经动脉灌注吉西他滨和5-氟尿嘧啶联合热疗治疗中晚期胰腺癌的临床分析

目的：探讨经动脉灌注吉西他滨（Gemcitabine，商品名健择）和5-氟尿嘧啶（5-FU）联合内生场热疗治疗中晚期胰腺癌的临床疗效。方法：18例中晚期胰腺癌患者，采用改良Seldinger技术，动脉插管后选择性置管于胰腺癌的供血动脉，灌注吉西他滨1000mg／m^2；之后行内生场热疗，热疗同时经动脉留置导管灌注卡铂400mg／m^2；热疗后，用输液泵经动脉留置管灌注5-FU 1g，连用2d。随访观察客观疗效、临床受益反应、患者的生存期及不良反应等。结果：18例患者的客观缓解率为22．20％，临床受益反应为44．40％，Kaplan-Meier法计算6、9和12个月的累积生存率分别为83．33％、66．67％和33．33％，频数分布法计算中位生存期为11个月。结论：经动脉灌注吉西他滨和5-FU联合内生场热疗治疗中晚期胰腺癌可获得较好的临床疗效，患者耐受良好，值得进一步研究。     

经PCS区域动脉灌注健择和5-氟尿嘧啶治疗中晚期胰腺癌的疗效观察

 目的　评价经PCS区域动脉灌注健择和 5 氟尿嘧啶治疗中晚期胰腺癌的疗效和安全性。方法　 36例中晚期胰腺癌患者分为 2组 ,16例行经PCS区域动脉灌注化疗 (B组 ) ,另 2 0例行外周静脉全身化疗 (A组 )。结果　B组临床受益反应有效率为 75 .0 % (12 / 16 ) ,A组为 4 5 .0 % (9/ 2 0 ) (P <0 .0 5 ) ,A组和B组 6个月、1年生存率和中位生存期分别为 35 .0 %、15 .0 %、6 .8个月和 6 8.7%、37.5 %、11.4个月 ,P<0 .0 5。结论　经PCS区域动脉灌注化疗较外周静脉化疗能提高中晚期胰腺癌的临床受益反应、改善生活质量 ,提高远期生存率。     

动脉灌注结合全身静脉化疗治疗中晚期胰腺癌的临床观察

目的:观察动脉灌注结合全身静脉化疗治疗中晚期胰腺癌的疗效。方法:对12例中晚期胰腺癌患者选择性给予腹腔干动脉和/或肠系膜上动脉灌注吉西他滨和5-氟尿嘧啶,第8天再给予吉西他滨全身静脉化疗。3周为1个治疗周期,完成两个周期后复查CT评价疗效,观察临床受益反应、有效率、生存期及毒副反应。结果:全组患者临床受益率66.7%,有效率(CR PR)16.7%,中位生存时间6.7个月,6个月及9个月累积生存率分别为59.4%、29.6%。毒副反应多为Ⅰ°～Ⅱ°均能耐受。结论:动脉灌注结合全身静脉化疗治疗中晚期胰腺癌可获得较好的疗效,提高生存质量,毒副反应较小,值得临床推广应用。     

经动脉药盒输注吉西他滨治疗37例晚期胰腺癌

目的：评价经动脉药盒输注吉西他滨对未经其他治疗的晚期胰腺癌的疗效。方法：57例均经手术探查未能切除并经病理证实为胰腺癌患者，采用介入的方法植入德国贝朗公司的Implantofix药盒，9例经左锁骨下动脉将药盒植入于左胸壁皮下，48例经右股动脉将药盒植入于右下腹股沟部。治疗组首次疗程总量分3次注入吉西他滨3.0g，氟尿嘧啶3.0g，白细胞介素－2600万U。对照组仅不输注吉西他滨。结果：57例介入药盒均植入成功，留置管通畅率达100％，留置管滑脱率为0％，2例老年肥胖女性患者右腹股沟部切口愈合不良而于术后2个月拔除药盒。57例按照胰腺癌患者临床受益反应的评价标准，分为治疗组（37例）、对照组（20例）。本研究主要疗效评估指标（临床受益反应）治疗组比对照组有效。27．2％的治疗组患者获疼痛程度、止痛剂用量的显著而持久的改善，而对照组为4.8%(P=0.0022)。临床受益反应持续时间治疗组18周，对照组13周。治疗组的中位生存期6.25个月，对照组为4.41个月，具有统计学意义（P＝0．0025）。治疗组6个月、9个月及12个月的生存率分别为46％、24％和18％，高于对照组的31％、6％和2％。结论：经动脉药盒输注吉西他滨对晚期胰腺癌有明显的缓解疼痛、延长生存期的作用，并为晚期患者提供了长期动脉内化疗灌注的良好、有效的途径。     

