静脉及腹腔联合化疗治疗滋养细胞肿瘤的探讨(附3例报道)

目的:探讨滋养细胞肿瘤治疗的另一种给药途径.方法:总结2000年以来以静脉联合腹腔化疗给药方式治疗的3例滋养细胞肿瘤患者治疗情况.结果:用常规给药途径治疗效果不佳的3例患者均取得满意疗效.其中2例痊愈出院,1例继续治疗.结论:静脉联合腹腔化疗对子宫穿破、盆腹腔病灶及术后局部复发的滋养细胞肿瘤患者,是一种有效的治疗方案.     

肿瘤患者化疗的静脉给药护理

化疗在肿瘤的综合治疗中占有重要地位。化疗的给药方式是以静脉给药为主。静脉穿刺是全身化疗的基础。大多数抗癌药物通过静脉途径给药，患常需多个疗程的化疗，需要反复静脉穿刺用药，所以化疗患的静脉给药护理十分重要。化疗药的品种多，具体用法有所不同。为保证化疗的顺利进行，肿瘤专科护理人员需熟知相关的知识。     

区域性热疗合并热化疗治疗腹腔转移瘤的临床研究

目的：介绍一种区域性加温联合多途径给药化疗治疗腹腔转移瘤的方法及其毒副作用。方法：用ＵＨＲ－９１５ＭＨｚ微波热疗机对１１例腹腔转移瘤病人进行１２次腹部加温,并对直肠、食管、和鼓膜进行测温,加温前给予度冷丁、氯丙嗪和东莨菪碱肌注,给予腹腔灌注４８℃～５０℃的ＤＤＰ溶液１２５０ｍｌ,并根据肿瘤部位,部分患者给予介入化疗,加温时间同时和加温后给予足量静脉化疗,结果：经测温显示各部位温度于加温后达４０℃以     

腹腔温热化疗及全身化疗治疗消化道肿瘤45例疗效观察

目的：探讨腹腔温热化疗及静脉化疗治疗消化道肿瘤的临床应用价值。方法：治疗组45例病人中32例为根治术后，采用腹腔内注人顺铂80－100mg，每7－10天重复，连用3－4次，之后给予FAM方案（氟脲嘧啶、阿霉素、丝裂霉素）静脉化疗，13例晚期失去手术机会的病人给予FAM方案静脉化疗配合腹腔化疗。并与对照组31例治术后单用FAM方案静脉化疗的病人相比较。结果：治疗组和对照组3年生存率分别为70％、40．3％（P＜0．01），腹腔复发率分别为6．25％、48．4％，肝转移率分别为3．13％、32．3％。疗效明显优于对照组（P＜0．01）。13例晚期期病人的近期疗效PR69．2％，明显优于单用公认的静脉联合化疗的疗效。结论：腹腔温热化疗＋静脉化疗不胆能有效降低胃肠道肿瘤术后腹腔复发及转移，提高3年生存率，而且能提高晚期病人的近期有效率及生存质量。     

双通道化疗治疗晚期腹腔肿瘤临床观察

目的 探讨腹腔化疗配合全身化疗治疗晚期腹腔肿瘤的临床疗效。方法 术后腹腔转移或失去手术机会的晚期腹腔肿瘤随机分为治疗组和对照组，治疗组用四氢叶酸钙、5—Fu、顺铂联合应用，行腹腔及静脉化疗。对照组行四氢叶酸钙、5—Fu、顺铂联用单纯静脉化疗。结果 治疗组有效率为60．41％，1年生存率为57％，对照组有效率为35．41％。1年生存率为35％。不良反应，治疗组较轻微。结论 腹腔联合静脉双通道化疗治疗晚期腹腔肿瘤，较单纯静脉化疗副作用明显减轻，有效率及1年生存率有所提高。     

胃肠恶性肿瘤的腹腔化疗

腹腔化疗(IPC)是一种高选择性区域治疗方法，在胃肠恶性肿瘤患者的姑息治疗和防止术后腹腔复发和转移方面具有重要意义。临床研究证明腹腔化疗具有明显的药代动力学优势及静脉化疗不可比拟的诸多优点，在肿瘤的综合治疗中发挥着重要作用，与腹腔温热灌注疗法结合起来疗效显著。     

