热化疗在保肢手术治疗下肢骨肉瘤中的应用

目的 研究术前肢体局部热化疗在手术治疗下肢骨肉瘤中的临床意义。方法 术前一周患肢注入化疗药物然后升温至41．8℃每次60—120rain。一周后行保肢手术治疗。结果 30例下肢骨肉瘤的患者在术前行局部热化疗后疼痛不同程度减轻，术中出血少，易切除并见瘤体缩小有坏死灶。结论 术前热化疗可以减轻患者疼痛，缩小肿瘤体积，有利于手术切除肿瘤，很大程度上保留肢体功能。     

经股动脉药盒导管植入系统治疗晚期恶性肿瘤

目的 探讨应用经皮股动脉穿刺药盒导管植入系统（ＰＣＳ）对晚期恶性肿瘤进行介入治疗的可行性，临床疗效。并发症及其处理。方法 经ＰＣＳ化疗灌注和（或）化疗栓塞治疗５３例晚期恶性肿瘤，其中原发性肝癌２４例，肝转移瘤１３例，胰腺癌２例，胃癌２例，宫颈癌术后复发７例，直脾性癌术后盆腔转移３例，盆腔横纹肌肉瘤１例，左髂骨尤文氏肉瘤１例，每４－６周为一疗程。结果 ５３例患者经ＰＣＳ治疗后生存期５－１８个月，中位     

超选择髂内动脉化疗治疗妇科恶性肿瘤36例分析

目的 应用超选择髂内动脉化疗治疗妇科恶性肿瘤并观察其疗效及副作用。方法 采用Seldinger’s改良法经皮股动脉穿刺行超选择髂内动脉化疗及栓塞治疗妇科晚期恶性肿瘤36例,其中卵巢癌16例、宫颈癌13例、阴道癌3例、子宫内膜癌2例、绒癌及子宫平滑肌肉瘤各1例。共进行48次超选择髂内动脉化疗,其中同时进行双侧超选择髂内动脉栓塞31次、肠系膜下动脉化疗13次、肝固有动脉栓塞2次、卵巢动脉栓塞1次。结果 完全缓解4例,部分缓解23例,无变化5例,进展4例,总有效率75％。其副反应主要为轻度消化道反应及栓塞综合症,无插管并发症。结论 超选择技术直接向及栓塞综合症,无插管并发症。结论 超选择技术直接向肿瘤供血动脉注射化疗药物,局部浓度高,疗效较好,副反应低。术前化疗疗效优于术后贫腔复发者;宫颈癌、子宫内膜癌及阴道癌优于卵巢癌。对卵巢癌如能插入卵巢动脉则疗效显著。     

支气管动脉灌注化疗治疗肺癌42例临床分析

目的探讨经支气管动脉灌注化疗治疗非小细胞肺癌的疗效、安全性和并发症的防治。方法回顾性分析42例行支气管动脉灌注化疗的非小细胞肺癌患者临床治疗经过。经右侧股动脉插管。采用Seldinger技术插管至降主动脉。造影显示支气管动脉。选择靶血管灌注化疗药物。结果完全缓解4例，部分缓解28例。稳定6例，进展4例；总有效率为76．2％。所有病例无严重并发症。结论经支气管动脉灌注化疗是治疗非小细胞肺癌的1种安全、有效的方式。     

维拉帕米联合化疗药物经靶动脉灌注治疗难治性大肠癌36例

 目的　观察常规治疗失败的大肠癌肝脏或盆腔转移肿瘤经靶动脉灌注维拉帕米及化疗药物的临床疗效及患者不良反应。方法　对36例经常规治疗失败的大肠癌肝脏或盆腔转移患者,采用 Seldinger技术,经皮穿刺股动脉选择导管至靶动脉,依次灌注维拉帕米15 mg、抗肿瘤药物、维拉帕米10 mg。介入治疗2个疗程后判断疗效。结果　2个疗程后36例大肠癌肝脏或盆腔转移患者的有效率（CR+PR）58.3 %,Karnofsky评分临床受益阳性91.7 %,体重临床受益阳性83.3 %,止痛药用量临床受益阳性80.6 %。所有患者未出现与心脏相关的不良反应,相关的化疗不良反应较静脉化疗轻。结论　维拉帕米联合化疗药物经靶动脉灌注,对常规治疗失败的大肠癌患者安全、有效。     