吉西他滨单药化疗与联合化疗治疗进展期胰腺癌的疗效观察

目的观察比较吉西他滨单药与联合化疗治疗进展期胰腺癌的疗效。方法回顾性分析了大连医科大学附属一院2002年至2009年收治的45例进展期胰腺癌患者的临床资料,吉西他滨单药组17例,剂量为1000mg/m2,d1、8,三周为一周期;吉西他滨联合治疗组28例,联合化疗方案包括吉西他滨1000mg/m2,d1、8,分别联合：（1）氟尿嘧啶425～600mg/m2,静滴或持续静脉泵入,d1～5;（2）顺铂60～75mg/m2,分3～4d静脉滴入;（3）奥沙利铂85～130mg/m2,d1,静脉滴入;（4）卡培他滨1000mg/m2,每天两次口服,d1～14。21d为一周期。采用Kaplan-Meier生存曲线分析患者的生存期,并比较两组间的临床受益率、中位疾病进展时间、中位生存时间及不良反应。结果吉西他滨联合组及单药组的临床收益率均得到提高,但两组间比较临床受益率、疾病控制率、中位生存时间均无统计学意义。结论吉西他滨联合化疗方案与吉西他滨单药治疗进展期胰腺癌相比,疗效、临床受益率、中位生存期均相似。     

吉西他滨联合氟尿嘧啶动静脉给药治疗晚期胰腺癌的临床观察

目的采用吉西他滨联合氟尿嘧啶动静脉给药治疗晚期胰腺癌，观察疗效，生存时间及不良反应。方法11例晚期胰腺癌患者第1天经肝动脉及肠系膜上动脉灌注吉西他滨1000mg／m^25-FU600mg／m^2，CF100mg；第2～5天外周静脉给药CF100mg(2小时)5-FU600mg／m^2(4小时)，第8天外周静脉给药吉西他滨1000mg／m^2(30分钟)3周一次，3个疗程。结果客观有效率27．3％，临床获益率81．8％；疼痛缓解率达81．8％。中位生存期11个月，其中12个月以上45．5％，24个月以上18．2％。主要毒副反应为骨髓抑制，脱发及消化道反应。结论吉西他滨联合氟尿嘧啶动静脉给药治疗晚期胰腺癌，在改善症状，延长生存期方面效果肯定，不良反应能耐受。     

吉西他滨治疗晚期肝癌疗效观察

目的评价吉西他滨肝动脉栓塞化疗治疗晚期原发性肝癌的临床疗效。方法随机抽取原发性肝癌患者18例为治疗组,采用吉西他滨治疗;随机抽取过去行5-Fu治疗的原发性肝癌患者23例为对照组。分别评价治疗前后两组患者的临床疗效及毒副反应。结果两组患者治疗后,吉西他滨组的临床疗效优于5-Fu组,不良反应轻微。结论吉西他滨肝动脉化疗栓塞治疗原发性肝癌是一种较理想的给药途径。     

吉西他滨联合顺铂在进展期胰腺癌动脉灌注化疗中的应用

目的评价吉西他滨(商品名健择)联合顺铂动脉灌注治疗进展期胰腺癌的疗效和毒副反应.方法对21例进展期胰腺癌患者采用吉西他滨联合顺铂动脉灌注化疗,治疗间隔时间为3周,随访观察患者临床受益反应、肿瘤情况、毒副作用及生存时间.结果21例患者的临床受益率为42.9%,客观缓解率为19.1%,中位疾病进展时间为4.2个月,中位生存时间为9.2个月.毒副反应较常见,但多为WHOⅠ～Ⅱ级.结论经动脉灌注吉西他滨和顺铂治疗进展期胰腺癌可获得较好的临床受益反应,无严重毒副反应.     