双通道化疗治疗晚期腹腔肿瘤临床观察

目的　探讨腹腔化疗配合全身化疗治疗晚期腹腔肿瘤的临床疗效。方法　术后腹腔转移或失去手术机会的晚期腹腔肿瘤随机分为治疗组和对照组 ,治疗组用四氢叶酸钙、5 -Fu、顺铂联合应用 ,行腹腔及静脉化疗。对照组行四氢叶酸钙、5 -Fu、顺铂联用单纯静脉化疗。结果　治疗组有效率为 60 41% ,1年生存率为 5 7% ,对照组有效率为 3 5 41%。 1年生存率为 3 5 %。不良反应 ,治疗组较轻微。结论　腹腔联合静脉双通道化疗治疗晚期腹腔肿瘤 ,较单纯静脉化疗副作用明显减轻 ,有效率及 1年生存率有所提高。     

静脉联合腹腔化疗治疗晚期胃肠肿瘤87例临床分析

目的：评价静脉联合腹腔化疗治疗对晚期胃肠肿瘤治疗效果和副作用。方法：对1996年至2000年11月间，我科对采用吡喃阿霉素静推、羟基喜树碱静滴、5-FU及顺铂腹腔灌注方法治疗87例晚期胃肠肿瘤进行分析，总结其的期治疗效果。结果：本组87例，总有效率52.9%(46/87)，中位生存期为15.7月，且毒副反应较轻。结论：静脉联合腹腔化疗是治疗晚期胃肠肿瘤的有效治疗手段，副反应轻，病人易于接受。     

早期巨块型宫颈癌术前新辅助化疗不同给药途径临床比较观察

目的 比较观察早期巨块型宫颈癌新辅助化疗中静脉给药途径和动脉给药途径的疗效和毒副反应.方法 人组19例Ib2期宫颈癌行新辅助化疗患者,比较观察行静脉化疗(11例)和动脉化疗(8例)患者在疗效和毒副反应上的差异.结果 2组总有效率比较差异无统计学意义(P＞0.05),但静脉化疗组总有效率稍低于动脉化疗组.2组毒副反应发生率比较差异无统计学意义(P＞0.05),但静脉化疗组局部疼痛发生率稍低于动脉化疗组.结论 对于早期巨块型宫颈癌,新辅助化疗经静脉给药和经动脉途径给药均可有效缩小肿瘤体积,经静脉途径给药简便,易行,安全,对防止盆腔淋巴结及远处转移更有效;经动脉给药需血管介入技术,费用略高,理论上总有效率优于静脉给药,是一种很好的给药方式.     

经IDDS对消化道肿瘤行区域性化疗的体会

目的：观察皮下埋植式给药装置（IDDS）在消化道肿瘤患者中的应用效果。方法：观察72例消化道肿瘤患者,将给药装置的导管插入患者相应的动脉或静脉内,术后定期将化疗药物经皮下埋植给药装置直接注射到肿瘤周围组织或容易受肿瘤侵犯的器官内,对患者进行区域性化疗。结果：在治疗过程中,未发生导管脱落、感染及堵塞,仅一例患者出现局部药物渗漏。除2例晚期肝癌患者近期死亡外,其余患者均按计划完成化疗。结论：经皮下埋植给药装置对消化道肿瘤进行区域性化疗是一种安全、可靠的临床治疗手段。     

子宫切除对治疗滋养细胞肿瘤价值的探讨

目的 评价子宫切除手术在滋养细胞肿瘤治疗中的作用。方法 对６８例行子宫切除术的滋养细胞肿瘤病例进行回顾性分析,其中侵蚀性葡萄胎３０例,绒癌３８例,结果２３例因年龄偏大,且无生育要求,术前经短暂化疗后,择期行全子宫切除术,２２例获完全缓解,总平均化疗程数为４．２。２７例因产生化疗耐药,且考虑病灶主要局限于子宫,在化疗的同时进行了全子宫切除术,２０例（７４．１％）获完全缓解,总平均化疗程数为９．４。     

子宫切除术在妊娠滋养细胞肿瘤治疗中的应用

目的探讨子宫切除术在妊娠滋养细胞肿瘤治疗中的应用.方法对本院1985年1月～2003年12月,因妊娠滋养细胞肿瘤而行子宫切除术的61例病例进行回顾性分析.结果年龄较大无生育要求患者术前经短暂化疗后择期行全子宫切除术,均获完全缓解;因子宫穿孔或子宫大出血而急诊的患者进行全子宫切除术,其中1例死于大出血;因产生化疗耐药,且考虑病灶主要局限于子宫的患者施行子宫切除辅助化疗;无生育要求者为缩短化疗疗程,行选择性子宫切除.结论应严格把握手术指征,根据年龄、疾病类型及是否为高危患者选择适当的手术方式.     

