Combined Therapy of Operation and Radiation in Primary Liver Cancer

Combined therapy of operation and radiation was carried out in 22patients with primary liver cancer in our hospital.All the patients weremales,ranging from 15-69 yr of age with an average of 44.5 yr.His-tological diagnosis was hepatocellular carcinoma in 21 cases andcholangioearcinoma 1 case.17(77.3％)patients were associated withliver cirrhosis,and 19(86.4％)patients had positive AFP bycounterimmunoelectrophoretic method.Clinically,6 patients were in stageⅠ,11 in stage Ⅱ and 5 in stage Ⅲ.Liver resection was performed on 17patients(5 local resections,5 right hemihepateetomies,2 left laterallobectomies,2 left hemihepatectomies,2 total right hepatectomies,and1 left medial Iobectomy)and palliative operation on the other 5 patients(4 hepatic artery ligations or operative embolizations and 1 hepaticartery infusion).For radiotherapy either local or perative whole-liverradiation with ~(60)Co was applied.Up to May 1983,19 patients who had been followed up had survivedfor more than 6 months.The survival rates at 1,2,3,4 years aftertreatment were 78.9％,66.7％,64.3％ and 44.4％ respectively with amedian survival duration of 36 months.Data have shown that the encou-raging results of this method are better than those of only liverresection or only radiotherapy at present.     

Postoperative radiotherapy for stage I thymoma: a prospective randomized trial in 29 cases

OBJECTIVE To determine the effect of postoperative radiotherapy on stage I thymoma.

METHODS Twenty-nine patients with stage I thymoma younger than 65 years, treated between August 1981 and January 1996 were included in this study. All patients were randomly assigned into two groups: surgery alone (13 patients) and surgery with postoperative radiotherapy (16). Staging was based on the surgical and pathologic criteria that the tumor had a complete capsule and without capsular invasion microscopically. Adjuvant radiotherapy was started within 4 weeks after surgery. Megavolage radiation, using the isocentric technique, was administered through an anterior field and/or two anterior oblique wedge fields. For the patients with lymphocytic predominant type, the dose was 50 Gy in 25 daily fractions for 5 weeks; for the patients with epithelial cell type or mixed type, the dose was 60 Gy in 30 daily fractions for 6 weeks. The survival rates were estimated by the Kaplan-Meier method.

RESULTS There was no recurrence and metastasis in either group. No acute and late radiological injuries were found among the patients receiving radiotherapy postoperatively. The 5-year and 10-year survivals were both 92% for the patients treated by surgery alone. However, the survival rates for patients who received radiotherapy were both 88%. There was no difference in the survivals in these two groups. Of the 3 died patients, 1 died of myasthenia gravis and 2 of intercurrent illness. No significant correlation was found between myasthenia gravis and radiotherapy.

CONCLUSIONS Postoperative radiotherapy is unnecessary for the patients with stage I thymoma. No relation is found between radiotherapy and myasthenia gravis.

     

Permanent hepatic artery embolization with dextran microspheres in 131 patients with unresectable hepatocellular carcinoma.

One hundred thirty-one patients with hepatocellular carcinoma were subjected to permanent hepatic artery embolization with dextran microspheres (G-25, 50-150 mu). Dextran hepatic artery embolization is indicated for massive, nodular or multinodular hepatocellular carcinoma with total bilirubin less than 3 mg/dl, serum albumin greater than 3.0 g/dl, tumor involvement area less than 50% or without involvement of the main portal vein. Following hepatic angiography a catheter was inserted superselectively into the hepatic artery feeding the tumor. Adriamycin (60-80 mg) or cisplatin (60-100 mg) was infused immediately before embolization. Under fluoroscopic guidance, 0.3-0.5 g of dextran microsphere embolizer permeated with 10 mg of mitomycin C was infused into the feeding artery through the catheter. Dextran microspheres caused marked homogeneous and distal micro-arterial embolization, especially in the arteriole with a caliber of about 100 mu. Dextran microspheres were not resorbed in a period of 16 weeks in humans, thus reducing or preventing the formation of intrahepatic and extrahepatic collaterals after hepatic artery embolization. Dextran hepatic artery embolization was very effective for not only main tumor but also daughter foci or metastatic nodules, as was confirmed histologically in 8 cases. The 1-year, 2-year and 3-year survival rates were 57.0%, 31.4% and 24.2% respectively.

