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。     

三维适形放疗结合区域性动脉灌注化疗治疗局部中晚期胰腺癌疗效观察

胰腺癌的发病率近年逐渐上升,已成为消化系统疾病中常见的恶性肿瘤之一。本病特点是病程短,发展迅速,以往常规放化疗效果差,愈后不佳[1]。     

支气管动脉灌注化疗加放疗治疗中晚期肺癌45例疗效分析

目的：报道中，晚期肺癌经介入化疗加放疗的疗效。材料与方法：从1997年7月间采用经支气管动脉灌注化疗2次，第2次动脉主化疗后1周加医用电子直线加速器外照射放疗，。治疗不能手术切除的ⅢB Ⅳ期非小细胞肺癌45例，放疗剂量DT55－68Gy。结果：近期疗效：CR率22．2％，PR率62．2％，显效率（CR＋PR）84．4％，有效缓解率95．6％，随访至2000年7月，全组病例0．5，1和2年生存率分别为93．3％（42例），68．8％（31例）和22．2％（10例）。结论：中晚期肺癌介入化疗加放疗的综合治疗可提高疗效和生存期。     

动脉药物灌注治疗胰腺癌疗效观察

动脉药物灌注进行区域性化疗治疗恶性肿瘤已广泛应用于临床。我院１９９２年６月～１９９７年６月对３３例晚期胰腺癌患者进行了动脉药物灌注化疗,取得了较好的疗效,报告如下。１临床资料１．１临床资料３３例患者,男性２９例,女性４例,年龄３４～７２岁。均经病理证...     

胃左动脉灌注化疗与手术综合治疗中晚期贲门癌

目的 对比研究单纯手术、单纯动脉灌注化疗和综合治疗对中晚期贲门癌的治疗效果。方法 79例中晚期贲门癌患者,分成单纯手术（A组）、单纯动脉灌注化疗（B组）和综合治疗组（C组）,进行对比研究。其中A组32例、B组18例,C组（先动脉灌注化疗后手术）29例,3例平均年龄分别为59．2岁、59．6岁、58．9岁,临床分期均为ⅢB期。结果 动脉灌注化疗（B组和C组）47例,半个月后95．7％患者症状改善,肿瘤缩小;肿瘤切除率：A组为62．5％（20／32）、C组为100．0％（29／29）;A组1、3、5年生存率分别为78．1％（25／32）、46．9％（15／32）和25．0％（8／32）,C组分别为93．1％（27／29）、79．3％（23／29）和（15／29）,2组术后3、5年生存率比较有显著性差异（P＜0．05）;B组和C组1年生存率比较,有非常显著性差异（P＜0．01）。结论 综合治疗组的手术切除率和术后生存率显著高于同期的单纯手术组和单纯动脉灌注化疗组。动脉灌注化疗1个月后为手术良好时机。     

动脉灌注健择治疗中晚期胰腺癌

目的 评价经动脉灌注健择治疗中晚期胰腺癌的疗效。方法 36例患者共行65次经动脉内灌注健择，药量按800～1200mg／m^2，间隔2～4周给药一次。结果 以疾病相关症状改善(DRSI)作为评价近期疗效依据，其中以疼痛改善最为显著。结论 经动脉内灌注健择是治疗中晚期胰腺癌的有效方法，可改善临床症状，提高生存质量。     

中晚期胰腺癌双途径化疗的临床观察

近年来胰腺癌的发病率和死亡率呈明显上升趋势,据有关统计,我国部分城市胰腺癌发病率已达到5．5～8．5／10万。由于胰腺癌发病隐袭和进展迅速,早期诊断十分困难,仅10％～15％的患者具有手术切除的机会,而术后多有复发转移。总体5年生存率不足5％,中位生存时间低于20个月,中位进展时间低于10个月,伴有远处转移的低于6个月。我科近3年来一直注意观察双途径化疗对晚期胰腺癌的临床疗效,现总结如下。     

动脉灌注化疗治疗晚期胰腺癌长期生存1例

胰腺癌是严重危害人类健康的一种疾病,其发病率占常见肿瘤的1％-2％。胰腺癌的特点为病程短,进展快,死亡率高;中位生存期在6个月左右。一旦失去手术机会,其他治疗方法的效果往往很差。我们对1例无法手术切除的晚期胰腺癌采用腹腔动脉灌注化疗方法,使其生存期达10年以上,现报道如下：     

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。     

Gemcitabine combined with continuous infusion 5-fluorouracil in advanced and symptomatic pancreatic cancer: a clinical benefit-oriented phase II study