妊娠滋养细胞肿瘤13例手术治疗临床分析

目的探讨手术治疗对妊娠滋养细胞肿瘤的疗效。方法回顾性分析13例妊娠滋养细胞肿瘤的临床资料。结果13例患者中有11例行全子宫切除术,2例行子宫病灶切除术。13例术前彩超均提示子宫存在病变,其中8例（61．5％）术后病理提示为坏死组织,5例（38．5％）可见滋养细胞。8例无滋养细胞残留的患者中2例（25．0％）HCG阳性,5例术后病理可见滋养细胞患者中有4例（80．0％）HCG阳性,两组相比差异无统计学意义（P〉0．05）。结论妊娠滋养细胞肿瘤的治疗虽以化疗为主,但手术治疗仍有重要价值。     

Placental site trophoblastic tumor with multiple metastases and complete response to salvage BEP regimen: a case report and review of the literature

Placental site trophoblastic tumor is a rare form of gestational trophoblastic disease, derived from invasive implantation site (intermediate) trophoblastic cells. It is frequently resistant to chemotherapy. Patients with metastases, however, frequently have progressive disease and die despite surgery and multiagent chemotherapy. In this case, a 24-year-old woman was referred because of intermittent vaginal bleeding episodes for 5 months following delivery. Multiple metastases in lungs, liver, kidneys, breast, pancreas, and adrenal and thyroid glands were detected. Combination therapy including surgery and multiagent chemotherapy was planned. Hysterectomy and pelvic lymph node dissection were performed. All metastatic lesions disappeared with EMA-CO treatment. However four courses of BEP regimen, salvage therapy, was performed for plateauing hCG level. Surgery and multiagent chemotherapy seem mainstay of treatment of cases having multiple metastases of PSTTs.     

Gestational trophoblastic tumors

Gestational trophoblastic tumor is a term applied to invasive mole, choriocarcinoma, and placental-site trophoblastic tumor. The overall cure rate in the treatment of these gestational trophoblastic tumors now exceeds 90%. This high success rate is the result of (1) inherent sensitivity of trophoblastic tumors to chemotherapy, (2) ability to monitor therapy effectively with the use of human chorionic gonadotropin as a tumor marker, and (3) identification of prognostic factors which allows categorization of patients into high- and low-risk groups for selection of treatment. Virtually all patients with nonmetastatic and low-risk metastatic disease can be cured using single-agent methotrexate or Actinomycin-D chemotherapy. Intensive therapy with combination chemotherapy including etoposide, high-dose methotrexate and Actinomycin D and, where indicated, adjuvant radiotherapy and surgery has resulted in cure rates of 80-90% in patients with high-risk metastatic disease. The factors which are most important in determining response to treatment are: (1) clinicopathologic diagnosis of choriocarcinoma, (2) metastases to sites other than the lung or vagina, (3) number of metastases, (4) previous failed chemotherapy, and (5) WHO score greater than or equal to 8.     

Gestational trophoblastic disease: does central nervous system chemoprophylaxis have a role?

In the UK there are standardized surveillance procedures for gestational trophoblastic disease. However, there are differences in practice between the two treatment centres in terms of definition of persistent gestational trophoblastic disease, prognostic risk assessment and chemotherapeutic regimens. The role of prophylactic chemotherapy for cerebral micrometastatic disease in persistent gestational trophoblastic disease is unclear. We have analysed the outcome of 69 patients with lung metastases who elsewhere might have received prophylactic intrathecal chemotherapy. Of the 69 patients, 67 received intravenous chemotherapy only. The other two patients had cerebral metastases at presentation. One patient who received only intravenous chemotherapy subsequently developed a cerebral metastasis, but this patient's initial treatment was compromised by non-compliance. This experience supports our current policy of not treating patients with pulmonary metastases, without clinical evidence of central nervous system (CNS) involvement, with prophylactic intrathecal therapy.     

