复发性软组织脂肪肉瘤术前化疗的临床观察

目的观察复发性脂肪肉瘤术前灌注化疗的疗效。方法21例复发性脂肪肉瘤患者,术前采用皮下埋植式动脉介入化疗系统,用阿霉素和顺铂为主,联合咖啡因治疗。结果病变影像改变有效18例,病理中重度以上化疗反应15例,平均随访39个月,术后肿瘤局部复发2例,肺转移1例,3例死亡。结论复发性脂肪肉瘤的治疗可以选择动脉灌注化疗,肿瘤组织学分类恶性程度高的化疗效果更好,以化疗后手术切除的肿瘤病理改变作为重要的预后评价标准。     

肉瘤样癌及癌肉瘤的新认识

长期以来，肉瘤样癌与癌肉瘤的组织学起源、病理分型等问题一直存在争议，类似名称众多，从而给病理诊断和临床治疗带来紊乱。从最新的WHO定义及病理学上的研究趋势着手，对此类肿瘤作一分析，还对发生在各部位的肉瘤样癌与癌肉瘤按其临床特点展开讨论。     

介入化疗与保肢手术治疗软组织肉瘤

目的研究术前动脉介入化疗与手术治疗肢体软组织肉瘤。方法21例肢体软组织肉瘤，其中13例(62％)术前影像学显示肿瘤邻近大血管或骨骼侵犯，采用股动脉及肱动脉插管，化疗2—3周后，施行肿瘤切除及保留肢体功能的手术。结果介入化疗后病理检查，肿瘤有不同程度的坏死，体积缩小，周围水肿浸润带减少，肿瘤与邻近组织术中易分离，术后随访6—62个月，患肢功能基本正常。结论对四肢软组织肉瘤侵犯大血管、骨骼者，术前动脉介入化疗可提高切除率，降低局部复发及保存患肢。     

胃肉瘤样癌1例

患者女,39岁,汉族.主因间断性上腹部隐痛半年,加重1周于2010年3月10日入我院胃肠外科.患者半年来上腹部饱胀不适,伴间断性隐痛,进食后加重,可自行缓解.无返酸,无明显恶心、呕吐,大便成形,量中等,无黑便、血便.自行口服"奥美拉唑"等药物,症状无明显好转.患者上诉症状加重1周,于当地医院查胃镜示:胃角处可见一处不规则溃疡病变,大小约2.5 cm×2.0 cm质脆.     

食管肉瘤样癌

目的　探讨食管肉瘤样癌的病理诊断及临床特点。方法　分析了 12例食管肉瘤样癌的临床资料、病理变化并复习有关文献。结果　 12例中 ,男性 10例 ,女性 2例。平均年龄 60岁。临床症状为逐渐加重的吞咽困难。病程从 10余天到 5个月。发生在食管中段者 5例 ,下段者 7例。大体形态 :8例呈典型的息肉样生长 ,2例呈蕈伞型 ,另 2例髓质型 ;病理均为鳞癌与肉瘤样成分 ,6例浸润深度位于粘膜固有膜或粘膜下层。 5例术后时间超过 5年者尚有 3例存活 ,5年生存率为 5 0 %。结论　食管肉瘤样癌本质上是一种特殊类型的癌 ,以息肉样生长为主 ,因病程短 ,浸润深度常较浅 ,手术切除预后好     

腹腔动脉介入化疗治疗癌性腹痛32例报告

我院自1992年8月～1993年8月对32例腹部晚期癌症疼痛经止痛药不能缓解的患者行腹腔动脉介入化疗取得了止痛效果确实,止痛时间长副作用小的效果。提示对晚期癌症腹痛患者阿片类止痛药不能有效止痛或阿片类成瘾者,不能一味增加阿片类止痛药的应用,只要条件允许应及早应用腹腔动脉介入化疗进行止痛。     

11例癌肉瘤临床病理及免疫组化分析

目的：探讨癌肉瘤组织学本质，为临床选择治疗方案提供理论根据。方法：应用ＳＰ免疫组化方法，对１１例癌肉瘤分别作了ＣＫ，ＥＭＡ及Ｖｉｍｅｎｔｉｎ标记，部分病例作了Ｓ－１００，α１－ＡＣＴ，Ｄｅｓｍｉｎ及Ｍｙｏｇｌｏｂｉｎ标记。结果：结合光镜ＨＥ切片及免疫标记进行分析，其中８例肿瘤中所谓间叶样成分，同时对ＣＫ或ＥＭＡ呈阳性表达，且癌与肉瘤样区有移行，诊断为肉瘤化癌；另３例癌与肉瘤间无移行关系，且两种成分     

