消化道肿瘤合并癌性腹水腹腔热化疗的临床观察

目前晚期消化道肿瘤的五年生存率仍很低 ,临床收治的病例中仍以中晚期为主 ,部分病例即使行根治性手术 ,仍有许多死于复发和转移 ,腹膜播散也是最常见的复发形式[1 ] 。腹膜表面复发 ,胃癌和肠癌复发率均占复发者 5 0 % ,胰腺癌占 70 %。消化道恶性肿瘤一旦出现腹膜转移 ,预后极差。近年来腹腔热化疗越来越受到临床医生的重视 ,成为治疗消化道恶性肿瘤腹膜转移行之有效的手段。本文报道采用腹腔热化疗和腹腔化疗治疗消化道恶性肿瘤合并癌性腹水各 31例 ,显示腹腔热化疗优于腹腔化疗 ,现报告如下 :1　资料和方法1 .1　临床资料　 2 0 0 1年 1…     

腹腔热化疗治疗恶性腹水的临床观察

目的　观察温热加局部化疗治疗恶性腹水的疗效、生存质量和不良反应。方法　 5 4例恶性腹水病人随机分为两组 ,治疗组和对照组。均置腹腔引流管 ,先予腹腔冲洗 ,后灌注化疗药物PDD 70mg。治疗组冲洗液及溶药液入腹温度为 45℃。对照组冲洗液及溶药液入腹不加温。每周重复 2次 ,2周为 1疗程。结果　近期疗效 :治疗组总有效率 80 %,对照组总有效率 5 4 2 %。远期疗效 :治疗组半年内生存率 3 3 3 %,1年以上生存率 2 6 7%。对照组半年内生存率 66 7%,1年以上生存率 4 2 %。经统计学处理 ,两组近期疗效、远期疗效均有显著差异 (P <0 0 5 )。Karnofsky评分 :治疗组评分升高占 70 0 %( 2 1/3 0 )。对照组评分升高占 5 0 %( 12 /2 4)。经统计学处理 ,两组有显著差异 (P <0 0 5 )。结论　腹腔温热化疗治疗恶性腹水疗效好 ,不良反应少 ,安全性高 ,值得推广。     

卵巢癌合并腹水腹腔化疗的疗效观察

目的　探讨卵巢癌腹腔化疗的最佳方案。方法　我院自 1988年至 1997年共收治卵巢癌合并腹水 45例。 2 5例采用MMC 6mg ,5 -FU 75 0mg ,AT12 586 0mg联合用药腹腔化疗 ;2 0例采用大剂量DDP单一药物加人工腹水腹腔化疗。结果　联合用药组有效率 76 % ,单一用药组有效率 85 %。结论　腹腔化疗是治疗卵巢癌合并腹水的有效方法 ;有效的药物浓度与充足的药液容量可以提高腹腔化疗的疗效 ;大剂量的DDP是腹腔化疗的理想药物     

卵巢癌合并腹水腹腔化疗的疗效观察

目的 探讨卵巢癌腹腔化疗的最佳方案。方法 我院自１９９８年至１９９７年共收治卵巢癌合并用腹水４５例。２５例采用ＭＭＣ６ｍｇ，５－ＦＵ ７５０ｍｇ，ＡＴ１２８６０ｍｇ联合用药腹腔化疗；２０例采用大剂量ＤＤＰ单一药物加人工腹水腹腔化疗。结果 联合用药组有效率７６，单一用药组有效率８５％。结论 腹腔化疗是治疗卵巢癌合并腹水的有效方法。有效的药物浓度与充足的药液容量可以提高腹腔化疗的疗效；大剂量的ＤＤＰ是     

顺铂腹腔注入治疗卵巢癌腹水的临床观察

晚期卵巢癌腹水的治疗相当困难,目前虽有一些治疗卵巢癌腹水的方法,但用顺铂腹腔内注入治疗卵巢癌腹水尚未见报道。我们在术前和术中用顺铂(各100mg)腹腔注入治疗20例晚期卵巢癌腹水患者。所有患者的全身状况在术前均得到明显改善,19例上皮性卵巢癌腹水患者一年内无腹水生长。该方法简单、安全,控制腹水生长效果明显,副作用少。     

腹腔灌注化疗加热疗治疗恶性腹水疗效观察

目的：观察腹腔灌注化疗加局部热疗治疗恶性腹水的疗效.方法：将70例恶性腹腔积液患者随机分为治疗组（35例）和对照组（35例）.腹腔置管引流腹水后,给予顺铂50mg腹腔灌注化疗,治疗组行腹腔灌注化疗后即刻行腹部局部热疗,对照组仅行腹腔灌注化疗,每周1次,4次后评价疗效.结果：治疗组总有效率（CR＋ PR）为77.14％,对照组总有效率（CR＋PR）为45.71％,两组比较差异有统计学意义（P＜0.05）.结论：腹腔灌注化疗加腹部局部热疗治疗恶性腹水较单纯腹腔灌注化疗疗效好,值得临床推广.     

