植入药泵灌注化学药物治疗晚期胃癌

[目的]观察植入式药泵灌注化学药物治疗晚期胃癌的疗效和并发症.[方法]回顾性分析1998～2002年手术证实无法切除的晚期胃癌,其中48例为单纯手术探查 术后全身化疗为对照组,32例术中行植入药泵灌注化疗为灌注化疗组.比较两组的并发症及术后1～3年生存率.[结果]两组均无严重并发症,3年生存率差异无显著性(P＞0.05),灌注化疗组的1年、2年生存率高于对照组,差异有显著性(P＜0.05).[结论]植入药泵灌注化疗是提高晚期胃癌1年、2年生存率的有效方法.     

皮下埋植式药泵动脉灌注化疗治疗大肠癌肝转移

[目的]探讨采用经皮下埋植式药泵肝动脉栓塞化疗治疗大肠癌肝转移的近期疗效、生存期及并发症。[方法]泵内化疗组24例采用经皮下埋植式药泵肝动脉栓塞化疗 ,对照组20例采用静脉化疗。[结果]泵内化疗组近期疗效 (CR +PR)为79.1% ,静脉化疗组为15% ,经检验两组差异有显著性 (P<0.05) ;泵内化疗组6个月、12个月、24个月的生存率分别为83.7%、63.5%、41.9% ,而静脉化疗组6个月、12个月、24个月的生存率分别为54.5%、29.7 %、14.6% ,经检验两组差异有显著性 (P<0.05)。[结论]采用经皮下埋植式药泵肝动脉栓塞化疗是治疗大肠癌肝转移安全、有效的方法之一 ,较静脉化疗能提高疗效及生存期     

Combined Intra-Arterial Chemotherapy and Irradiation of Malignant Gliomas

Seventy-nine patients with malignant gliomas (19 anaplastic astrocytomas and 60 glioblastoma multiforme) received 4 cycles of infra-ophthalmic carotid injection of 160 mg carmustine, 2mg vincristine IV and procarbazine orally SO mg 3 times daily for 1 week, followed by whole-brain irradiation, with a midpoint dose of 54 Gy/6 weeks. Response, judged by CT-scan, was seen in 31 out of 57 evaluable patients with a median survival of 30 months and 40% survival at 3 years. In all patients who responded to the treatment, a tumour regression was seen on CT-scan after chemotherapy before irradiation. In the 26 patients with progressive disease under chemotherapy, the median survival was 5 months. None of the patients who had progressive disease during chemotherapy had benefit from irradiation. The most important prognostic factors were good pretreatment performance status, glucocorticoid dependency and age. Few serious side-effects of the angiographic procedure were seen. Leukoencephalopathy was not observed in this study.     

骨肉瘤的大剂量化疗

本文报告ＨＤＭＴＸＣＦＲ治疗原发性骨肉瘤１８例的临床疗效，所有病例除一例经Ｘ线诊断外，余经病理学确诊。ＭＴＸ每疗程剂量０．５～３．０／Ｍ￣２，静滴ＭＴＸ开始至ＣＦ解救时间为１６～１８小时，其毒副反应轻，无一例发生意外。骨肉瘤术后辅助化疗后２年生存率５５．６％，生存５年以上者３例。本文提示，骨肉瘤的辅助化疗有肯定疗效，ＨＤＭＴＸ为有效的辅助化疗方案之一，但剂量不宜过低，只要注意水化，尿碱化及ＣＦ解救，此疗法是安全的。     

新辅助介入化疗在局部晚期宫颈癌治疗中的价值

  目的  探讨新辅助介入化疗在局部晚期宫颈癌临床治疗中的作用。  方法  对87例局部晚期宫颈癌患者进行回顾性分析, 根据新辅助化疗的不同途径分为新辅助介入化疗(IA-NAC)组42例和新辅助静脉化疗(IV-NAC)组45例。化疗方案为DDP(顺铂)60mg/m2+BLM(博来霉素)25 mg/m2+VCR(长春新碱)1 mg/m2+MMC(丝裂霉素)10mg/m2; 或DDP 70mg/m2+ADM(阿霉素)30 mg/m2。化疗后根据检查决定手术或放疗。评价两组的近期和远期疗效、手术切除率、病理学变化和不良反应。  结果  两组近期疗效均较好, 但无显著性差异; 3、5年生存率两组比较差异无统计学意义(P > 0.05);Ⅱ_b期患者的手术率IA-NAC组高于IV-NAC组, IA-NAC组平均生存时间较IV-NAC组长(P < 0.05)。  结论  新辅助动脉介入化疗的组织缓解率、平均生存时间较静脉化疗好, 但未能提高其远期生存率。      