血清CA19-9水平检测对吉西他滨方案化疗晚期胰腺癌患者预后的临床预测

背景与目的：吉西他滨是晚期胰腺癌化疗最有效的药物之一。CA19-9对胰腺癌诊断、判断手术疗效及检测术后复发等具有较为肯定的临床价值。本研究通过检测接受含吉西他滨方案化疗的晚期胰腺癌患者化疗前后血清CA19-9的动态水平，分析血清CA19-9水平与化疗疗效及生存的关系。方法：选取中山大学肿瘤防治中心收治的71例经病理学证实的不能手术切除的局部晚期和（或）伴有远处转移的胰腺癌患者，KPS评分≥70，一线接受吉西他滨单药或以吉西他滨为基础的联合方案化疗，化疗前后进行血清CA19-9的动态测定。结果：71例患者中10例（14．1％）血清CA19-9基线水平在正常范围内，61例（85．9％）有不同程度的升高，两组患者的总生存时间分别为9．0个月和7．9个月。差异无统计学意义（P=0．797）。基线CA19-9升高的61例患者中位基线CA19-9水平为682U／mL，基线CA19-9低于中位值的患者总生存时间显著长于高于中位值者（9．6个月和5．1个月，P=0．001）；两组影像学客观有效率和临床获益率相比均未达到统计学意义（P〈0．05）。化疗后CA19-9下降大于25％的患者总生存时间显著长于CA19-9无下降或下降小于25％的患者．分别为10．2个月和5．0个月，影像学客观有效率分别为47．8％和10．5％，临床获益率分别为69．2％和8．0％，差异均有显著性（P〈0．01）。多因素分析显示，对于基线CA19-9高于正常的患者，化疗前基线CA19-9水平、化疗后CA19-9下降率及肿瘤细胞分化程度是预测接受含吉西他滨方案化疗的晚期胰腺癌患者生存的独立危险因素。结论：对于基线血清CA19-9水平升高的晚期胰腺癌患者，接受含吉西他滨方案化疗时．化疗前CA19-9升高的水平和化疗后下降的比率可以预测晚期胰腺癌患者的预后。     

高能聚焦超声联合动脉灌注化疗治疗晚期胰腺癌32例

[目的]观察高能聚焦超声（HIFU）联合动脉灌注化疗治疗晚期胰腺癌的临床效果。[方法]32例晚期胰腺癌患者随机分为两组：A组为HIFU＋动脉灌注化疗,B组为单纯动脉灌注化疗。[结果]A组有效率为64．7％,B组为40％;A组临床受益率70．5％,B组为3313％,两组比较差异有统计学意义（P〈0．05）。[结论]HIFU联合动脉灌注化疗治疗晚期胰腺癌有较好的疗效。     

动脉持续灌注化疗与静脉全身化疗治疗中晚期胰腺癌的疗效分析

Objective: To compare the curative effectiveness of continuous transarterial infusion chemotherapy and systemic venous chemotherapy in treating patients with advanced pancreatic cancer, and to evaluate the value of selective continu-ous transarterial infusion chemotherapy in treating advanced pancreatic cancer. Methods: Of the 51 patients with advanced pancreatic cancer receiving chemotherapy with gemcitabine and 5-fluorouracil, 25 patients were treated with selective con-tinuous transarterial infusion chemotherapy, 26 were treated with systemic venous chemotherapy, and curative effective-ness was analyzed retrospectively. Curative effectiveness included tumor volume, clinical benefit response (CBR), acute and subacute toxic reactions of antitumor drugs, survival rate and median survival time. Results: The objective effective rate in transarterial group was 32.0% versus 23.1% in systemic group without any significant difference (P = 0.475). Clinical benefit rates in transarterial group and systemic group were 80.0% and 50.0% respectively (P = 0.025). The 6-, 9-and 12-month accumulated survival rates and median survival time in transarterial group were higher than those of the systemic group (P = 0.002), the differences were statistically significant. However, the adverse reactions between the two groups were not statistically significant. Conclusion: Compared with systemic chemotherapy, continuous transarterial infusion chemotherapy with gemcitabine and 5-fluorouracil could improve clinical benefit rate and survival time of patients with advanced pancreatic cancer, it is safe and reliable, and the adverse reactions is less.     

