肺癌的外科治疗进展

第 10届世界肺癌大会于 2 0 0 3年 8月 10～ 14日在加拿大温哥华召开 ,有关肺癌的外科治疗 ,会议共安排了“肺的孤立性结节”、“局部晚期肺癌的手术”、“诱导治疗后的手术”、“电视辅助胸外科”、“新辅助化疗”等 5个专题 ,还有 3场墙报展示和讨论。1　关于肺孤立性结节诊断治疗的进展肺孤立性结节 (solitarypulmonarynode ,SPN )的诊断一直是临床难点之一 ,本次大会对此的诊治策略体现如下几个特点。随着多探头螺旋CT的应用 ,越来越多直径小于 2cm的肺孤立性结节被发现 ,由于确诊手段的局限 ,这类结节的诊治策略一直是所谓的“等待与…     

肺癌放射治疗进展

放射治疗目前仍为肺癌治疗的主要手段之一 ,根据最新统计 ,肺癌患者在其治疗过程中至少在一个疗程中应用放射治疗的比例在北美为 79% ,在澳大利亚为 76 % [1] 。 1974年至 1995年间肺癌 5年生存率停留在 15 %以内[2 ] ,治愈者多为经手术治疗的Ⅰ /Ⅱ期患者。 35 %～ 4 0 %的肺癌患者就诊时即为局部晚期 ,不能手术切除但仍有治愈可能[3] 。这些患者经单纯传统放射治疗的 5年生存率极差 ,寻求新的治疗技术及通过联合治疗改善疗效是肺癌放射治疗研究中的热点。在第十届世界肺癌大会上 ,有关肺癌放射治疗的文章近三百篇 ,内容包括三维适形放射治…     

肺癌以手术为主的多学科综合治疗进展

肺癌为高发肿瘤 ,其中 75 %为非小细胞肺癌(NSCLC)。手术治疗是NSCLC的最佳治疗方法 ,早期手术切除的NSCLC 5年生存率ⅠA期为 6 7% ,ⅠB期 5 7% ,ⅡA期 5 5 % ,ⅡB期 39% ,ⅢA期 2 3%。但NSCLC被发现时 ,仅 2 0 %～ 30 %的病例有手术指征 ,约 6 5 %～ 70 %的病例为不适宜手术的Ⅲ、Ⅳ期患者。即使能够手术 ,手术后约有 70 %的患者发生复发和转移。因此要获得肺癌治疗的良好效果 ,国内外学者均提倡以手术为主的多学科综合治疗。在今年 5月召开的第 39届ASCO年会上 ,ASCO主席强调“几乎所有癌肿均需多学科治疗” ,提出肿瘤内科…     

蹒跚前进的肺癌研究

 这一期杂志 ,编发了一组肺癌研究的文章。2 0 0 4年的统计数字表明 ,肺癌的年死亡率 ,仍然高踞各种癌症之首。在美国 ,2 0 0 4年的预测新肺癌病例为 17.4万 ,死亡为 16 .0万 ,比所有消化系癌症的死亡总和 13.5万还要多。尽管女性肺癌仍在逐年增长 ,但从 1992年开始 ,美国男性肺癌的死亡率在下降 ,这让人看到些许的曙光。也提示着肺癌诊断和治疗的进步。低剂量螺旋CT和脱氧葡萄糖电子发射扫描 (FDG PET)的临床应用 ,是肺癌筛查诊断和分期的巨大进步。前者已被证实提高了早期肺癌的检出率 ,后者则矫正了 2 0 %肺癌的分期从而避免了不必要的剖胸探查。当然 ,任何一种检查方法都有其不足 ,如何发挥其优势弥补其劣势使其更完善是医生的职责。本期广东省人民医院赵振军医生的论文 ,便提出了CT、MRI和PET在诊断肺部肿块上互补的观点 ,相信对临床医生会有所启发。实际上 ,图像融合技术如PET CT正在大踏步地进入临床 ,恰恰代表了这种发展趋向。生物芯片技术之一的组织芯片 ,作为一种高通量、质量归一而又简单快捷的技术 ,一经面世便受到青睐 ,但其在库存石蜡组织上的位点标本采样的可靠性如何一直备...     