放射介入动脉灌注、栓塞治疗妇科恶性肿瘤

目的　探讨妇科恶性肿瘤治疗的新方法及其治疗效果。方法　对 13例妇科晚期恶性肿瘤行股动脉穿刺插管至双侧髂内动脉处 ,或超选择插至肿瘤供血动脉 ,经导管动脉内灌注化疗 ,然后用明胶海绵栓塞 ,使化疗药物直接作用于肿瘤 ,并阻断其血液供应。结果　 13例均插管成功 ,顺利进行灌注化疗及栓塞 ,9例进行了超选择插管。术后观察临床症状均不同程度得到了改善 ,经复查肿瘤明显缩小。结论　通过放射介入对肿瘤供血动脉进行超选择插管灌注化疗及栓塞 ,对晚期妇科恶性肿瘤 ,尤其是难以手术或术后复发者进行此项治疗 ,能更加直接地作用于肿瘤部位 ,杀灭肿瘤细胞 ,使肿瘤缺血、坏死、缩小 ,效果明显。     

肉瘤及癌性溃疡的术前化疗泵化疗

目的 观察四肢软组织肉瘤及鳞癌性溃疡术前行皮下埋植式动脉化疗的疗效.方法 自2003年7月至2007年11月治疗肉瘤及鳞癌性溃疡患者21例,男11例,女10例.年龄14～83岁,平均50岁.上肢6例,下肢15例.其中鳞癌6例,滑膜肉瘤4例,恶性纤维组织细胞瘤3例,脂肪肉瘤2例,骨肉瘤2例,恶性黑色素瘤2例,上皮样肉瘤1例,皮肤隆突性纤维肉瘤1例.癌性溃疡主要症状为疼痛、感染和出血;术前经化疗泵给予表阿霉素和顺铂,鳞癌加用博莱霉素,恶性黑色瘤加用氮烯咪胺,2～3周期后观察疗效.结果 疼痛缓解总有效率(RR)为86.0%;溃疡愈合总有效率(RR)为71.0%;3例溃疡出血患者有明显止血效果;化疗后行手术13例,保留肢体手术11例,截肢手术2例.结论 对于难治性肉瘤及癌性溃疡可采用皮下埋置式导向化疗,提高肿瘤区域的化疗药物浓度,有效控制肿瘤破溃所产生的疼痛、感染及出血症状,为手术创造了低血供及清晰的外科边界,减少复发率.     

38例子宫内膜间质肉瘤的诊断和治疗

:[目的]研究子宫内膜间质肉瘤的诊断和治疗方法。[方法]对38例子宫内膜间质肉瘤进行回顾性分析 ,其中Ⅰ期13例 ,Ⅱ期14例 ,Ⅲ期7例 ,Ⅳ期4例 ,38例均经手术治疗。10例术后补充放疗 ,11例补充化疗 ,7例补充放疗加化疗。[结果]本组病例总的3年及5年生存率分别为54 3 %(19/35)及45 5%(15/33) ,Ⅰ期病例3年及5年生存率分别为76 9 %(10/13)及61 5%(8/13) ,Ⅱ期为50.0 %(7/14)及46 2 %(6/13)。[结论]子宫内膜间质肉瘤的预后和组织类型、临床分期、治疗方法密切有关 ,综合运用手术、放疗、化疗及孕激素治疗能减少阴道及盆腔复发 ,提高生存率。     