Gemcitabine and 5-fluorouracil are the only two compounds with reproducible activity against advanced pancreatic cancer (APC). We have evaluated a novel combination of gemcitabine and 5-fluorouracil on the clinical benefit response (CBR) end point. Eleven consecutive patients with symptomatic APC were entered in a two-stage phase II trial. Gemcitabine was administered by intravenous (i.v.) bolus injection at the dose of 1,000 mg m(-2) on days 1, 8, 15 and 5-fluorouracil 500 mg m(-2) was given by continuous i.v. infusion on days 1-5. Treatment was repeated every 28 days. A CBR was achieved in 7/11 patients. The mean time to loss of CBR was 26.5 weeks (range 14-18, median 22). Toxicity was mild and no APC patient experienced WHO grade 3 toxicity. The gemcitabine/5-fluorouracil combination is well tolerated and produces a symptomatic relief in the majority of APC patients.     

吉西他滨联合氟尿嘧啶和顺铂治疗晚期胰腺癌

目的：观察吉西他滨（CEM）,氟尿嘧啶（5－FU）及顺铂（DDP）三药联合化疗对晚期胰腺癌的客观疗效及其临床受益反应（CBR）,方法：GEM 800mg/m^2,5-FU 600mg/m^2,DDP 30mg/m^2,于第1,8,15天静滴,28天为1周期,按WHO标准评价疗效,同时综合评估临床受益反应（CBR）指标：疼痛,体力状况及体重变化。结果：全组共29例,25例化疗两周期以上,其中PR6例（24．0％）,NC12例（48．0％）,PC7例（28．0％）,参照CBR综合指标,CBR率为62．1％（18／29）,主要毒性为消化道反应及骨髓抑制,其中血小板Ⅲ-Ⅳ度毒性为27．6％（18／29）,失访18例,结论：吉西他滨联合氟尿嘧啶及顺铂对晚期胰腺癌具有一定的肿瘤客观解率,临床受益反应率高,毒副反应能耐受,值得进一步研究。     

Clinical benefit response of concurrent chemoradiotherapy with protracted 5-fluorouracil infusion in patients with locally advanced pancreatic cancer

Background Pancreatic cancer is a highly virulent disease with a poor prognosis. Although objective tumor response to chemotherapy and/or radiotherapy is low, some patients show an improvement in their symptoms after treatments, without obvious tumor regression. Methods We assessed the clinical benefit of concurrent chemoradiotherapy with protracted 5-fluorouracil infusion in patients with locally advanced pancreatic cancer. Sixteen patients were enrolled in this study. The clinical benefit response to the chemoradiotherapy was evaluated by 2 indicators, including pain (intensity of pain and consumption of morphine) and performance status. A patient was defined to be a clinical benefit responder if 1 of these 2 variables was positive, and the other variable was positive or stable. Results Seven patients (44%) responded. Six patients (38%) were classified as stable, and 3 (19%) as nonresponders. The survival period in responders was significantly longer than that in nonresponders and stable patients. Conclusion Concurrent external-beam radiation therapy, with protracted 5-fluorouracil infusion, may be a meaningful treatment for locally advanced pancreatic cancer.     

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。     

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。     

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.     

Treatment of advanced pancreatic carcinoma with a combination of protracted infusional 5-fluorouracil and weekly carboplatin: A Mid-Atlantic Oncology Program study

Background: Advanced pancreatic cancer is a rapidly fatal disease whosecourse has been little influenced by chemotherapy. Earlier studies have shownsome modest promise for the combination of protracted infusional5-fluorouracil (PIF)and cisplatin. We sought to evaluate a regimen of possibly lesser toxicity,PIF plus weekly carboplatin.Patients and methods: Fifty-four patients with advanced adenocarcinoma ofthe pancreas were treated with a regimen of protracted infusional fluorouracil300 mg/m²/day for 70 days and carboplatin 100mg/m²/weekly on weeks 1 through 10 of a 12-week cycle. Aftera two-week rest, cycles were repeated until progression.Results: Median duration on treatment was 82 days (range 4–490 days).Toxicity was mild. Grade 3–4 toxicities were anemia 11%,leukopenia 6%, thrombocytopenia 2%, nausea/vomiting 7%,diarrhea 9%, mucositis 9%, and renal 2%. Response wasevaluable in 47 patients. There were two complete and seven partial responses(17% overall objective response rate among all patients). Stabledisease for greater than 12 weeks was seen in 19 patients (40%) andprogression in 19 (40%). The median overall survival was 22 weeks(1–99), with 61 weeks median survival in responders (22–99).One-year survival was 13%.Conclusions: Response and survival results with this regimen are at leastequal to the best combination regimens reported, and were obtained with a lowoverall rate of serious toxicity.