局部热疗联合腹腔灌注化疗治疗癌性腹水的临床观察

目的:探讨局部热疗联合腹腔灌注化疗治疗癌性腹水的临床疗效和不良反应.方法; 32例晚期癌症患者合并癌性腹腔积液,接受局部热疗和腹腔灌注化疗(化疗主要应用顺铂和氟尿嘧啶).结果: 32例中,CR 6例(18.7%),PR 14例(43.7%),SD 8例(25%),总有效率(CR+PR)为62.5%(20/32).结论; 局部热疗在治疗晚期癌性腹水患者中无明显不良反应,局控率满意.     

双通路化疗联合热疗治疗腹腔转移癌的临床研究

目的观察全身化疗 顺铂(DDP)腹腔内灌注化疗联合热疗治疗癌性腹腔积液的疗效。方法67例癌性腹腔积液病人随机分为两组,治疗组34例DDP腹腔内注入加热疗,对照组33例单用DDP腹腔内注入,两组病人均同时应用全身化疗。结果腹腔积液控制有效率治疗组为85.3%,对照组为63.6%,治疗组明显优于对照组(P<0.05)。毒副作用无显著差异(P>0.05)。结论双通路化疗 热疗有协同作用,能有效提高腹腔积液控制率,提高病人生存质量,值得临床推广使用。     

腹腔热灌注化疗联合静脉化疗治疗卵巢癌伴腹腔积液的临床观察

目的 观察腹腔热灌注化疗联合静脉化疗治疗卵巢癌伴腹腔积液的临床疗效.方法 采用回顾性调查方式,共42例卵巢癌伴腹腔积液患者分为热疗组和非热疗组.热疗组21例采用腹腔热灌注化疗 静脉化疗.非热疗组21例采用腹腔灌注化疗 静脉化疗,剂量与对照组相同.每组治疗均为3个周期.结果 患者经治疗后腹水均有不同程度的减轻,其中热疗组有效率80.95%,明显高于非热疗组的66.67%.结论 热疗联合化疗药物治疗卵巢癌伴腹腔积液具有协同作用,增强抗癌效应.     

射频热疗联合腹腔化疗治疗癌性腹腔积液的疗效观察

目的观察射频热疗联合腹腔化疗治疗癌性腹腔积液的疗效、患者生活质量的改善及其副作用。方法确诊为癌性腹腔积液的患者68例,随机分为两组,采用中心静脉导管胸腔闭式引流尽可能排尽腹腔积液后,实验组给予腹腔灌注顺铂化疗,然后进行腹腔射频热疗。对照组仅为腹腔灌注顺铂化疗。结果治疗组与对照组有效率分别为70.59%和47.06%,P<0.05。主要毒副反应发生率两组相仿。结论射频热疗联合腹腔化疗治疗癌性腹腔积液疗效较好,提高生活质量,安全性高。     

腹腔热化疗联合静脉化疗治疗老年人恶性腹水的临床观察

目的:探讨腹腔热化疗联合静脉化疗对老年性消化道来源恶性腹水患者的治疗效果、不良反应和对生活质量的影响。方法:对23例因消化道肿瘤来源恶性腹水住院的老年病例,顺铂60mg进行腹腔灌注后,用NRL-002型内生场肿瘤热疗系统行腹部局部热疗60～120分钟。所有病例均行锁骨下深静脉穿刺,氟尿嘧啶(5-FU)225mg/(m2.d)持续静脉滴注,21天为1个周期。按照WHO标准评价疗效及毒性。结果:23例患者近期治疗总有效率为60.87%,其中完全缓解(CR)3例,部分缓解(PR)11例,稳定(NC)5例,无效(PD)4例,中位生存时间(MST)为5.5月。主要毒性表现为消化道反应。结论:腹腔热化疗联合静脉化疗治疗老年人消化道肿瘤来源恶性腹水具有一定的疗效,毒副作用轻,且能提高患者生存质量,值得进一步研究。     