盆腔动脉灌注化疗及栓塞治疗晚期及复发性膀胱癌

[目的]探讨髂内动脉灌注化疗及栓塞在晚期及复发性膀胱癌中的治疗作用。[方法]对22例晚期及复发性膀胱癌采用Seldinger技术经一侧股动脉入路向两侧髂内动脉灌注化疗药物并进行栓塞。疗效按全国肿瘤化疗会议制定的统一标准判断。[结果]全部病例总的临床有效率(完全缓解 部分缓解)为68％，所有临床症状均得到明显缓解，未出现严重并发症。[结论]对于晚期膀胱癌及复发性膀胱癌，进行两侧髂内动脉灌注化疗及栓塞近期疗效明确。     

经皮股动脉穿刺胃左动脉插管药物灌注治疗晚期贲门癌的初步观察

本文报告经皮股动脉穿刺选择性胃左动脉插管药物灌注治疗晚期贲门腺癌10例,以同期经周围静脉化疗的晚期贲门腺癌16例为对照,灌注或化疗药物均为5-氟脲嘧啶 丝裂霉素。结果表明胃左动脉灌注者全身反应小,能缓解吞咽困难症状,可使个别病人肿瘤缩小,提高手术切除率。故认为经皮股动脉穿刺胃左动脉插管灌注化疗是治疗晚期贲门癌的可行方法之一。     

Outcome of radiation-related osteosarcoma after treatment of childhood and adolescent cancer: a study of 23 cases.

PURPOSE: We analyzed the clinical features and outcome of patients with radiation-associated osteosarcoma treated during the era of contemporary chemotherapy. PATIENTS AND METHODS: The characteristics and outcome of 23 patients (17 males and six females) treated during childhood or adolescence for a solid tumor who later developed osteosarcomas within the radiation field between 1981 and 1996 were reviewed. RESULTS: The median dose of radiation delivered to the first cancer was 47 Gy. Nineteen patients also received chemotherapy. The median time between radiotherapy and the diagnosis of secondary osteosarcoma was 8 years. Histologic slide review showed conventional central osteosarcoma with various differentiation patterns in 21 cases, together with one case of high-grade surface osteosarcoma and one of periosteal osteosarcoma. The sites of involvement were the craniofacial bones in six cases, the first cervical vertebra in one, the girdle bones in seven, and the extremities of long bones in nine. Three patients had metastatic disease at the diagnosis of osteosarcoma. Palliative therapy was administered to seven patients. The aim of treatment was curative for 16 patients, two of whom underwent amputation without further therapy. Intensive chemotherapy regimens were administered to 14 patients before and/or after surgery. Fifteen patients achieved complete surgical remission. Twelve patients were alive and disease-free at a median follow-up duration of 7.5 years. Overall and event-free survivals at 8 years were 50% and 41%, respectively. CONCLUSION: Patients with radiation-related osteosarcoma and resectable lesions can be cured with surgery and intensive preoperative and postoperative chemotherapy.     

Periosteal osteosarcoma

An analysis of 6 patients with periosteal osteosarcoma treated by the authors along with a review of 55 patients reported in the literature demonstrates that periosteal osteosarcoma is distinctly different from conventional osteosarcoma or periosteal chondrosarcoma. Periosteal osteosarcoma is a less aggressive tumor than conventional osteosarcoma. It is a relatively well-differentiated chondroblastic osteosarcoma occurring on the surface of the long bones of the extremities. Three patients demonstrated frank medullary invasion of tumor, two grossly and one microsurgically. Patients treated with marginal resection had a 70% local recurrence rate. Patients receiving wide resection or primary amputation have survived longer with less recurrence of disease. Overall, 10 of 61 patients are dead with metastatic disease with a mean reported follow-up of 6 years and 7 months. Adjunctive therapy has been of no demonstrable aid in terms of prolonging survival. Medullary extension of this tumor should not be used to exclude this diagnosis. The authors believe that the treatment of choice is wide resection without adjunctive chemotherapy.     