     

Clinical values of palliative gastrectomy for late-staged gastric cancer

Objective To investigate the clinical importance of palliative gastrectomy for late-staged gastric cancer. Methods From June 1994 to October 2001,95 patients with late-staged gastric cancer underwent palliative operation. Clinicopathological and prognostic parameters between 64 patients with palliative gastrectomy (PG group) and 31 patients with unresectable operation (UO gruop) was compared retrospectively. Results The age and gender ratioes were not different between the two groups. The incidence of large volume (diameter≥8 cm), serosal invasion (T4) and late TNM stage (Ⅳ stage) were significantly higher in the UO group than that in the PG group. There was no difference in peritoneal disemination, distant lymph node and hepatic metastasis, and tumor location between the two groups. The one- and two-year survival of the patients in the PG group was 48. 1 % and 23.1% ,and significandy better than 13.5% and 0 in the UO group. Conclusion Palliative gastrectomy, compared with unresectable operation, can     

Assessment of multimodality therapy for thymoma

Background This study was designed to analyze the accuracy and reliability of several prognostic indicators for long-term survival of thymoma patients. Methods Data from 142 patients treated for thymoma at the Tianjin Medical University Cancer Hospital from January 1954 to January 2001 were retrospectively analyzed. The Kaplan-Meier method and Cox＇s proportional hazards model test were used for single and multi-variable analyses respectively. The Log-rank test was used to compare survival between groups. Results The sizes and extent of the tumors were classified as I-IV according to the Masaoka clinical staging scale. Respective 5- and 10-year survival rates were： 93.8% and 79.2% in stage I, 79.3% and 55.2% in stage II, 53.1% and 34.4% in stage III, and no survivors in stage IV. Among 30 patients with associated myasthenia gravis, 19 had generalized myasthenia gravis and 11 had ocular myasthenia gravis; 5- and 10-year survival rates were 83.3% and 60.0%, respectively. The 5- and 10-year survival rates for 112 patients without myasthenia gravis were 53.6% and 42.0%, respectively. Eighty-four patients had radical resection and nine had palliative resection. Eighty-nine patients had radiotherapy and 55 patients had postoperative radiotherapy. Single or multi-variable analyses showed that the main prognostic indicators are Masaoka clinical staging, thymoma-associated myasthenia gravis, and the treatment method. Conclusions The most important indicators of long-term survival in thymoma are Masaoka clinical staging and the completeness of resection. The primary treatment method for thymoma should be wide tumor resection. Pre- and/or postoperative radio- and/or chemotherapy should be given according to individual treatment requirements.     

An improved technique for bloodless hepatic resection on in situ cold perfused liver.

An improved technique for bloodless hepatic resection using in situ isolation and asanguinous hypothermic perfusion was described to deal with huge liver tumors involved in the liver hilum, the main hepatic veins and retrohepatic inferior vena cava. The original Fortner's technique was modified, including the choice of incision; semi-isolated perfusion of the liver portion preserved through the single portal vein; suprahepatic outlet of the perfusate and the shortening of the period of hepatic ischemia by reperfusion of hepatic artery prior to the repair or reconstruction of the portal vein. The initial successful experience of the technique applied to 2 pediatric cases with giant liver tumors was reported, and the indications, intraoperative and early postoperative courses were discussed.

     

Effect of carboplatin based combination chemotherapy on ovarian cancer.

OBJECTIVE To investigate the effect of carboplatin based combination chemotherapeutic regimen given intraperitoneally and intravenously on ovarian epithelial cancer.

METHODS Carboplatin based combination chemotherapy was given intraperitoneally and intravenously to 48 patients with epithelial ovarian cancer. Of them, 10 cases with ascites had received no treatment before, and 38 patients had undergone cytoreductive surgery prior to the study.

RESULTS The results of this study showed that carboplatin based combination chemotherapy could not only reduce the tumor mass but also decrease the amount of ascites (P < 0.05) in patients with ascites. The response rate was 80% (clinical complete response rate was 10%) in untreated patients with ascites. The 3-year survival rate of patients with ovarian epithelial cancer was 92.3% in stage I, and 30% in stage III patients after the cytoreductive surgery. Tumor recurrence occurred during the course of chemotherapy in 15% of stage I patients and 53.3% of stage III patients.

CONCLUSIONS Carboplatin based combination chemotherapy given intraperitoneally and intravenously has potent effect on untreated ovarian cancer with ascites. But carboplatin based chemotherapy could not overcome the problem of drug resistance. To improve the prognosis of ovarian cancer, much more researches on the mechanisms of drug resistance need to be carried out.