Proton Beam Therapy and Continuous Intra-Arterial Chemotherapy for Polymorphous Low-Grade Adenocarcinoma in the Hard Palate

Polymorphous low-grade adenocarcinoma is a rare malignant tumor that mainly occurs in salivary glands, particularly in the hard palate. To date, surgery has been the most commonly used treatment method with the aim of achieving negative margins of resection. Here, we report a case of a 51-year-old woman who presented with a painless growing mass in her oral cavity with Rouviere''s lymph node metastasis. Laboratory data showed severe anemia because of bleeding from the tumor. We inserted two catheters into the bilateral external carotid arteries via the superficial temporal arteries, and began continuous intra-arterial infusion with cisplatin and a cisplatin-neutralizing agent. The bleeding stopped after the first infusion, and we continued with weekly arterial cisplatin infusion and proton beam therapy (70.4 GyE in 32 fractions). A decrease in tumor volume has been maintained for 2 years, with no evidence of new metastasis.Key Words: Polymorphous low-grade adenocarcinoma, Proton beam therapy, Continuous intra-arterial chemotherapy     

A Psychosocial Intervention for Patients with Soft Tissue Sarcoma

Support groups have increasingly been demonstrated to be an effective intervention in reducing psychological difficulties and emotional problems in patients with cancer. This report describes a pilot support group intervention based upon a modified version of Cain and collleagues' (1986) thematic counseling model for patients who have been treated for soft tissue sarcoma and are free of disease. The modified thematic counseling model consisted of eight group sessions that focused on providing information about soft tissue sarcoma, management of stress, relaxation techniques, and coping skills. In addition, time was set aside for general discussion of personal concerns. Common themes reported by patients were: communication with family, friends and physicians, anxiety about lack of information about soft tissue sarcoma, and major financial disruption because of their illness. At the conclusion of the eighth session, patients were given an informal survey and asked to rate the value of different aspects of the program for them. They reported that feelings of isolation, anger, depression, and anxiety significantly decreased; and their level of self-confidence increased dramatically. This pilot support group intervention is recommended as a model for enhancing the quality of life of patients with soft tissue sarcoma. © 1997 John Wiley & Sons, Ltd.     

Primary Chemotherapy and Delayed Surgery (Neoadjuvant Chemotherapy) for Telangiectatic Osteogenic Sarcoma of the Extremities

Summary

Twelve patients with telangiectatic osteogenic sarcoma (TOS) of the extremities were treated with neoadjuvant chemotherapy, according to two different protocols.

Preoperatively the patients received high-dose methotrexate(HD-MTX)/cisplatinum(CPD) or HD-MTX/CPD/adriamycin(ADM). CPD was delivered intra-arteriously, the other drugs intravenously. Limb salvage surgery was performed in eight instances and four patients underwent amputation. Post operative chemotherapy was tailored according to the grade of necrosis determined by preoperative treatment on the primary tumor. In ten cases (83%) the grade of necrosis resulted higher than 95%.

The mean length of follow-up was 3.5 years with a range of 18 to 72 months. Ten patients (83%) reimained continuously disease-free, while two patients developed lung metastases and died of uncontrolled disease. No local recurrences were observed.

These results are better than those observed in 167 contemporary cases of conventional osteosarcoma treated with the same protocols. This study confirms that TOS is not always a lethal tumor as suggested by prior reports. Employing neoadjuvant chemotherapy a high percentage of patients with TOS can be cured and in most of them, limb sparing surgery is possible and safe.     

Intra-Arterial Chemotherapy is Reliable in Preventing High-Risk Superficial Bladder Cancer from Recurrence and Progression

Abstract

The purpose of this prospective study was to evaluate the therapeutic effects of intra-arterial chemotherapy in preventing high-risk superficial bladder cancer from recurrence and progression. From May 2003 to December 2007, 52 patients were divided randomly into 2 groups. Twenty-five patients were given intra-arterial chemotherapy with gemcitabine and cisplatin, and 27 patients received intravesical instillation with epirubicin. After 6-67 months of follow-up (median, 40 months), the overall recurrence-free rates of the intra-arterial chemotherapy and intravesical instillation groups were 83.3% and 33.4%, respectively (p=0.001 log rank). Tumor progression was not found in the intra-arterial chemotherapy group while 7 patients in the intravesical instillation group had tumor progression. The overall tumor progression free rates were 100% and 58.5%, respectively (p=0.009 log rank). The patients with functional bladders were 100% and 81.5% in the intra-arterial chemotherapy and intravesical instillation groups after 67 months of follow-up, respectively. In conclusion, intra-arterial chemotherapy is more effective than intravesical instillation in preventing high-risk superficial bladder cancer from recurrence and progression.     