Osteosarcoma arising in Paget's disease of the mandible

Although osteosarcoma is a well-known complication of Paget's disease of bone, it uncommonly develops in the jaw bones. We present an osteosarcoma arising in Paget's disease of the mandible with unique features of a normal serum alkaline phosphatase level, and histologic features of telangiectatic change in the osteosarcoma and association with cemento-osseous dysplasia. Sixteen reported cases of osteosarcoma arising in Paget's disease of the jaw bones (OPJ) are also reviewed and compared to osteosarcoma arising in Paget's disease occurring in the entire skeleton (OPS) and osteosarcoma arising de novo in the jaw bones (OJ). Females are more commonly involved in OPJ in contrast to a male predominance in OPS and OJ. OPJ also has a distinctively higher percentage involving blacks compared to OPS. The prognosis of OPJ is poor, with 69% of patients dying within two years after diagnosis. Early recognition, early and aggressive treatment are important to improve the prognosis and are hence emphasized.     

TECIA法体外药敏试验对骨与软组织肿瘤的检测结果

目的 探讨组织块培养-终点染色-计算机图像分析法(TECIA)药物敏感性试验在骨与软组织肿瘤个体化化疗中的应用价值.方法 采用TECIA法对70例骨与软组织肿瘤组织标本进行体外组织块培养,用常用化疗药物进行药物敏感性试验.结果 70例骨与软组织肿瘤中,阿霉素的抑制率最高,为47.70%;17例骨肉瘤中,表阿霉素抑制率最高,为53.79%;软组织肉瘤20例中,异环磷酰胺的抑制率最高,为53.48%;其他骨与软组织肿瘤33例,阿霉素的抑制率最高,为48.21%.结论 TECIA法药敏试验可能是实现骨与软组织肿瘤个体化化疗的有效方法.     

Osteosarcoma arising from a multiple exostoses lesion: case report

A case of osteosarcoma arising from a multiple exostoses lesion is presented. Poorly differentiated osteosarcoma occurred in a twelve-year-old girl's proximal tibia where an exostosis was confirmed from radiographs. We treated this patient with preoperative chemotherapy, thigh amputation and postoperative chemotherapy, but she died of multiple pulmonary metastases seven months after surgery. The osteosarcoma, complicated by multiple exostoses, had a very poor prognosis because it was resistant to various anticancer agents.     

De novo osteogenic sarcoma of mastoid bone

The most common primary malignant tumor of the bone is osteosarcoma. Primary involvement of the craniofacial bones in osteosarcoma is relatively rare. The mandible and the maxillae are the most commonly affected bones of the head. Here, we report a rare case of de novo high-grade osteogenic sarcoma of the mastoid region of the temporal bone and discuss thediagnostic and therapeutic properties.     

Long-term outcome after polychemotherapy and intensive local radiation therapy of high-grade osteosarcoma

BackgroundCurrent standard therapy for high-grade osteosarcoma is neoadjuvant chemotherapy and complete resection of the primary tumour. Irradiation can improve local control if complete tumour resection is not possible or refused, but data on long-term outcome are not available.Patients and methodsWe report on long-term results for overall survival, occurrence of local recurrence and metastasis, joint function and side-effects in 13 patients with high-grade osteosarcoma having been treated with a combination of local irradiation and polychemotherapy (median follow-up of 13.5 years).ResultsTen of the 13 patients were alive 4–23 years after diagnosis. Three patients suffered local recurrence, in 2 of them tumour control and long-term survival could be achieved by secondary salvage surgery and polychemotherapy. In 5 patients pathological fractures of the irradiated bones occurred, none of them was associated with local recurrence. In 7 of the 10 long-term survivors good or fair joint function was achieved.ConclusionsWe conclude that combination of chemotherapy and intensive local irradiation can achieve long-term local control and even cure in high-grade osteosarcoma. Thus radiation therapy may represent an alternative to definite surgery in selected patients, in particular in those with good response to chemotherapy, when surgery is not feasible or refused.