腹腔热灌注配合双途径化疗治疗消化道恶性肿瘤的临床观察

目的 观察腹腔热灌注配合全身双途径化疗治疗消化道恶性肿瘤的近期 有效率、腹水控制情况、毒副反应。方法 58例被随机分为实验组和对照组，对照组单纯应用全身化疗，实验组采用双途径化疗。结果 实验组近期有效率56．67％，腹水有效率为72．73％，对照组近期有效率为32．29％，腹水有效率为30％，差异有显著性（P＜0．05）。副反应两组对比，差异无显著性（P＞0．05）。结论 腹腔热灌注配合全身双途径化疗是治疗消化道恶性肿瘤－有效、毒副反应较轻的方法。     

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.     

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,CR6例（18．7％）,PR14例（43．7％）,sD8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。     

Intraoperative intraperitoneal chemotherapy with cisplatin in epithelial ovarian cancer

Objective

To assess retrospectively the feasibility of intraoperative intraperitoneal (IP) chemotherapy with cisplatin in epithelial ovarian cancer.

Methods

IP chemotherapy during optimal staging surgery was performed in 10 patients who were diagnosed with primary epithelial ovarian cancers between April 2008 and February 2011. Cisplatin (70 mg/m² in 1 L normal saline solution) was administered in the abdominal cavity for 24 hours postoperatively and then adjuvant chemotherapy was started 2-4 weeks after surgery. Perioperative toxicity of the combined treatment was evaluated until the initiation of postoperative adjuvant chemotherapy.

Results

A total of 23 adverse events were observed in 9 of 10 patients (grade 1, 7; grade 2, 13; grade 3, 3; grade 4, 0). In descending order of frequency, adverse events affected the gastrointestinal system (n=14), hematologic system (n=6), pulmonary system (n=2), and genito-urinary system (n=1). The adverse events did not affect adjuvant systemic chemotherapy schedules. One patient experienced disease recurrence in the liver 16 months after surgery. The remaining 9 patients have been well controlled by chemotherapy and/or observation during the follow-up period of 4 to 39 months after surgery.

Conclusion

Intraoperative IP chemotherapy with cisplatin during surgical procedures is considered feasible for the treatment of primary epithelial ovarian cancer. Further studies, including long-term, prospective and comparative trials, are needed to validate the efficacy of this combined therapy.     

伴有血性或非血性腹水肝癌患者的腹腔化疗研究

目的观察腹腔化疗对伴有血性或非血性腹水肝癌患者的疗效及安全性是否相同。方法将伴有腹水的43例肝癌患者按腹水性质及治疗方法分为4组：A组13例,为非血性腹水进行腹腔化疗组;B组15例,为非血性腹水对症治疗组;C组8例,为血性腹水进行腹腔化疗组;D组7例,为血性腹水对症治疗组。腹腔化疗均采用羟基喜树碱（HCPT）16mg／m^2、氟尿嘧啶（5-Fu）1000mg／m^2、地塞米松10mg,1周后重复,共2～4次。结果A组中位生存时间（MST）为4．3个月（1．8～9．3个月）,腹水完全缓解（CR）1例（7．7％）,部分缓解（PR）5例（38．5％）,有效率46．2％,治疗期间常见副反应为白细胞、血小板下降;B组MST为2．5个月（1．7—8．3个月）,腹水控制有效率0;C组MST为1．3个月（0．5—1．4个月）,腹水控制有效率0,治疗期间常见副反应为恶心、呕吐以及白细胞、血小板下降;D组MST为1．8个月（0．8—2．9个月）,腹水控制有效率0。结论腹腔化疗对非血性腹水的肝癌患者有一定疗效,但对血性腹水的肝癌患者疗效不佳。     

Improvement in intraperitoneal intraoperative cisplatin exposure based on pharmacokinetic analysis in patients with ovarian cancer