Hepatic Abscess Following Hepatic Arterial Infusion Chemotherapy with an Implantable Pump

A patient with an intrahepatic abscess associated with an implantable pump for hepatic arterial infusion for metastatic colonic tumor is described. In view of the increased use of this device, clinicians should be aware of this complication.     

内引流加区域动脉灌注健择治疗晚期胰头癌

[目的]评价内引流加区域性动脉灌注健择(吉西他滨)治疗晚期胰头癌的可行性.[方法]对25例经病理确诊不能手术切除的晚期胰头癌病人行各种胆肠内引流术,术中、术后用健择作区域性动脉(如胃十二指肠动脉和/或胰十二指肠下动脉)灌注化疗.[结果]25例病人中可评价疗效者23例,其中PR3例,MR6例,SD11例和PD3例;临床受益反应评价有效率为65.2%(15/23).死亡9例,平均生存10.9月,另14例已存活1.5～21月.所有病人未发现明显的毒副作用.[结论]内引流加区域性动脉灌注健择化疗是治疗晚期胰头癌的一种较好的方法,可明显改善病人的生活质量、提高临床受益反应,病人耐受良好.     

皮下埋植式动脉化疗联用保肢手术治疗骨肉瘤

:目的　评价皮下埋植式动脉化疗联用保肢术治疗骨肉瘤的疗效。方法　15例骨肉瘤,男10例,女5例。年龄14～24岁。股骨下段14例,腓骨上段1例。Enneking分级:ⅡB期12例,ⅢA期3例。术前动脉置管导向化疗6次,行肿瘤边缘或扩大切除,病灶骨端酒精灭活,髓内针、骨水泥充填固定。术后继续化疗4次。结果　术前化疗后症状消失,X线、CT显示病灶缩小、硬化或消失,新骨形成,边缘相对整齐,手术所见肿瘤组织液化、坏死,与周围组织分离。镜下肿瘤细胞坏死率大多达90%以上。全组中位生存期365个月,局部复发率20%。结论　皮下埋植式动脉化疗,操作简便、安全、毒副反应小,达到了维持肿瘤内药物浓度高,有效杀灭瘤细胞的目的,为保肢疗法提供一个更安全的切除缘。肿瘤细胞坏死率对判定疗效、评估预后、指导术后化疗有重要价值。     

中药预防和治疗放化疗所致口腔溃疡临床观察

目的临床对照观察中药外用(嗽口)对鼻咽癌放疗所致口腔溃疡(放射性口腔炎)的预防作用和内服、外用中药对化疗所致口腔炎的治疗作用。方法观察在放疗期间采用中药外用和未用两组口腔溃疡发生率差异,观察采用中药内服加外用与西药局部处理两组疗效差异。组间率的差异采取χ2检验。结果预防用药组口腔溃疡发生率15%(3/20),未用药组90%(18/20),组间差异有显著性(P<0.01)。治疗中药组有效率96.7%(29/30),西药对照组有效率86.7%(26/30),组间差异有显著性(P<0.01)。结论中药外用预防放射性口腔炎,方法简便经济,预防效果显著,尚未见类似报道。中药内服外用治疗化疗所致口腔溃疡疗效优于对照组,且无毒副作用。     

中药预防和治疗放化疗所致口腔溃疡临床观察

目的临床对照观察中药外用（嗽口）对鼻咽癌放疗所致口腔溃疡（放射性口腔炎）的预防作用和内服、外用中药对化疗所致口腔炎的治疗作用。方法观察在放疗期间采用中药外用和未用两组口腔溃疡发生率差异，观察采用中药内服加外用与西药局部处理两组疗效差异。组间率的差异采取．）（。检验。结果预防用药组口腔溃疡发生率15％（3／20），未用药组90％（18／20），组间差异有显著性（P〈0．01）。治疗中药组有效率96．7％（29／30），西药对照组有效率86．7％（26／30），组间差异有显著性（P〈0．01）。结论中药外用预防放射性口腔炎，方法简便经济，预防效果显著，尚未见类似报道。中药内服外用治疗化疗所致口腔溃疡疗效优于对照组，且无毒副作用。     

宫颈癌新辅助化疗中动脉介入化疗现状

宫颈癌现多采用新辅助化疗联合手术或放射治疗的综合治疗模式。ⅠB_2期与ⅡA期宫颈癌运用术前动脉介入化疗已得到公认;ⅡB期以上是否采用术前动脉介入化疗尚存在争议。疗效评价方法多样。文章就术前动脉介入化疗的临床意义、适应证及疗效评价方法作一综述。