     

Right Hemicolectomy and Multivisceral Resection of Right Colon Cancer:A Report of 21 Cases

The long-and short-term outcomes in 21 patients with right colon cancer after right hemicolectomy and multivisceral resection surgery were investigated. Short-term therapeutic effects and long-term survival rate were retrospectively analyzed in patients with right colon cancer. These individuals underwent right hemicolectomy in combination with multivisceral resections including pancreatic head, duodenum, kidney, liver, gallbladder, and abdominal wall at the Department of General Surgery in the Henan Tumor Hospital between January 2003 and August 2014. The patients had an average age of 58.9 years(range: 39–78). Three patients had metastatic invasion only to the duodenum; meanwhile 18 patients had invasion to the duodenum and other adjacent organs. The median survival time was 41 months(95% CI: 6.972–75.028) with one death in the perioperative period. No patients lost follow-up. One-, 3-, and 5-year survival rate was 75%, 56%, and 43%, respectively. It was concluded that indications for surgery should be tightly controlled. Favorable clinical outcomes of right hemicolectomy and multivisceral resection surgery were demonstrated for patients with right colon cancer at the T4 stage.     

Causes of death and long-term prognosis after myocardial infarction in patients with diabetes mellitus.

The long-term prognosis and causes of death of myocardial infarction (MI) in 62 diabetics were studied. The mean follow-up time was 6.2 years, 11 patients died in the acute stage of MI, 9 of them (81.8%) had anterior infarction and their major causes of death were ventricular fibrillation and cardiogenic shock (72.2%). 19 died in the follow-up period, 14 of them (73.68%) had inferior and anterior septal infarction; and most died of reinfarction and sudden death. The cumulative survival rate 1, 2 and 5 years after MI was 80.7%, 71.9% and 57.9%, respectively. The results suggest that treatment and prevention of MI in patients with diabetes be more attentive to prevent ventricular fibrillation and cardiogenic shock during the acute stage and in the later stage more attention should be paid to preventing reinfarction. At any stage of the disease, strict diabetic control is of vital importance.

     

Lipiodolization with or without gelatin sponge in hepatic arterial chemoembolization for hepatocellular carcinoma.

Fifty-two patients with unresectable hapatocelluar carcinoma were divided into 2 groups. Group A (n=24) received lipiodolization with gelatin sponge and group B (n=28) lipiodolization alone. Angiography after hepatic arterial chemoembolization revealed a satisfactory accumulation of lipiodol and obliteration of the micovasculature in the tumors in both groups. However, prolonged obliteration of proximal hepatic arteries was noted in 70%-80% of patients in group A, in contrast to the patency of the arteries in group B. Collateral circulation was found more frequently in group A than in group B, in which recanalization of tumor vessels and phenomenon of iodized oil "wash-out" were seen. There were no significant differences in therapeutic effects in patients with low risk. In those with high risk, the response rates were 28.6% and 64.2%. The half-year survival rates were 28.5% and 62.8%, 1-year survival rates 7.1% and 27.5%, and 2-year survival rates 0% and 13.7% in group A and B respectively. The differen     

原发性肝癌术后复发的再次外科治疗

1980～1990年,作者收治原发性肝癌660例,手术切除124例(18.8％)。术后肝内复发者32例(肝内复发率25.8％),2 年以内复发者占93.8％。93.7％合并肝硬化,15.5％并发门脉高压症。复发肝癌中4例(3.2％,4/124)行再切除,术后生存平均26.8月;22例行B超引导肝癌复发灶无水酒精注射术,术后8例死亡,平均生存8.5月;10例行肝动脉栓塞化疗或肝动脉结扎及插管化疗,术后生存平均16.8月,对照组仅4.5月。复发癌再次外科治疗以再切除术为首选(术后生存26.8～42.6月),成为继小肝癌切除,大肝癌二期切除后提高肝癌切除疗效的第三条途径。     

大肝癌手术切除探讨（附16例分析）

报告16例大肝癌手术切除治疗效果，癌块直径>7cm。其中巨块型12例，癌块>10cm9例；癌块>14cm3例，均经病理证实。Ⅱ期切除3例，均经肝固有动脉结扎加插管注药化疗，肿块缩小后再手术，术后生存1年4例，2年3例，3年4例，4年1例，全组中位生存期24.1个月，并对大肝癌的手术适应证及术式选择等进行了探讨。     