动脉持续灌注化疗与静脉全身化疗治疗中晚期胰腺癌的疗效分析

Objective: To compare the curative effectiveness of continuous transarterial infusion chemotherapy and systemic venous chemotherapy in treating patients with advanced pancreatic cancer, and to evaluate the value of selective continuous transarterial infusion chemotherapy in treating advanced pancreatic cancer. Methods: Of the 51 patients with advanced pancreatic cancer receiving chemotherapy with gemcitabine and 5-fluorouracil, 25 patients were treated with selective continuous transarterial infusion chemotherapy, 26 were treated with systemic venous chemotherapy, and curative effectiveness was analyzed retrospectively. Curative effectiveness included tumor volume, clinical benefit response (CBR), acute and subacute toxic reactions of antitumor drugs, survival rate and median survival time. Results: The objective effective rate in transarterial group was 32.0% versus 23.1% in systemic group without any significant difference (P = 0.475). Clinical benefit rates in transarterial group and systemic group were 80.0% and 50.0% respectively (P = 0.025). The 6-, 9- and 12-month accumulated survival rates and median survival time in transarterial group were higher than those of the systemic group (P = 0.002), the differences were statistically significant. However, the adverse reactions between the two groups were not statistically significant. Conclusion: Compared with systemic chemotherapy, continuous transarterial infusion chemotherapy with gemcitabine and 5-fluorouracil could improve clinical benefit rate and survival time of patients with advanced pancreatic cancer, it is safe and reliable, and the adverse reactions is less.     

Continuous transarterial infusion chemotherapy with gemcitabine and 5-Fluorouracil for advanced pancreatic carcinoma

Purpose: Pancreatic carcinoma is one of the most malignant tumors of the alimentary system, with relativelyhigh incidence rates. The purpose of this study was to assess the efficacy and safety of two regimens for advancedpancreatic carcinoma: continuous transarterial infusion versus systemic venous chemotherapy with gemcitabineand 5-fluorouracil. Methods: Of the 48 patients with advanced pancreatic carcinoma receiving chemotherapy withgemcitabine and 5-fluorouracil, 24 received the selective transarterial infusion, and 24 the systemic chemotherapy.For the continuous transarterial infusion group (experimental group), all patients received gemcitabine 1000mg/m2,given by 30-minute transarterial infusion, on day 1 of a 4-week cycle for 2 cycles, and a dose of 600 mg/m2 5-fluorouracil was infused on days 1~5 of a 4-week cycle for 2 cycles. For the systemic venous group (controlgroup), gemcitabine and 5-fluorouracil were infused through a peripheral vein, a dose of 1000 mg/m2 gemcitabinebeing administrated over 30 min on days 1 and 8 of a 4-week cycle for 2 cycles, and a dose of 600 mg/m25-fluorouracil was infused on days 1~5 of a 4-week cycle for 2 cycles. The effectiveness and safety were evaluatedafter 2 cyclesaccording to WHO criteria. Results:The objective effective rate in transarterial group was 33.3%versus 25% in the systemic group, the difference not being significant (P=0.626). Clinical benefit rates(CBR) inthe transarterial and systemic groups were 83.3% and 58.3%, respectively (P=0.014). The means and mediansfor survival time in transarterial group were higher than those of the systemic group (P < 0.005). at the sametime, the adverse effects did not significantly differ between the two groups (P > 0.05). Conclusion: Continuoustransarterial infusion chemotherapy with gemcitabine and 5-fluorouracil could improve clinical benefit rate andsurvival time of patients with advanced pancreatic carcinoma, compared with systemic venous chemotherapy.Since adverse effects were limited in the transarterial group, the regimen of continuous transarterial infusionchemotherapy can be used more extensively in clinical practice. A CT and MRI conventional sequence can beused for efficacy evaluation after chemotherapy in pancreatic carcinoma.     