恶性腹腔积液体外高频深部热疗联合腹腔化疗的临床观察

目的:观察体外高频深部热疗联合腹腔化疗治疗恶性腹腔积液的近期疗效和不良反应。方法:70例患者随机分为体外高频深部热疗联合腹腔化疗组(治疗组)35例和单用腹腔化疗组(对照组)35例,均采用中心静脉导管腹腔内置管引流,引流量1 000～2 000mL/d,需3～5d,最大限度引尽腹腔积液后经中心静脉导管注入分别含有顺铂40 mg/m2、5-氟尿嘧啶750mg/m2、地塞米松10mg的生理盐水1 500～2 000mL,肝素帽封管,嘱患者每10min变换体位1次使药物在腹腔内分布均匀。治疗组于给药后30min开始腹部体外高频深部热疗,设定治疗温度43℃,持续1h,对照组单用腹腔化疗,两组均每周1次共3次,然后评定近期疗效,观察不良反应。结果:治疗组完全缓解(CR)23例,部分缓解(PR)8例,有效率(RR)88.58%;对照组CR 12例,PR 10例,RR62.86%;两组比较差异有统计学意义,χ2=6.29,P=0.01。Kamofsky评分改善分别是27例(77.14%)和18例(51.43%),两组比较差异有统计学意义,χ2=5.04,P=0.02。不良反应均能耐受,两组比较差异无统计学意义,P>0.05。结论:体外高频深部热疗联合腹腔化疗治疗恶性腹腔积液疗效明显提高,不良反应减轻。     

全身化疗联合局部热疗治疗晚期胃癌的疗效观察

目的:研究FOLFOX4方案联合射频热疗治疗晚期胃癌的疗效和不良反应.方法:33例患者接受FOLFOX4方案化疗的同时给以热疗.L-OHP(85-100)mg/m2,静脉滴入2h, d1;CF 200mg/m2静脉滴入2h, d1、d2;氟尿嘧啶(5-FU) 400 mg/m2,静脉推注d1、d2,600 mg/m2持续静滴22h,d1、d2;每2周重复, 28天为1周期.热疗每周2次,每次60分钟.3个周期化疗后评价疗效.结果:33例患者 CR 4例(12.1 %) 、PR 13例( 39.4 %) , 有效率(CR+PR)51.5%.不良反应主要为胃肠反应、骨髓抑制和感觉神经毒性.结论: FOLFOX4方案化疗联合热疗应用于晚期胃癌疗效肯定,不良反应能耐受.     

热疗联合FOLFIRI化疗治疗晚期结直肠癌的临床观察

目的:观察热疗联合FOLFIRI全身化疗治疗晚期结直肠癌的疗效和不良反应.方法:将2005年5月～2009年8月在我院住院治疗的53例晚期结直肠癌患者,随机分为A、B两组,A组(治疗组,26例)接受热疗联合FOLFIRI全身化疗,肿瘤局部区域热疗,温度43℃,每次60分钟,每周2次;B组(对照组,27例)接受常规FOLFIRI全身化疗.化疗方案为伊立替康180mg/m2,静脉滴入90 min,d1;亚叶酸钙 200mg/m2,静脉滴入2h,d1,2;5-氟尿嘧啶400mg/m2,静脉推注,d1,2,600mg/ m2,持续静滴22h,d1,2;14天为1个周期;治疗4个周期后,评价疗效及不良反应.结果:与常规全身化疗相比,热疗联合全身化疗组(A组)有效率、疾病无进展生存时间(PFS)及总生存期(OS)有明显提高,差异有统计学意义(P＜0.05),不良反应未增加.结论:对晚期结直肠癌患者,热疗联合FOLFIRI化疗疗效较好,不良反应能耐受.     