Ovarian cancer is the leading cause of gynecological cancer-related death in Western countries. The present treatment standards for ovarian cancer are based on the association of debulking surgery with platinum-based chemotherapy. Another strategy that could be further investigated is intraperitoneal chemotherapy (IP). We previously described that the 2-h administration of intraoperative IP cisplatin did not reach satisfactory concentrations. In the present study, we present the results of a pharmacokinetic analysis performed after two consecutive 1-h IP 30 mg/l cisplatin administrations. Twenty-seven patients with advanced epithelial cancer classified FIGO stage IIIC were included in the study. Blood and IP samples were taken over a 24-h period, during and after IP treatment. Both total and ultrafiltered (Uf) platinum (Pt) concentration levels were analyzed. Biological and clinical toxicities were also recorded. With this strategy, IP Pt concentrations stayed above the target concentration (10 mg/l) for a satisfactory length of time. The serum Pt concentrations were higher than those observed with the “one-bath” protocol and they induced the occurrence of recoverable renal toxicities (3 grade 1, 7 grade 2 and 4 grade 3). The best predictive parameter for renal failure was the total Pt 24-h Area Under the Curve (AUC) with a threshold value of 25 mg h/l RR = 0.31 (95% CI 0.13 − 0.49, P < 0.01). Administration of an increased amount of cisplatin is feasible and a satisfactory level of IP Pt concentrations is obtained. However, this improvement is associated with an increase in serum Pt levels and resulting renal toxicities. An attractive solution would be to decrease Pt transfer from peritoneum to bloodstream. A phase 1 study using intraoperative IP epinephrine in order to decrease this transfer is presently being carried out.     

Prognosis of epithelial ovarian cancer related to its ascites

Epithelial ovarian cancer (EOC) is usually complicated with ascites. However, it is uncertain up to now that whether ascites affects the patient's prognosis. Therefore, we made a retrospective analysis of the clinical, pathological and followed-up data of 101 in-patients operated with tumor debulking surgery in our hospital from January 1986 to December 1993 to detect whether EOC ascites is related to the pateint's prognosis.MATERIALS AND METHODSPatients 101 ovarian cancer cases wer…     

复发卵巢癌腹腔温热化疗联合全身化疗临床研究

目的探讨复发卵巢癌卡铂腹腔温热化疗联合多西他赛全身化疗的疗效和毒副作用。方法将70例Ⅲ～Ⅳ期复发卵巢癌患者按随机原则选择35例作为治疗组,采用卡铂腹腔温热化疗联合多西他赛全身化疗;35例作为对照组,采用卡铂联合多西他赛全身化疗,并对两组化疗后1,3,5年生存率及毒副作用对照研究,并经统计学χ2检验。结果治疗组1,3,5年生存率分别为88.6%（31/35）、65.7%（23/35）和37.1%（13/35）,对照组分别为80.0%（28/35）、51.4%（18/35）和22.9%（8/35）,两组比较差异无显著性（P〈0.05）。毒副作用主要是骨髓抑制,白细胞下降率（Ⅲ～Ⅳ度）分别为5.7%（2/35）和31.4%（11/35,P〈0.05）。结论复发卵巢癌卡铂腹腔温热化疗联合多西他赛全身化疗的疗效优于卡铂联合多西他赛全身化疗,且毒副作用轻,有利于提高患者的生存率及生存质量。     

Intraperitoneal chemotherapy in patients with advanced ovarian cancer: the con view

OBJECTIVES: In this paper we wish to present the reasons why i.p. chemotherapy cannot be accepted as standard of care for first-line systemic treatment of advanced ovarian carcinoma. METHODS: The recent literature on i.p. chemotherapy is critically reviewed. All possible arguments against i.p. chemotherapy are reviewed. CONCLUSIONS: Intraperitoneal chemotherapy is associated with a higher toxicity rate than i.v. chemotherapy. For this reason, none of the regimens investigated in the three Gynecologic Oncology Group (GOG) studies can be used as standard treatment outside clinical protocols. The trials on i.p. chemotherapy have suggested a survival difference. However, in the two most recent trials, i.p. chemotherapy or not was not the only research question because different schedules and dosages were used. In addition, the significance of the most recent GOG 172 study was only weak (p = .03), and the result was nonsignificant for progression-free survival. Intraperitoneal chemotherapy should be used only in the context of properly designed clinical trials. These trials must either assess i.p. therapy in comparison with the standard treatment or address the issue of route of administration for equivalent dosages and schedules of the same drugs, and not a mosaic of these questions. In addition, these trials should investigate i.p. regimens that are less toxic than the regimens used in the three GOG trials, and which can be combined with molecular targeted therapies.     