经动脉灌注健择化疗联合三维适形放射治疗局部晚期胰腺癌的临床研究

Objective： To evaluate the clinical effect of transarterial infusion chemotherapy of gemcitabine plus three dimensional conformal radiotherapy on patients with local advanced pancreatic cancer. Methods： Fifty-one patients with local advanced pancreatic cancer from June 2002 to February 2004 were enrolled, twenty-four patients of combined group were treated with transarterial infusion chemotherapy of gemcitabine plus three dimensional conformal radiotherapy, while twenty-seven patients of control group were treated only with transarterial infusion chemotherapy of gemcitabine. Results： There were significant statistical differences between two groups in clinical benefit response （91.7% versus 74.1%, P 〈 0.01） and overall remission rate （70.8% versus 33.3%, P 〈 0.01）. The 6-month survival rate, 12-month survival rate and 24-month survival rate of combined group were 83.3%, 62.5% and 37.5% respectively, while that of control group were 55.6%, 33.3% and 11.1% respectively. This showed significant difference between the two groups. Conclusion： Transarterial infusion chemotherapy of gemcitabine plus three dimensional conformal radiotherapy may be better than single transarterial infusion chemotherapy of gemcitabine in improving survival rates and elongating survival time of patients with local advanced pancreatic cancer.     

经动脉灌注健择化疗联合三维适形放射治疗局部晚期胰腺癌的临床疗效分析

目的评价经动脉灌注健择化疗结合三维适形放射治疗局部晚期胰腺癌的疗效。方法51例局部晚期胰腺癌患者，其中24例采用经动脉灌注健择化疗结合三维适形放射治疗（综合治疗组），27例单纯应用经动脉灌注健择化疗（对照组）。结果综合治疗组和对照组临床获益反应有效率分别为91．7％和74．1％，两者差异有统计学意义（P〈0．01）；综合治疗组总有效率（CR＋PR）为70．8％，对照组总有效率（CR＋PR）为33．3％，两组差异有统计学意义（P〈0．01）；综合治疗组和对照组的6、12和24个月生存率分别为83．3％、62．5％、37．5％和55．6％、33．3％、11．1％，两组差异均有统计学意义（P（0．05）。结论经动脉灌注健择联合三维适形放射治疗局部晚期胰腺癌，在提高生存率、延长生存期方面优于单纯经动脉灌注健择化疗。     

选择性动脉插管持续灌注化疗治疗晚期胰腺癌的疗效分析

背景与目的：晚期胰腺癌化学治疗效果差。本研究目的是探讨选择性动脉插管持续灌注化疗治疗晚期胰腺癌的临床疗效与应用价值。方法：20例晚期胰腺癌经选择性动脉插管持续灌注化疗。采用Seldinger技术经股动脉插管留置导管12例,经左锁骨下动脉插管植入药盒导管系统8例。导管选择至肿瘤供血动脉持续灌注化疗药物。9例采用THP-ADM HCPT 5-FU／CF方案,11例采用GEM CBP 5-FU／CF方案,4天为一疗程。4～6周重复1次疗程。治疗后观察客观缓解率、临床受益疗效(CBR)和病人的生存时间。结果：客观缓解率10％(CR、PR各1例),临床受益疗效70．0％,6个月及9个月生存率分别为58．8％和39．2％,中位生存期8．8个月。无出现插管合并症。结论：选择性动脉插管持续灌注化疗治疗晚期胰腺癌安全可靠。临床受益疗效良好,可提高患者的生存质量和生存期。值得临床进一步观察研究。     