非小细胞肺癌化疗进展

引言肺癌是发病率和死亡率很高的常见恶性肿瘤之一。近年来随着化疗药物,尤其是分子靶点药物的开发应用,以及肺癌多学科治疗模式的发展,肺癌总的5年生存率提高到15%,较20世纪60年代的8%有了较大进步。现将近两年来在化疗方面的重要临床试验结果及进展总结如下。1术后化疗的观念改变对于肺癌患者术后是否辅助化疗一直存在异议,20世纪末总结的多数资料不支持肺癌完全切除术后辅助化疗,但是自从2003年ASCO会议上报告了第一个显示肺癌术后化疗能延长生存期的大规模III期临床试验(IALT)结果后,使人们对术后化疗有了新的认识。IALT(International adjuvantlung cancer trial)涉及全球33个国家148个中心的1867例肺癌患者,平均年龄59岁,其中男性80%,女性20%,鳞癌47%,腺癌40%,其他13%,I期36%,II期25%,III期39%;随机分为术后化疗组935例,单纯手术组932例,化疗方案采用顺铂加足叶乙甙或长春花碱或长春花碱酰胺或诺维本,分析结果显示术后化疗组患者的5年生存率和无疾病生存率均高于单纯手术组,5年生存率分别为44.5%与40.5%(P=0.03),5年无...     

N2非小细胞肺癌治疗进展

肺癌是目前世界上最常见的恶性肿瘤之一 ,随着我国工业化速度的加快和吸烟率的增加 ,肺癌的发病率在我国城镇中正迅猛增长 ,已成为我国城市人口恶性肿瘤死亡原因的第一位[1] 。按世界人口调整率 ,2 0 0 0年我国肺癌男、女性发病率分别增长至 3 8.46× 10 -5和 15 .70× 10 -5,仅次于胃癌和肝癌 ,居我国恶性肿瘤的第三位。由于约 75 %的肺癌患者在发现时已属中晚期 ,目前肺癌的总 5年生存率约10 %。国内外众多作者报道N2 非小细胞肺癌 (N2 NSCLC)患者单纯手术后治疗效果不佳 ,其 5年生存率为 17.3 %～2 7.9% [2 ,3 ] 。N2 NSCLC完全性…     

胸腔高温灌注化疗治疗肺癌

本报告对8例肺癌患采用胸腔内高温灌注化疗，即将持续恒温42～44℃的等渗盐水中加入高剂量顺铂灌注1～2小时，病理检查表明高温使肿瘤细胞变性坏死，而对正常组织无明显损害。由此提示高温胸腔灌注化疗对于肺癌可能是一种安全和有效的治疗方法。     

肺癌p53基因治疗临床研究进展

肺癌是当前世界上对人类健康与生命危害最大的恶性肿瘤之一 ,发病率呈不断上升趋势。虽然近年来化学、放射、生物和外科治疗手段不断发展 ,但肺癌患者总的生存率仍然没有明显的改善 ,迫切需要有新的有效治疗手段的出现。由于分子生物学和分子遗传学的迅速发展 ,对肺癌分子机制的认识也不断深入 ,利用DNA重组和基因转移技术的肺癌基因治疗成为极有发展前景的治疗方法。本文对 p5 3基因治疗策略应用于肺癌临床治疗的研究情况做一介绍 ,并探讨其在肺癌治疗中的潜在应用价值。1　肺癌 p5 3基因治疗的体外实验p5 3基因已成为基因治疗最主要和最…     

化疗在肺癌综合治疗中的作用

随着有效新药的发展,防治化疗不良反应等辅助治疗的进步,化学药物治疗晚期非小细胞肺癌,特别是小细胞肺癌疗效明显提高,因而,在肺癌的综合治疗中有不可取代的功能。其应用：治疗局部晚期或有播散性病变及复发患者;新辅助化疗;辅助化疗;化学预防。结合临床实践与文献重点讲座其治疗原则与新方法。     

支气管动脉灌注化疗治疗肺癌的临床研究

目的　探讨支气管动脉灌注化疗 (BAI)对中晚期肺癌的疗效及影响因素。方法　对 45例中晚期肺癌进行BAI治疗 ,与同期接受全身化疗的 40例中晚期肺癌进行比较。结果　除开 1例大细胞肺癌 ,BAI组完全缓解 (CR) 15例 ( 3 4.1% ) ,部分缓解 (PR) 18例 ( 4 0 .9% ) ,缓解 (CR +PR) 3 3例 ,缓解率 75 .0 % ,与全身化疗之间的疗效 ( 5 0 .0 % )有显著性差异 ,前者优于后者 (P <0 .0 5 ) ,前者毒副反应亦少于后者 (P <0 .0 5 ) ,但BAI组有 1例灌注后截瘫。在BAI组中 ,小细胞未分化癌、鳞癌、腺癌的缓解率分别为 94.5 %、66.6%、40 .0 %。BAI组鳞癌和腺癌的缓解率显著高于全身化疗组 (P <0 .0 5 )。结论　BAI的疗效优于全身静脉化疗 ,且毒副反应低。鳞癌首选BAI治疗 ,小细胞未分化癌以全身化疗为基础 ,辅助应用BAI治疗 ,腺癌可先行BAI治疗 ,配合全身化疗或放疗     