肺肉瘤样癌1例

1病案摘要患者男性,63岁,因“左侧胸闷,咳嗽半年,痰中带血1月”于2006年5月13日入院。胸部CT检查示:左肺上叶中央型肺癌,伴左肺上叶阻塞性炎症。行纤维支气管镜活检示:恶性肿瘤。腹部彩超及头颅CT检查均未见异常。于2006年5月16日行左肺癌根治术,术后病理检查示:“左上肺”恶性     

进展期胃癌术前动脉灌注化疗的临床观察

本文报告12例进展期胃癌患者术前应用动脉灌注化疗，以提高手术切除率结果，本组病人经动脉灌注化疗1～2次后临床症状均有不同程度缓解。腹部包块缩小10例，占83．3％。在12例均手术探查中，有8例手术切除，占66．7％，其中D1根治术2例D2根治术4例，姑息性切除2例。组织学效果：轻度有效2例，中度有效5例，显著有效1例。疗效满意。因此，进展期胃癌术前动脉灌注化疗对改善临床病期，缩小原发病灶，使不能手术的患者变为可能手术有极其重要意义。     

Effectiveness of carboplatin and etoposide selective intra-arterial chemotherapy for progressive soft-tissue sarcoma

Four patients with advanced soft tissue sarcomas were treated by selective intra-arterial injection of carboplatin (450 mg/m2/2 hr) and etoposide (200 mg/m2/2 hr). After 2-4 courses of treatment, tumor size was remarkably reduced. Three of the 4 patients became candidates for limb-salvage surgery with a safety margin. During the treatment, patients showed no significant complications except for slight nausea and myelosuppression. This protocol might be a recommendable treatment for advanced soft tissue sarcomas.     

Preoperative intra-arterial infusion chemotherapy for advanced squamous cell carcinoma of the mouth and oropharynx

Twelve patients with advanced locoregional (Stage III and IV) squamous cell carcinoma of the oral cavity and oropharynx underwent treatment with cisplatin, vinblastine, bleomycin, and 5-fluorouracil, given by intra-arterial infusion, as primary adjuvant therapy, in preparation for radiation therapy and surgery. Responses were observed during or immediately after infusion therapy in 8 of 12 (67%) of patients (1 complete response, 7 partial responses). Infusion chemotherapy was followed by radiation therapy alone in five patients and by radiation and surgery in six patients. The protocol was initiated in August 1981, and six patients are now free of their primary cancer, at 21 to 36 months, whereas six have died with disease. Arterial infusion of a combination of effective antineoplastic agents is a promising method for the preparation of selected patients for radiation therapy and surgery, as it is less likely to produce serious systemic toxicity and it requires a shorter period than systemic neoadjuvant chemotherapy.     

Ameloblastic sarcoma: pathogenesis and treatment with chemotherapy.

A recurrent tumor in a young male demonstrates the progression of an ameloblastic fibroma to an ameloblastic sarcoma. Chemotherapy with Actinomycin D, Vincristine, and Cytoxan produced a complete response without evidence of recurrence 4 years after initiation of chemotherapy. The patient developed an aggressive malignant melanoma 1 year after all chemotherapy was discontinued.     

Neoadjuvant chemotherapy with intra-arterial infusion in the treatment of advanced cervical cancer

Neoadjuvant chemotherapy (NAC) with intra-arterial infusion was performed in the treatment for 53 patients with advanced cervical squamous cell carcinoma. After NAC with intra-arterial infusion of the anticancer agents including cisplatin via internal iliac artery or uterine artery, 42 patients received radical hysterectomy. The response to therapy was observed in 45 of all patients (84.9%) clinically, and 36 of 42 patients (85.7%) pathologically. Cancer cells disappeared in 11.9% of patients with cervical invasion, 69.2% with vaginal wall invasion and 39.4% with parametrium invasion after NAG. Five-year survival rates were 100% in stage I, 71.5% in stage II, 52.2% in stage II and 0% in stage IV. The group of patients without cancer in the parametrium after NAC showed a significantly better 5-year survival rate than the group with residual cancer in the parametrium. According to the results, the elimination of cancer invasion to the parametrium by NAC is thought to be important for improvement of the prognosis in advanced cervical cancer.     