晚期复治消化系肿瘤腹水的腹部透热化疗临床观察

目的:探讨腹部透热全身热疗系统在晚期复治性原发性肝癌、胃肠道癌及间质肿瘤恶性腹水腹腔化疗治疗中的辅助及增效治疗作用价值及意义.方法:试验组(18例)抽放恶性腹水后腹腔内灌注DDP+5-FU主药物后即刻行高功率微波腹部透热全身热疗,恒温期温度41～42℃,维持＞60 min.对照组(24例)仅行腹腔灌注化疗,用药方法同试验组.结果:42例复治恶性腹水总缓解率57.1%(24/42),其中试验组77.8%(14/18),对照组41.7%(10/24),前者有效率明显高于后者,差异有统计学意义,P＜0.05.试验组及对照组患者中位生存时间分别为30和25周.2组不同治疗方法的毒副反应发生率及程度差异无统计学意义,P＞0.05.结论:以腹腔灌注化疗联合经腹透热全身热疗治疗晚期肿瘤恶性腹水较常规单纯腹腔化疗疗效好,且毒副反应少,并有一定程度延长患者生存期作用,有临床实际应用价值.     

持续热灌注腹腔化疗结合体外高频热疗治疗恶性腹腔积液36例

目的 观察持续热灌注腹腔化疗结合体外高频热疗治疗恶性腹腔积液的疗效及安全性.方法 利用腹腔热灌注化疗仪持续热灌注顺铂60～80 mg,替加氟1g,0.9％氯化钠溶液2000 ～3000 ml.使灌注入腹腔的液体温度控制在41～43℃,同时结合腹部体外高频热疗.分析患者疗效及生存情况.结果 36例恶性腹腔积液患者中,治疗后完全缓解14例（38.9％）,部分缓解12例（33.3％）,无变化10例（27.8％）,有效率为72.2％（26/36）.患者中位生存期9.6个月,1年生存率76％.生存质量改善,不良反应轻,无治疗相关死亡.结论 持续热灌注腹腔化疗结合腹部高频热疗治疗恶性腹腔积液安全、有效、简便,值得临床推广.     

奥沙利铂联合甲酰四氢叶酸和氟尿嘧啶治疗晚期结直肠癌的临床观察

目的:评价奥沙利铂(LOHP)联合氟尿嘧啶(5FU)、甲酰四氢叶酸(CF)治疗晚期结直肠癌的近期疗效和不良反应。方法:采用LOHP85mg/m2,静脉滴入,持续2h,d1;CF300mg,静脉滴入,持续1h,d1～d5;5FU500mg,静脉滴入,持续4h,d1～d5。21d为1个周期,治疗3个周期后评价疗效。结果:共治32例,CR0例,PR12例,MR10例,SD6例,PD4例,总有效率37.5%(12/32)。不良反应主要为轻度的感觉神经毒性,轻度骨髓抑制及恶心、呕吐。结论:LOHP、5FU和CF联合应用治疗复治晚期结直肠癌患者有一定的疗效,不良反应较轻。     

奥沙利铂联合氟尿嘧啶及甲酰四氢叶酸治疗晚期大肠癌近期疗效分析

目的 :评价国产奥沙利铂 (oxaliplatin ,L OHP)联合氟尿嘧啶及甲酰四氢叶酸 (CF)治疗大肠癌的疗效和毒副反应。方法 :2 8例晚期大肠癌患者 ,予国产L OHP 12 0mg/m2 ,静脉滴入 ,持续 2h ;CF 15 0mg/m2 ,静脉滴入 ,持续 2h ;5 -氟尿嘧啶 ( 5 FU ) 5 0 0mg/m2 ,静脉滴入 ,持续 >4h ,于CF滴完后用。每 3周重复 1次 ,用药 2个周期后评价疗效。结果 :2 8例患者中 ,无完全缓解 (CR) ,部分缓解 (PR) 9例 ,稳定 (SD) 12例 ,进展 (PD) 7例 ,总有效率(RR ,CR PR) 3 2 1% ( 9/2 8) ,中位无进展生存期 6 7个月 ,中位生存期 9 8个月。毒副反应主要是末梢神经毒性、恶心呕吐、骨髓抑制及静脉炎等 ,患者均可耐受。结论 :国产L OHP联合 5 FU /CF治疗晚期大肠癌具有较好的疗效     