PEA方案治疗滋养细胞肿瘤45例临床分析

目的：观察PEA（顺铂＋足叶乙甙＋更生霉素）方案治疗滋养细胞肿瘤的疗效和不良反应。方法：回顾性分析我院2006年3月至2008年11月间应用PEA方案治疗滋养细胞肿瘤患者45例,其中侵袭性葡萄胎患者22例,绒癌患者23例;初治患者36例,耐药患者9例。结果：45例妊娠恶性滋养细胞肿瘤患者,42例完全缓解,总完全缓解率为93.3%。其中初治侵袭性葡萄胎的治愈率为100%,绒癌的完全缓解率为86.95%,耐药妊娠恶性滋养细胞肿瘤的完全缓解率为77.8%（7/9）。主要化疗不良反应为I-Ⅱ级恶心、呕吐和骨髓抑制。结论：PEA方案可作为滋养细胞肿瘤的一线化疗方案,其疗效肯定,不良反应小,适宜临床应用。     

妊娠滋养细胞肿瘤治疗后的妊娠结局

妊娠滋养细胞肿瘤化疗治愈率较高,治愈后的再次妊娠结局非常值得关注.妊娠滋养细胞肿瘤化疗后避孕1年后再妊娠,妊娠结局与一般人群相似,近年研究发现化疗完成至首次妊娠的时间间隔影响妊娠结局,对化疗后6个月内妊娠的患者需严密监视,建议化疗后避孕1年后再次妊娠.     

Management of gestational trophoblastic diseases: subsequent pregnancy experience

Patients with gestational trophoblastic disease (GTD) can usually achieve complete sustained remission while retaining their fertility even in the presence of wide-spread metastasis. Following complete and partial mole, our patients had 1,239 and 205 later pregnancies, respectively, which resulted in 68.6% and 74.1% term live births, respectively. Patients with either type of hydatidiform mole have, in general, a normal later pregnancy experience. After one molar pregnancy, the risk of a molar pregnancy in a later conception was about 1%. Our patients who received chemotherapy for persistent gestational trophoblastic tumor had 522 later pregnancies, which resulted in 358 (68.6%) term live births and only 10 (2.5%) major and minor congenital anomalies. Data from other centers involving 2,598 later pregnancies also indicate that after chemotherapy patients can generally anticipate a normal future reproductive outcome.     

Major surgeries performed for gestational trophoblastic neoplasms in a teaching hospital in Tehran, Iran

Objective

This study aim was to evaluate indications and outcomes of surgical interventions performed in patients with gestational trophoblastic neoplasm.

Methods

During January 1995 to December 2005, 110 patients with a diagnosis of persistent gestational trophoblastic neoplasm were treated in our Gynecologic Oncologic Department. Risk score calculation was carried out based on the revised FIGO 2000 scoring system for gestational trophoblastic neoplasm. Data from the patients'' records and pathologic reports were analyzed by the chi-square and Fisher''s exact tests and logistic regression. The Kaplan-Meier method including the log rank test was used to compare survival and recurrence.

Results

Eight patients did not complete their treatment and were excluded from the study. We evaluated treatment responses and outcomes in 102 patients. Seventy-nine patients (77.5%) responded fully to chemotherapy while 23 patients (22.5%) required surgery. Among 23 patients who underwent surgery, 10 cases (43.5%) had bleeding, and 13 cases (56.5%) had drug resistance. Several factors were found to be significantly different between the groups who responded to chemotherapy and those who needed surgery, including age (p=0.001), antecedent non-molar pregnancy (0.028), tumor stage (p=0.009), and pre-treatment risk scores (p=0.008). But, the total courses of chemotherapy (p=0.521), need to salvage chemotherapy (p=0.074), survival rates (p=0.714), and disease free survival rates (p=0.206) were not significantly different.

Conclusion

The data suggest that age, antecedent non-molar pregnancy, tumor stage and the prognostic score are clinical predictors of need for surgery. But, it dose not seem that surgery have any effect on the total course of chemotherapy, need for salvage chemotherapy, and patient prognosis.