GP方案区域化疗与静脉化疗治疗进展期胰腺癌疗效的对比研究

目的:对比分析采用GP方案胰腺区域性动脉灌注与静脉化疗治疗晚期胰腺癌的临床疗效。方法:采用随机法将68例晚期胰腺癌分为胰腺区域性动脉灌注组36例和静脉化疗组32例,平均化疗2.5个周期。结果:胰腺区域性动脉灌注组有效率为25.0%,中位疾病进展时间为9个月,临床获益率为50.0%,中位生存期为12个月,6个月生存率为55.6%,9个月生存率为25.0%;静脉化疗组有效率为12.5%,中位进展时间为3个月,中位生存期为5.5个月,临床获益率为25.0%,6个月生存率为31.2%,9个月生存率为18.7%。胰腺区域性动脉灌注组有效率、临床获益率、中位进展时间、中位生存期及生存率均高于静脉化疗组,差异有统计学意义,P<0.05。胰腺区域性动脉灌注组白细胞及血小板减少发生率分别为27.8%和25.0%,静脉化疗组分别为71.9%和56.3%。两组比较差异均有统计学意义,χ2值分别为13.189和6.911,P值分别为0.000和0.009。结论:GP方案胰腺区域性动脉灌注是治疗进展期胰腺癌的有效方案,且毒副反应可耐受。     

药盒埋置持续性动脉灌注化疗治疗中晚期胰腺癌的临床研究

 目的　评价药盒埋置持续性动脉灌注化疗治疗中晚期胰腺癌的临床效果。方法　采用左锁骨下动脉药盒埋置持续性动脉灌注化疗治疗的 2 5例胰腺癌患者为介入治疗组 ,同期接受全身化疗的 2 8例胰腺癌患者为全身化疗组 ,两组均给予健择 +5 氟尿嘧啶方案 ,比较两组临床受益反应、肿瘤大小变化、患者生存情况以及毒副反应。结果　介入治疗组和全身化疗组临床受益率分别为 5 2 .0 %和 2 1.4 %(P <0 .0 5 ) ;总有效率 (CR +PR)分别为 16 .0 %和 10 .7% (P >0 .0 5 ) ;中位生存时间分别为 8.1个月和 6 .8个月 (P >0 .0 5 ) ,半年累积生存率分别为 79.4 %和 5 2 .3% (P <0 .0 5 ) ;1年累积生存率分别为 35 .7%和31.5 % (P >0 .0 5 )。毒副反应以胃肠道反应为主 ,无Ⅲ度以上的血液学、胃肠道及肝肾功能的毒副反应。结论　药盒埋置持续性动脉灌注化疗可以提高中晚期胰腺癌的临床受益率和短期生存率     

吉西他滨联合奥沙利铂治疗晚期胰腺癌30例

Objective: To evaluate the activity and safety of combination chemotherapy with gemcitabine plus oxaliplatin (GEMOX regimen) in patients of advanced pancreatic carcinoma. Methods: 30 patients with advanced pancreatic cancer were enrolled into this study. All patients received gemcitabine 1000 mg/m2, given by 30-minute intravenous infusion, on days 1 and 8 of each 21-day cycle. Oxaliplatin 100 mg/m2 was administered as a 2 h infusion on day 1 of each 21 day. Clinical outcomes for patients treated with two cycles of chemotherapy were evaluated according to WHO criteria. Results: All 30 patients were eligible for effectiveness and safety analysis. Objective response rate was approximately 20.0%. Clinical benefit response (CBR) was a composite of assessment of pain, performance status and body weight. The pain relief rate, improve-ment rate of performance status and body weight were 53.3%, 46.7% and 36.7%, respectively. The main adverse effects were bone marrow depression, peripheral nerve toxicity and gastrointestinal reaction. There was no treatment-related death during the chemotherapy. Conclusion: The high response rate with low toxicity observed in this study suggests that GEMOX regimen may be an effective alternative curative treatment for patients with advanced pancreatic carcinoma and can be used more extensively in clinical practice.