以草酸铂为主的联合化疗方案治疗晚期胃癌

目的 :目的 :观察草酸铂 (L OHP)联合氟尿嘧啶 (5 FU)、甲酰四氢叶酸钙 (CF)和足叶乙甙 (VP 16 )治疗晚期胃癌的疗效。方法 :采用随机分组方法将 5 3例晚期胃癌患者分为两组 ,治疗组 2 7例 ,用L OHP 130mg/m2 ,加于葡萄糖注射液中静滴 3小时 ,第 1天 ;CF 10 0mg/m2 ,静滴第 1～ 5天 ;5 FU 30 0mg/m2 ,于CF后静滴 ,维持 6小时 ,第 1～ 5天 ;VP 1610 0mg ,静滴 ,第 1～ 3天 ;对照组 2 6例用DDP 80mg/m2 ,静滴第 1天 ,CF、5 FU和VP 16用法同治疗组。每 3～ 4周为一个周期。二个周期评价疗效。结果 :治疗组CR 3例 ,PR 15例 ,总有效率 6 6 7% ;对照组CR 1例 ,PR 9例 ,总有效率为 38 5 %。两组总有效率间差异有显著性 (P <0 0 5 )。治疗组周围感觉神经毒性发生率较对照组高 ,恶心、呕吐的发生率较对照组低 ,两组间差异均有显著性 (P <0 0 5 )。结论 :L OHP联合CF、5 Fu和VP 16方案治疗晚期胃癌疗效较好 ,不良反应轻 ,能耐受 ,值得进一步在临床推广使用     

奥沙利铂联合亚叶酸钙/5-氟脲嘧啶持续滴注治疗晚期胃肠癌

目的：观察奥沙利铂(L-OHP)联合亚叶酸钙(CF)、5-氟脲嘧啶(5-Fu)方案治疗晚期胃肠癌的近期疗效.方法：22例晚期胃肠癌患者,其中胃癌15例,大肠癌7例,化疗前均经锁骨下静脉留置中心静脉导管。L-OHP 130mg／m^2,静滴3小时,第1天;CF100mg／天,静滴2小时,第1～5天;5-FU500mg,静注,第1天,500mg／天,微量泵持续静脉滴注120小时：21天为1周期。结果：全组患者获得CR2例,PR10例,总有效率为54．5％。其中胃癌的有效率为53．3％;大肠癌的有效率为57．1％。骨髓抑制的发生率为59．1％,Ⅲ／Ⅳ度者仅1例;胃肠道反应主要为口腔粘膜炎与腹泻,发生率为54．5％,无Ⅲ／Ⅳ度胃肠道反应;突出的毒性反应是L—OHP引起的外周感觉神经异常,发生率为59．1％(13／22)：结论：L—OHP联合CF／5-FU持续滴注120小时的化疗方案治疗晚期胃肠癌近期疗效较高,耐受性好,值得进一步观察。     

A case of irinotecan-resistant colon cancer responding to chronotherapy with oxaliplatin, 5-FU,l-LV

We report a case of irinotecan-resistant colon cancer responding to chronotherapy with oxaliplatin (L-OHP), 5-FU, l-LV (l-Leucovorin). A 72-year-old man was examined at a certain hospital because of constipation and appetite loss. Chest computed tomography (CT) revealed lung metastases, and abdominal CT revealed liver metastases. He was then referred to our hospital. A colonoscopy revealed type 2 tumor in the colon, at the hepatic flexure. We diagnosed adenocarcinoma of the colon with metastases to the liver and lung. Resection of the primary lesion was performed, and chemotherapy consisting of systemic administration of CPT-11, 5-FU and l-LV was performed. After 2 courses of combined treatment with CPT-11/5-FU/l-LV, CT revealed considerable reduction of the metastatic tumors. However, after 3 courses of combined treatment, progressive disease was observed and new brain and bone metastases were detected. We imported and used a non-approved/pending drug, oxaliplatin from the Remedy and Health Corporation, with informed consent from the patient and his family and our clinical ethics committee. Chronotherapeutic schedules have been performed, from which the safety and activity of oxaliplatin against advanced colorectal cancer was reported. Our patient received a 5-day course of chronomodulated 5-FU and l-LV (750 and 300 mg/body/day, respectively; peak delivery rate at AM 4:00 hours) with L-OHP on the first day of each course (100 mg/body, as a 6-hour infusion). Each course was again repeated every 21 days. A partial response was observed in the liver and lung metastases. These results indicate that chronomodulated 5-FU and LV with L-OHP therapy could be an effective regimen for cases of irinotecan-resistant colon cancer.     