不能切除肝癌的二期切除（附22例报告）

目的：探讨不能切除肝癌二期切除的必要性及手术指征和手术方式。方法：自1990年至2000年收治不参切除肝癌229例,经各种综合预治疗后有22例获二期切除,其中行肝左叶切除3例,不规上叶切除12例,肝右后叶切除＋门脉癌栓清除4例,肝右后叶切除＋部分膈肌切 中下肺切除1例,肝右叶切除＋部分膈肌切除2例,二期切除距末次治疗时间20天－4个月,中位时间2．3个月。结果：22例二期切除标本均残瘤细胞,术后近期死亡例,1、3、5年生存率为72．73％、45．45％、18．18％,结论不能切除肝的二期切除是提高中晚肝癌切除率,延长生存期的有效途径。     

A Controlled Clinical Study between Hepatic Arterial Infusion with Embolized Curcuma Aromatic Oil and Chemical Drugs in Treating Primary Liver Cancer

Ｏｂｊｅｃｔｉｖｅ：Ｔｏｅｖａｌｕａｔｅｔｈｅｅｆｆｅｃｔｉｖｅｎｅｓｓ,ｔｏｘｉｃｉｔｙａｎｄｐｒｏｓｐｅｃｔｉｖｅａｐｐｌｉｃａｔｉｏｎｏｆｈｅｐａｔｉｃａｒｔｅｒｉａｌｉｎｆｕｓｉｏｎ（ＨＡＩ）ｗｉｔｈｅｍｂｏｌｉｚｅｄＣｕｒｃｕ ｍａＡｒｏｍａｔｉｃｏｉｌ（ＣＡＯ）ｉｎｔｒｅａｔｉｎｇ ｐｒｉｍａｒｙｌｉｖｅｒｃａｎｃｅｒ（ＰＬＣ）．Ｍｅｔｈｏｄｓ：Ｉｎｔｈｅｔｒｅａｔｅｄｇｒｏｕｐ, 32 ｐａｔｉｅｎｔｓｗｉｔｈＰＬＣｗｅｒｅｔｒｅａｔｅｄｂｙＨＡＩｗｉｔｈ 1 - 3ｍｌｅｍｂｏｌｉｚｅｄＣＡ…     

中晚期原发性肝癌介入治疗后二期切除

目的：探讨中，晚期原发性肝癌介入治疗的方法及其对二期手术切除的价值，方法：对140例不能手术切除的中，晚期原发性肝癌，经不同介入方法治疗。结果：20例获得二期切除（二期切除率为14．3％），综合治疗组（B组）二期切除率和5年生存率分别为24．1％（14／58）和47．1％，高于单方法组（A组）的7．3％（6／82）和0，两组比较差异有显著性（P均＜0．01），二期切除与非二期切除患者的1，3，5年生存率分别为95．0％，63．5％，32．9％及58．3％，17．6％，5．5％。结论：介入方法治疗中，晚期原发性肝癌可获得二期手术切除，综合介入治疗方法的二期切除和远期生存率高于单一的介入治疗方法。     

Analysis of follow-up data in 83 cases of primary liver cancer]

Eighty-three patients with primary liver cancer (PLC) having survived over 5 years were investigated. 50.6% (42/83) of them were in Stage I and 49.4% (41/83) were in Stage II. Resection was performed in 94.0% (78/83), and hepatic artery ligation and/or cannulation was done in 6.0% (5/83). By the end of March 1990, 66.3% (55/83), were cancer-free, 4.8% (4/83) were living with the cancer, 20.5% (17/83) died from recurrence or metastasis of cancer, 7.2% (6/83) died from liver failure, and 1.2% (1/83) lost followup. 29 cases survived over 10 years after resection of PLC. A comparison with 811 patients having less than 5 years during the same period demonstrates that early discovery, lower gamma glutamyl transpeptidase (gamma-GT) and alanine aminotransferase (ALT), tumor less than or equal to 5 cm, single nodule, well-encapsulated tumor, radical resection, and alpha fetoprotein (AFP) normalization after resection may contribute to prolonged survival. It is concluded that early detection and early radical resection are essential to improve the therapeutic effects.     

肝动脉灌注结合全身化疗治疗进展期肝内胆管细胞癌的效果观察

目的:评估肝动脉灌注结合全身化疗治疗进展期肝内胆管细胞癌的疗效.方法:将41例肝内胆管细胞癌患者按治疗方法不同分为灌注组和单纯化疗组.灌注组22例经肝动脉灌注5-Fu和顺铂,同时给予吉西他滨静脉滴注;单纯化疗组19例给予吉西他滨和顺铂静脉滴注.对比分析两组疗效.结果:灌注组CR 1例,PR 7例,SD 9例,有效率38...     