肺癌的化疗进展

第九届世界肺癌会议于 2 0 0 0年 9月11～ 15日在日本东京召开 ,来自世界各地的肺癌基础研究和临床工作者聚集一堂 ,交流肺癌各个领域的最新研究成果。本次会议共征集到肺癌化疗论文 3 0 9篇 ,占全部论文的 3 0 % ,其中卫星会报告论文 2 0篇 ,化疗分会场报告论文 2 0 8篇 ,墙报 81篇。本次会议的肺癌化疗论文表明ＮＳＣＬＣ未来的治疗方向是在基础化疗的基础上加用靶向性更强的生物治疗药物 ,而ＳＣＬＣ未来的研究趋势和方向则是更有效、更合理地将化疗与放疗结合 ,并针对血管形成和自分泌因子采取靶向性治疗。现就本次会议有关肺癌化疗的研…     

Advances in chemotherapy for lung cancer

Combination therapy with platinum preparations still occupies a central position in chemotherapy for lung cancer. Third-generation regimens that combine an anticancer drug and a platinum preparation that were published in the 1990s remain standard therapy for untreated non-small-cell lung cancer today. Cisplatin or carboplatin is used as the platinum preparation, but combination therapy with cisplatin has been found to have a greater antitumor effect than combination therapy with carboplatin. However, there is very little difference between them, and on balance, when adverse reactions, etc. are taken into consideration, we do not think that it makes much difference which one of them is used. Clinical studies of combinations between platinum preparations and pemetrexed and S-1, which have been developed since 2000, have been conducted recently. Docetaxel has been established as standard therapy for recurrent cases, but based on the results of recent comparative studies, a survival-prolonging effect has been shown for pemetrexed and for EGFR tyrosine kinase inhibitors(gefitinib, erlotinib), which are molecularly targeted drugs, and it has now become possible to select treatment methods by choosing from a number of anticancer drugs. EGFR tyrosine kinase inhibitors have been demonstrated to have a very high cytoreductive effect on lung cancers that have EGFR gene mutations. The frequency of EGFR gene mutations is high in East Asia, including Japan, whereas it is very low in Western countries. Thus, the future course of development of chemotherapy for non-small-cell lung cancer may differ in Western countries and Asia, and the method of using EGFR tyrosine kinase inhibitors is expected to have great implications in Asia.     

小细胞肺癌药物治疗进展

小细胞肺癌（small cell lung cancer,SCLC）约占肺癌患者的13% 。与非小细胞肺癌相比具有早期转移倾向及对一线细胞毒性化疗药物敏感的特点。目前的治疗方式包括手术、胸部及脑部放疗和化疗。以铂类联合依托泊苷为标准一线化疗,治疗后复发率较高。拓扑替康单药为标准二线化疗,新型的靶向和免疫治疗等疗效均欠佳。因此小细胞肺癌的治疗亟待有新的突破。     

晚期非小细胞肺癌维持化疗的进展

维持化疗是指患者在完成标准的几个周期化疗且疾病得到控制后再接受的化疗,其理论基础是基于Goldie和Coldman假说:尽早使用非交叉抑制药物可以在耐药产生前增加杀伤肿瘤细胞的效能,使治疗效果最优化。但同时也延长了治疗时间,且化疗的毒性反应可在体内蓄积,导致过度治疗。因此维持化疗在肺     

老年晚期非小细胞肺癌化疗进展

老年肺癌的发病率逐年上升,多数医生对老年患者采用化疗并不积极,使许多身体状态尚好的老年患者丧失了延长生命的机会.现综述近年来应用于老年非小细胞肺癌患者的单药以及联合化疗方案.     