奥沙利铂联合氟脲嘧啶、亚叶酸钙治疗晚期胃癌临床观察

目的：观察奥沙利铂联合氟脲嘧啶、亚叶酸钙治疗晚期胃癌的疗效和安全性。方法：26例晚期胃癌，采用L-OHP130mg／m^2静滴4小时第1天；CF200mg／m^2静滴2小时后5-Fu500mg／m^2静滴4小时第1—5天，每三周重复。结果：26例晚期胃癌中，CR 2例(7．7％)，PR 11例(42．3％)，CR PR 50．0％。中位缓解期为5．5个月，中位生存期为11．0个月。毒性反应主要是感觉神经毒性(65．4％)，其次为恶心呕吐(53．8％)和腹泻(46．2％)。骨髓抑制毒性小。结论：L-OHP联合5-Fu、CF治疗晚期胃癌疗效肯定，耐受性良好，值得临床进一步应用。     

Whole-body hyperthermia (41.8 degrees C) combined with bimonthly oxaliplatin, high-dose leucovorin and 5-fluorouracil 48-hour continuous infusion in pretreated metastatic colorectal cancer: a phase II study.

BACKGROUND: Second- and third-line treatments remain a challenge in advanced colorectal cancer. Studies of bimonthly regimens of high-dose leucovorin (LV) and 5-fluorouracil (5-FU) by continuous infusion combined with oxaliplatin (L-OHP) have shown encouraging response rates in patients not responding to a bimonthly LV/5-FU regimen. Hyperthermic enhancement of L-OHP efficiency by increased DNA adduct formation has been demonstrated in vitro. This study was designed to address feasibility, toxicity and efficacy issues of whole-body hyperthermia (WBH) as an adjunct to L-OHP/LV/5-FU in pretreated patients after progression to first- and second-line treatments with LV/5-FU by continuous infusion and irinotecan. PATIENTS AND METHODS: Forty-four patients with advanced colorectal cancer, who had progressed during or within 3 months after completion of chemotherapy with LV/5-FU 24-h infusion (LV/5-FU(24h)) (eight patients) or irinotecan combined with or after LV/5-FU(24h )(36 patients), were treated with L-OHP 85 mg/m(2), 2-h intravenous (i.v.) infusion, followed by LV 200 mg/m(2), 1-h i.v. infusion, and 5-FU 3 g/m(2), 48-h continuous infusion. Every second cycle of the biweekly regimen was combined with WBH, thus allowing a comparison of toxicity with and without WBH in the same patient. Whole-body hyperthermia was administered by a humidified radiant heat device. The target temperature of 41.8 degrees C was maintained for 60 min. L-OHP (2-h infusion) was started at a core body temperature of 39 degrees C. RESULTS: All patients could be evaluated for toxicity, and 41 patients were evaluable for response. A total of 273 L-OHP-containing regimens were administered, 130 with and 143 without WBH. Hyperthermic treatment combined with L-OHP/LV/5-FU showed no unexpected toxicities. WHO grade 3 toxicities were rare and evenly balanced between cycles given with or without WBH. One early death occurred due to sepsis and tumor lysis. The overall response rate was 20%, with two complete and six partial responses. Twenty-three patients (56%) had stable disease and nine patients (22%) progressive disease. With a median observation time of 70 weeks, the median time to progression was 21 weeks [95% confidence interval (CI) 17-25 weeks] and the median survival was 50 weeks (95% CI 39-61 weeks) from the start of therapy. CONCLUSIONS: This trial suggests some advantage of combining L-OHP/LV/5-FU with WBH. Results compare favorably with the activity of similar regimens without WBH in less extensively pretreated patients. These data support further evaluation and warrant phase III studies.     

