对照，以止吐效果为主要指标的多侧面观察比较。结果急性期和延迟期消化道反应防治（０°－Ⅰ°，下同）有效率分别是：胃复安３４％、２８％；利多卡因８２％、Ｘ％；恩丹西酮８８％、８４％；综合防治用药９４％、１００％。结论以安定、地塞米松、胃复安联合按需用药是较理想的抗癌化疗止吐处方。     

Continuous systemic 5-fluorouracil infusion in advanced colorectal cancer: results in 91 patients

Ninety-one patients with metastatic colorectal cancer were treated with continuous ambulatory 5-fluorouracil (5FU) infusion 250-300 mg/m2/day through a chronic indwelling central venous catheter. Twenty-six of the 91 patients (29%) had received previous bolus 5FU. Fifty-eight of the 91 patients (64%) had two or more sites of disease, and 74 of 91 patients (81%) had liver metastases. Results were complete remission in 5 of 91 (6%), partial remission in 25 of 91 (27%), stable disease in 33 of 91 (36%), and progressive disease in 28 of 91 (31%), for an overall response rate of 30 of 91 (33%); median duration of response was 7 months. Twenty-six of 65 previously untreated patients (40%) experienced objective response. Median survival from initiation of treatment for all patients was 11 months. Forty-one percent of patients experienced no significant toxicity and were able to continue therapy without treatment interruption. Toxicities necessitating treatment interruption included stomatitis in 35 patients (39%), hand-foot syndrome in 33 patients (36%), and diarrhea in 10 patients (11%). No significant myelosuppression or serious catheter-related complications were encountered. We conclude that continuous systemic venous infusion of 5FU produces a higher response rate than traditional bolus 5FU schedules, with apparent enhancement of survival and easily managed toxicity.     

Autologous Stem-Cell Transplantation for Primary Central Nervous System Lymphoma: Systematic Review and Meta-analysis

Background

Primary central nervous system lymphoma (PCNSL) is an aggressive form of non-Hodgkin lymphoma. Methotrexate is first-line chemotherapy. Autologous stem-cell transplantation (ASCT) is increasingly used as an alternative consolidative treatment to whole-brain radiotherapy.

组织内泵入式化疗给药系统初探

目的:探讨通过局部组织吸收化疗药物的靶向控释给药系统的安全性与可行性。方法:自制植入式化疗给药泵装置,并植入实验兔体内,将5-Fu持续、直接释放于兔子的肌肉和皮下组织内,设立自身两侧对照,不同时间取材,病理检验给药与非给药后的组织改变,统计评价两者之间的差异。结果:给药与非给药后的组织病理改变差异无统计学意义。结论:组织内低浓度缓慢泵入5-Fu,依靠局部组织吸收,进行化疗这一控释给药靶向系统是安全可行的。     

进展期胃癌术中温热灌洗及置泵术后灌注化疗的临床研究

目的探讨进展期胃癌手术切除后腹腔及肝转移的防治方法。方法将282例进展期胃癌切除术后患者分成术中腹腔温热低渗灌洗化疗及术后动脉灌注化疗组169例(简称治疗组)和单纯术后静脉化疗组113例(简称对照组),并对其腹腔转移率、肝转移率及3年生存率进行对照研究。结果治疗组腹腔转移率为21.9%,肝脏转移率12.4%,3年生存率74.6%;对照组腹腔转移率46.0%,肝脏转移率27.4%,3年生存率46.8%。结论术中温热低渗灌洗化疗及术后动脉灌注化疗对进展期胃癌术后腹腔复发和肝转移有良好的防治作用。     

Neoadjuvant and adjuvant chemotherapy in bladder cancer

State of the art treatment for invasive bladder cancer is cystectomy. Intensive clinical investigation has been performed in the last years about the role of neoadjuvant and adjuvant chemotherapy. Although neoadjuvant treatment seems not to increase long-term survival, it seems to play a role in the possibility of bladder preservation strategies. Adjuvant chemotherapy, in high-risk patients, seems to improve disease-free survival and time to progression. Nevertheless, new prospective studies should be performed to clarify its role in improving survival.      