Advances in our understanding of postoperative adjuvant chemotherapy in resectable non-small-cell lung cancer

PURPOSE OF REVIEW: After publication in 1995 of a meta-analysis of adjuvant chemotherapy in the treatment of NSCLC, a number of randomized trials investigated adjuvant chemotherapy using more active chemotherapeutic regimens and larger numbers of accrued patients per trial. This review will focus on recent clinical trials for adjuvant chemotherapy, and will help to interpret the applicability of these results to daily clinical practice. RECENT FINDINGS: Four large-scale randomized trials that used platinum-based chemotherapy have reported positive results during the last 3 years. These trials included cisplatin-based chemotherapy [the International Adjuvant Lung Cancer (IALT) trial], cisplatin plus vinorelbine [the National Cancer Institute of Canada (NCIC) BR10 trial], and carboplatin plus paclitaxel [the Cancer and Leukemia Group B (CALGB) 9633 trial]. More recently, another adjuvant trial [Adjuvant Navelbine International Trialist Association (ANITA)] was reported, which has added greatly to our understanding of the potential role of adjuvant treatment. Regarding adjuvant UFT (tegafur and uracil) chemotherapy, an individual patient data-based meta-analysis demonstrated its significant effect on survival in selected patients with completely resected non-small-cell lung cancer. SUMMARY: Recent trials indicate a survival benefit of postoperative adjuvant chemotherapy. These findings are anticipated to change the clinical management of patients with completely resectable non-small-cell lung cancer.     

Advances in platinum cancer chemotherapy

In the past 4 years substantial progress has been made in the development of platinum cancer chemotherapy. A number of drug candidates have undergone clinical trials and one second generation platinum drug, carboplatin, has been approved for use in the treatment of ovarian and small cell lung cancer. This review covers the major developments since the last international conference on Platinum Chemotherapy in Vermont, and attempts to highlight the primary factors that appear to be influencing the synthesis and screening of potential third generation platinum drugs.A predominant feature in the evaluation of analogues has been the emphasis on chelating diamine complexes, in particular those of diaminocyclohexane, which show activity in L1210 tumours that are resistant to cisplatin, and the use of a wide range of carboxylate ligands as a means of circumventing solubility and toxicity problems inherent in the parent compounds. There has also been an increased effort in studies relating to complexes containing mixed amines and functionalised amines, building on the assumption, which remains valid to date, that two amines are a necessary requirement for anti-tumour activity. Efforts have also been made to address the use of complexes containing biologically active ligands, and the concept of targeting compounds to specific organs and formulating drugs to achieve more specific activity or controlled release of drugs with lower toxicities. These may provide a viable route to drugs that can be administered more easily, for example by an oral route, or show a different spectrum of activity. However, it may prove difficult to adequately characterise these more complex systems.The major problem encountered in evaluating cisplatin analogues, as with other prospective cancer drugs, is finding reproducible anti-tumour screens that are predictive of the behaviour of the drugs in the clinic. Progress is being made in the development of sensitive and resistant human tumour xenograft lines and this area should be monitored with interest, as it may provide a key to the development of a future platinum drug, hopefully with a wider range of activity than either cisplatin or carboplatin. Address for offprints: Johnson Matthey Technology Centre, Blount's Court, Sonning Common, Reading, RG4 9NH, United Kingdom     

Advances in ovarian cancer chemotherapy

Traditionally, surgery and radiation represented the pillars of cancer therapy. In contrast to the European approach, in the United States chemotherapy for ovarian cancer has replaced radiation for a long time. Nevertheless, with the aim being cure of the patient, both approaches result in a sometimes severely diminished quality of life for the woman. With the recognition that aggressiveness in therapy many times did not correlate with improved survival time, paradigms in the treatment of women with reproductive organ cancers have shifted lately. Modern antiproliferative therapy strives for both, maximizing survival time as well as quality of life. New therapeutic concepts as well as an abundance of new drugs await the conclusion of clinical trials to identify their potential role in the advancement of ovarian cancer therapy. This article reviews the most recent literature available on systemic and intraperitoneal chemotherapy of early-stage and advanced epithelial ovarian cancer, high-dose chemotherapy, and biologic and gene therapy. Chemotherapy of germ cell and malignant ovarian stromal tumors is also discussed. Extensive tables provide a comprehensive overview of ongoing clinical trials in the US as well as elsewhere.     

肺癌的化学预防研究进展

肺癌是目前全球癌症死亡的首要原因,已经成为全球共同面对和急需解决的公共卫生问题之一。虽然在多学科治疗以及精准医学理念的指导下,肺癌疗效在不断提高,但远期生存率仍较低,因此,预防其发生意义重大。预防包括生物预防和化学预防,本文就化学预防研究进展进行综述。