Hepatic arterial infusion chemotherapy with oxaliplatin in unresectable liver metastases from colorectal cancer after systemic chemotherapy failure

We report 5 cases of colorectal liver metastases (CRLM) with hepatic arterial infusion (HAI) oxaliplatin after systemic infusion chemotherapy failure. Patients with unresectable CRLM and history of systemic chemotherapy failure were treated with HAI oxaliplatin (L-OHP 100 mg/body, 2 hours) combined with intravenous (iv) levofolinate calcium (175 mg/body, 2 hours) and iv bolus 5-FU (500 mg/body) every 2 weeks. RESULT: An average age was 58 years. All patients had previously received FOLFOX. Lung metastases had already existence before HAI oxaliplatin in 4 patients. A median of 10 treatments were administered (range 5-14). Serum level of CEA was decreased in 4 cases. In 2 patients, lung metastasis developed while a PR was obtained in the liver metastasis. Progress disease (PD) was confirmed in other 3 patients. No major toxicity was presented. The median time to progression free survival was 3.0 months and the median overall survival was 7.1 months. CONCLUSION: HAI oxaliplatin might be beneficial as a salvage therapy for CRLM without extrahepatic metastasis, which demonstrated an acceptable tolerability and maintenance of QOL.     

奥沙利铂联合亚叶酸钙及5-氟尿嘧啶治疗晚期大肠癌的临床观察

目的观察奥沙利铂(L-OHP)联合亚叶酸钙(CF)及5-氟尿嘧啶(5-Fu)治疗晚期大肠癌的疗效及不良反应。方法将我院2002年10月~2005年10月收治的65例晚期大肠癌,随机分为A组和B组,A组奥沙利铂130mg/m2静脉滴注2小时,第1天;亚叶酸钙200mg/m2持续静滴24小时,第1~5天;5-氟尿嘧啶500mg/m2持续静滴24小时,第1~5天;每3周重复。B组羟基喜树碱(HCPT)8mg/m2静脉滴注,第1~5天;亚叶酸钙200mg/m2,静脉滴注2小时,第1~5天;5-氟尿嘧啶500mg/m2持续静滴24小时,第1~5天,每3周重复。所有病例均接受2周期化疗。结果A组CR2例,PR12例,SD11例,DD8例,总有效率42.4%,B组CR1例,PR5例,SD16例,PD10例,总有效率18.8%,A组的主要不良反应是周围神经炎及恶心呕吐、骨髓抑制。结论奥沙利铂联合亚叶酸钙及5-氟尿嘧啶疗效优于羟基喜树碱、亚叶酸钙、5-氟尿嘧啶联合化疗,不良反应轻,值得临床推广。     

含奥沙利铂方案治疗晚期胃癌的临床观察

背景与目的:体外实验证明奥沙利铂(oxaliplatin,L-OHP)能明显抑制胃癌细胞株的生长,并与绝大多数抗癌药物具有相加或协同细胞毒作用。本研究观察L-OHP联合醛氢叶酸(leucovorin,LV)、5-氟尿嘧啶(5-fluorouracil,5-FU)和足叶乙甙(etoposide,VP-16)作为一线方案治疗晚期胃癌的疗效和毒性,并与传统化疗方案进行对比。方法:采用非随机分组方法将48例晚期胃癌患者分为两组,即L-OHP+LV+5-Fu+Vp-16方案组(治疗组)25例和DDP+LV+5-Fu+Vp-16方案组(对照组)23例。L-OHP135mg/m2,静滴,第1天(对照组则为DDP20mg,静滴,第1～5天);LV200mg,静滴,第1～5天;5-FU500mg/m2,静滴,维持6h,第1～5天;VP-16100mg,静滴,第1～5天。3～4周为1疗程。结果:治疗组有效率64.0%(16/25),对照组有效率34.8%(8/23),治疗组有效率高于对照组,两组差异有显著性(P<0.05,χ2检验)。治疗组患者的中位生存期为11.5个月,1年生存率为45.6%;对照组患者的中位生存期为10.5个月,1年生存率为36.5%,治疗组中位生存期、1年生存率均高于对照组,但无统计学意义(生存期P>0.05,log-rank检验)。治疗组周围感觉神经症状的发生率较对照组高(P<0.05,秩和检验),恶心、呕吐的发生率较对照组低(P<0.05,秩和检验),其余不良反应两组之间无显著性差异。结论:初步观察L-OHP+V