三维适形放疗联合鸦胆子油乳介入治疗原发性肝癌临床研究

目的探讨三维适形放射治疗联合介入化疗治疗肝癌的临床效果。方法选取本院2007年9月至2009年3月收治的78例无法手术切除的肝癌患者,随机分为单纯介入治疗组38例(鸦胆子油乳10mg/m2,5-Fu 500mg/m2,顺铂40mg/m2,表阿霉素40mg/m2);介入治疗(同前)加三维适形放射治疗组40例,放射治疗肿瘤的平均剂量为56Gy(50～60Gy),观察两组患者1年无进展生存率、1.5年总体生存率与毒性反应情况。结果平均生存时间,单纯介入化疗组为(9.2±2.1)个月,介入化疗加放射治疗组为(13.5±1.9)个月,两组比较差异有统计学意义(P<0.05);单纯介入化疗组1年总体生存率为45.4%,而介入化疗加放射治疗组为58.5%,两组比较差异有统计学意义(P<0.05);1.5年总体生存率介入联合放射治疗组(28.4%)显著高于单纯介入治疗组(7.8%),差异有统计学意义(P<0.05);两组在发热、腹痛等不良反应发生率方面比较差异无统计学意义(P>0.05)。结论三维适形放射治疗联合鸦胆子油乳为基础的介入治疗让部分肝癌患者临床受益,三维适形放射治疗后尚需进一步的措施防止远处转移和肝功能恶化。     

原发性肝癌经皮肝动脉药物灌注和栓塞治疗

本文收集了44例、年龄26～70岁,全部经AFP、B超、CT及血管造影证实均符合原发性肝癌诊断标准的一组病例,行67次肝动脉灌注化疗(HAI)和/或肝动脉栓塞治疗(HAE),其中5例辅以原发灶和转移灶的酒精硬化治疗并行随访观察;结果全部病例自觉症状改善,5例腹水和黄疸消失,2例黑便消失,1例锁骨上和腹股沟转移淋巴结软化,66.7％肝脏有不同程度缩小,16.8％保持稳定,一年以上随访的11例中6例存活超过一年,生存超过6个月的占64.7％,经上述治疗后有4例中晚期肝癌重新获得手术切除。介入治疗对中晚期肝癌是一项极其有效的方法。本组全部病例治疗后症状均改善,提高了生存质量。治疗方法以联合治疗最佳,特别对巨块及结节型伴或不伴转移者,辅以原发灶和转移灶酒精硬化治疗,其疗效明显提高。     

肝移植术后早期肝动脉血供不良与胆道并发症

目的分析肝移植术后早期肝动脉血供不良(HAI)背景下胆道并发症(BC)的临床转归。方法自1999年2月至2004年2月,本单位共施行原位肝移植术240例。术中肝动脉和胆道重建均采用改良的显微外科吻合技术,术后动态监测肝动脉血流动力学及胆树完整性,回顾性研究肝移植术后早期HAI对胆道并发症发生与预后的影响。结果32例(13.3%)受体发生胆道并发症,其中11例(4.6%)病人移植后早期出现HAI(HAI组),21例(8.7%)移植后早期未出现HAI(nonHAI组)。HAI组包括3例肝动脉血栓形成(HAT)和8例肝动脉狭窄(HAS)。3例HAT病人均成功实施急诊取栓术,2例HAS病人接受短期抗凝药物治疗。HAI组术后出现7例胆道狭窄和4例胆漏,6例行内镜和/或放射介入治疗,4例行吻合口修补及胆道引流术,1例行药物治疗。8例病人死亡,3例治愈。HAI组病人术前血清总胆红素水平显著高于nonHAI组(373μmol/L±94μmol/Lvs111μmol/L±45μmol/L,P=0.008)。HAI组病人的1年和3年生存率分别为54.6%和16.4%,nonHAI组为66.3%与61.2%,两组差异有统计学意义(P=0.042)。结论肝移植术后早期出现HAI的胆道并发症病人预后不良;移植后早期应加强彩色多普勒超声动态监测,尽快恢复肝动脉正常血流;具有早期HAI背景者一旦发生胆道并发症,需及时施行介入治疗或中转手术并考虑再次肝移植的必要性。