腹腔内贝伐珠单抗联合腹腔热灌注化疗治疗卵巢癌腹腔积液的临床观察

目的 观察腹腔内贝伐珠单抗联合腹腔热灌注化疗治疗卵巢癌腹腔积液的疗效和安全性,分析腹水内血管内皮生长因子（VEGF）水平对贝伐珠单抗治疗卵巢癌腹腔积液的临床意义。方法 将46例卵巢癌伴腹腔积液患者随机分为治疗组（n=25）和对照组（n=21）,均应用TC方案（紫杉醇135mg／m2静脉注射d1+卡铂 AUC=5 静脉注射d1）全身化疗,3周重复1次;同时腹腔内给予顺铂40mg／m2+43～45℃ 0.9%生理盐水1500～3000ml热灌注化疗,每2周重复1次,连续治疗6周。治疗组在上述治疗基础上每次热灌注化疗后腹腔内注入贝伐珠单抗300mg,治疗6周。评价患者疗效、生活质量改善及不良反应。酶联免疫吸附法（ELISA）检测46例患者治疗前、后腹水中VEGF水平。结果 治疗组治疗后腹水VEGF水平为（468.30±42.80）pg/ml,明显低于治疗前的（2785.89±305.22）pg/ml（P＜0.05）;治疗组治疗后腹水VEGF水平明显低于对照组治疗后的（820.20±61.49）pg/ml（P＜0.05）。治疗组的有效率（RR）为92.0％（23／25）,对照组为61.9％（13／21）,差异有统计学意义（P＜0.05）。治疗组中VEGF阳性者的RR达1000％,VEGF阴性者为50.0％,差异有统计学意义（P＜0.05）。治疗组的生活质量（QOL）改善率为92.0％,对照组为57.1％,差异有统计学意义（P＜0.05）。46例患者对治疗的耐受良好,无严重不良反应。结论 腹腔内贝伐珠单抗联合腹腔热灌注化疗治疗卵巢癌腹腔积液的疗效优于单纯腹腔热灌注化疗,生活质量明显改善,安全性好,尤其对于腹水VEGF阳性卵巢癌患者更加适合。     

腹腔热灌注化疗联合内生场热疗治疗复发性卵巢癌的临床观察

目的评估腹腔热灌注化疗联合内生场热疗对晚期复发性卵巢癌的疗效。方法22例晚期复发卵巢癌患者注入预热的氯化钠溶液（NS）＋顺铂（DDP）＋依托泊苷（VP16）,同时采用NRL-002内生场热疗机热疗60—120min,每周热灌注化疗1次,单纯热疗1次。结果总有效率（CR＋PR）63．6％,CA125明显下降,CD4／CD8比值及NK细胞数较治疗前升高,临床受益反应81．8％,中位疾病进展时间（MTTP）及中位生存时间（MST）分别为7．8个月和18．5个月。结论腹腔热灌注化疗联合内生场热疗治疗晚期复发性卵巢癌疗效确切,能改善患者的生活质量,不良反应轻,值得临床推广。     

Doxorubicin levels in the serum and ascites of patients with ovarian cancer.

AIMS: To investigate the diffusion and accumulation of doxorubicin metabolites in the ascites of patients with ovarian cancer following intravenous injection, as a model for intraperitoneal accumulation of drugs. METHODS: The concentrations of doxorubicin and its metabolites [Doxorubicinol (Dox-ol), 7-deoxydoxorubicinolone (7d-Dox-ol-on) and 7-deoxydoxorubicinone (7d-Dox-on)] were measured using high-performance liquid chromatography in the serum and in the ascites of seven patients with recurrent ovarian carcinoma suffering from symptomatic ascites and treated with intravenous doxorubicin. RESULTS: Doxorubicin metabolites accumulated in the peritoneal cavity. The concentrations of the doxorubicin metabolites were initially higher in the serum compared to the ascitic fluid, but following several hours the doxorubicin metabolites became higher in the ascites, and remained detectable in the ascites for up to 168h, long after disappearance from the serum. CONCLUSIONS: Doxorubicin metabolites accumulate in the ascites and are cleared more slowly from the peritoneal compartment than from the serum. Accumulation in the peritoneal cavity with prolonged half-life should be considered when administering medication in patients with ascites.     

腹腔温热灌注药物治疗恶性腹水的临床探讨

目的：探讨腹腔温热灌注药物恶性腹水的新疗法。方法：穿刺插管腹腔浊热水加热癌药灌注。治疗22例腹腔恶性肿瘤引起的腹水。结果：控制腹水的有效率达68.2%，提高生活质量的有效率达72.7%。结论：腹腔温热灌注药物治疗恶性腹水，方法简便，疗效满意，毒副作用少。