Preoperative chemotherapy treatment of breast cancer--a review

Despite proven benefits of neoadjuvant chemotherapy in patients with locally advanced, invasive breast cancer, no regimen is recommended as the treatment of choice. Neoadjuvant chemotherapy regimens encompass single-agent and combination therapy and sequential treatment. For this report, the author reviewed the literature to determine which regimen, if any, was most beneficial. The results indicated that studies have yielded a wide range of response rates, but no single regimen has emerged as a clear leader. The literature is compounded further by lack of standardized criteria to determine pathologic complete response (which is predictive of survival benefits) and between-study variation in the stringency by which this endpoint is defined. Given the lack of a preferred treatment regimen in the neoadjuvant setting, identifying patients who are likely to respond to specific agents could inform treatment decisions, improve treatment outcomes, and aid in avoiding unnecessary exposure to potential toxicities. The development of novel agents for use alone or in combination with existing agents may improve response rates further in the neoadjuvant setting, especially because a significant proportion of breast tumors can be resistant to many current antineoplastic agents. Particularly noteworthy are the epothilones and their analogs because of their low susceptibility to common tumor-resistance mechanisms. Initial data have indicated that ixabepilone, which is an epothilone analog, has activity in the neoadjuvant setting, and predictive factors for response have been identified. The future of neoadjuvant therapy lies in tailoring treatment to individual patients by identifying response predictors and developing novel agents. This ultimately may lead to improved outcomes for women with breast cancer.     

Cancer chemotherapy by intra-arterial infusion with adriamycin

Adriamycin was given by arterial infusion to 32 patients with different types of advanced cancer. The drug was used for inducing the first remission. In responsive cases maintenance treatment was given with conventional agents. Twenty-six patients were adequately evaluable. Seventeen patients adequately treated showed objective improvement and 7/17 regression >50%. Head and neck cancer was the disease most sensitive to adriamycin by arterial infusion. Of 32 patients receiving adriamycin, 23 had one or more side effects, 14 had morbidity, and 2 patients died. In comparison with other conventional drugs, adriamycin by prolonged arterial infusion produces a higher percentage of side effects and not a higher percentage of therapeutic response.     

Experiences with intra-arterial chemotherapy for head and neck cancer

During the 10-year period from 1966-1975, 250 patients with various head and neck cancers were treated by intra-arterial chemotherapy using single agents or various combinations. Only 15 patients showed response of I-C category according to Karnofsky's criteria, and 100 patients had I-B response. Another 100 patients showed I-A category of response and 35 patient had progressive disease out of which 5 patients exhibited excessive toxicity to drugs, eventually succumbing to it. A majority of patients in nonresponding (O-O) category and I-A category were earlier treated by radiotherapy, and intra-arterial chemotherapy was given for recurrent disease. The responses were relatively good whenever chemotherapy was given as a primary treatment before surgery and radiotherapy. Again response was additive when chemotherapy was given concurrently with radiotherapy.     

Adjuvant chemotherapy in the treatment of primary soft tissue sarcomas, with special reference to intra-arterial infusion chemotherapy

Seventy-eight cases of adjuvant chemotherapy for primary soft tissue sarcoma including 51 cases of intra-arterial infusion chemotherapy were studied. The patients ranged in age from 1 to 92 years with a median age of 34 years. Thirty-nine patients were male and 39 were female. The seventy-eight cases were comprized of 17 rhabdomyosarcoma, 12 liposarcoma, 12 neurogenic sarcoma, 10 malignant fibrous histiocytoma, 8 leiomyosarcoma, 7 angiosarcoma, 8 others and 4 unclassified sarcomas. Fifty-one patients with soft tissue sarcoma of the extremities were treated by intra-arterial infusion chemotherapy with either VCQ (Vincristine and Carbazilquinone) or VCQ, A (Vincristine, Carbazilquinone and Adriamycin). Out of 42 patients with measurable lesions, 2 CR, 4 PR, 33 NC and 3 PD were obtained. Histological examinations demonstrated histological effect of GI 19, G IIa 11 and G IIb 7 by Ohboshi and Shimosato's criteria. Remarkable effects of treatment were noted in most rhabdomyosarcoma patients. After intra-arterial infusion chemotherapy, a variety of surgical procedures ranging from marginal resection and wide resection to radical amputation were employed in 44 patients. Local recurrence was 27% and distant metastasis developed in 47% of cases.     

Preoperative intra-arterial chemotherapy in patients with osteosarcoma: case report of seven patients below the age of 18 years.

In the period between 1987 and 1989, seven patients under 18 years of age with osteosarcoma of a lower limb were treated by preoperative intra-arterial chemotherapy. The age of the patients ranged from 12 to 17 years, the median age being 14.5 years. The polyethylene catheter was placed surgically into the lower epigastric artery. Two combinations of cytostatics were administered: adriamycin-bleomycin-cisplatin and high-dose methotrexate-vincristine-cisplatin. All patients, after two or three courses, underwent surgical resection of limb tumor. Tumor destruction ranged from 20 to 100%. Four patients with necrosis from 80-100% remained free of disease from 18 to 30 months: two, having necrosis of 40% and 95% respectively, died. The youngest patient whose necrosis was as low as 20%, after completion of the systemic chemotherapy, developed local recurrence and pulmonary metastases.