胃癌的辅助治疗与新辅助治疗

胃癌是全世界范围内的常见肿瘤.约40%的胃癌患者可行根治术,但术后复发或远处转移率高.为提高胃癌根治术的机会,改善患者生存,以手术为主的多学科综合治疗一直是研究热点,但东西方国家在治疗模式、化疗方案选择和治疗结果等方面存在差异.     

Intra-Peritoneal Cisplatin Combined with Intravenous Paclitaxel in Optimally Debulked Stage 3 Ovarian Cancer Patients: An Izmir Oncology Group Study

Background: The advantage of intra-peritoneal (IP) chemotherapy (CT) in the initial management of ovarian cancer after cytoreductive surgery is well known. The feasibility and toxicity of a treatment regimen with an IP + intravenous CT (IPIVCT) for optimally debulked stage III ovarian cancer were here evaluated retrospectively. Materials and Methods: A total of 30 patients were treated in our institution between October 2006 and February 2011. Patients received IV paclitaxel 175 mg/m2 over 3 hours followed by IP cisplatin 75 mg/m2 on day 1; they also received IP paclitaxel 60 mg/m2 on day 8. They were also scheduled to receive 6 courses of CT every 21 days. Results: The median age of the patients was 55 years (35-77), and the majority had papillary serous ovarian cancer (63.3%). The patients completed a total of 146 cycles of IPIVCT. Twenty-eight were able to receive at least three cycles of IPIVCT and 18 (60%) completed the scheduled 6 cycles. Two patients discontinued the IPIVCT because of toxicity of chemotherapy agents and 6 had to stop treatment due to intolerable abdominalpain during IP drug administration, obstruction and impaired access. Grade 3/4 toxicities included neutropenia (6 patients; 20%), anemia (2 patients; 6.7%) and nausea-vomiting (2 patients; 6.7%). Doses were delayed in 12 cycles (8%) for neutropenia (n=6), thrombocytopenia (n=3) and elevated creatinine (n=3). Drug doses were not reduced. The median duration of progression-free survival (PFS) was 47.7 months (95%CI, 38.98-56.44) and overall survival (OS) was 51.7 months (95%CI, 44.13-59.29). Two and five-year overall survival rates were 75.6 % and 64.8%, respectively. Conclusions: IPIVCT is feasible and well-tolerated in this setting. Its clinically proven advantages should be taken into consideration and more efforts should be made to administer IPIVCT to suitable patients.     

食管癌的新辅助化疗和辅助化疗现状

食管癌是我国最常见的恶性肿瘤之一,严重威胁着人们的健康和生命。早期食管癌的治疗首选手术。为了提高局部晚期食管癌的疗效,人们进行了多种治疗模式的探索,如术前放疗、术前化疗、术前放化疗以及术后化疗等。本文就目前新辅助化疗和辅助化疗在食管癌治疗中的价值作一综述。     

介入化疗加栓塞术与新辅助化疗全身静脉化疗在宫颈癌根治性手术患者中的应用效果比较

目的 研究新辅助化疗全身静脉化疗对比介入化疗加栓塞术对行宫颈癌根治性手术患者的临床疗效.方法 选取确诊并接受治疗的宫颈癌患者50例,将采用新辅助化疗全身静脉化疗联合宫颈癌根治性手术治疗的25例患者作为对照组;将采用介入化疗加栓塞术联合宫颈癌根治性手术治疗的25例患者作为治疗组.对两组患者的临床治疗效果、术后的病理变化情况及不良反应发生情况进行比较.结果 治疗组的有效率为76.0％,高于对照组的44.0％(P﹤0.05);治疗组的淋巴结转移率为28.0％,低于对照组的52.0％(P﹤0.05);治疗组的呕吐、肝肾功能损害、骨髓抑制、脱发及色素沉着的发生率均低于对照组(P﹤0.05).结论 介入化疗加栓塞术比新辅助化疗全身静脉化疗在行宫颈癌根治性手术中取得了更好的临床治疗效果.