动脉内灌注的新辅助化疗在晚期直肠癌的应用

目的探讨动脉内灌注的新辅助化疗(NACT)对晚期直肠癌的疗效。方法对36例不能切除的晚期直肠癌采用动脉置泵灌注化疗的新辅助化疗,为MFH方案:5-Fu 500 mg/m2,丝裂霉素(MMC)6 mg/m2,拓喜(HCPT)20 mg/m2,每周1次,两周1个疗程,休息4周后重复,共2—3个疗程。结果完全缓解(CR)6例,部分缓解(PR)23例,稳定(MR)7例。有效率(CR+PR)为80.5％,CR 6例全部获得手术切除,PR 23例中手术切除15例。术后病理检查发现癌细胞均有不同程度的核固缩、碎裂、胞浆凝固、变性,细胞间质水肿、纤维增生、炎细胞浸润,血管内膜增厚、血栓形成。结论动脉内灌注的新辅助化疗作为晚期直肠癌综合治疗的一部分,对改善病期,使不可能手术患者变为可能手术,提高手术切除率可以发挥重要作用,并使癌肿组织学形态发生明显改变。     

局部晚期和复发直肠癌放射治疗配合动脉灌注化疗疗效分析

目的探讨动脉灌注化疗提高局部晚期和复发直肠癌放射治疗疗效。方法62例直肠癌随机分为放射治疗配合动脉灌注化疗(综合组)31例,单纯放射治疗(单放组)31例。动脉插管化疗采取经肠系膜下动脉和髂内动脉灌注,每次氟尿嘧啶600mg/m2,顺铂70mg/m2,2～3周重复,共2～3次。放射治疗采用8～18MVX射线照射,总量达DT40～50Gy时争取手术,不能手术者加量至DT60～70Gy。结果综合组有效率为83.9%,单放组有效率为54.8%(P<0.01)。综合组1、3、5年生存率分别为90.3%、68.8%、52.0%,单放组分别为80.7%、50.6%、29.8%(P<0.05),综合组和对照组中位生存时间分别为65个月和39个月。综合组副反应大,但患者均能耐受。结论放射治疗辅以动脉灌注化疗为局部晚期和复发直肠癌有效治疗方法。     

晚期结直肠癌化疗的研究进展

随着细胞毒药物和分子靶点药物的发展,晚期结直肠癌患者姑息化疗的有效率以及生存期取得了瞩目的成效,患者中位生存期可超过2年。本文通过比较单药化疗与联合化疗以及不同联合化疗方案的优劣,分析卡培他滨能否替代5-FU的作用;阐述打打停停(stop-and-go)的化疗观念,介绍贝伐单抗和西妥昔单抗这两种分子靶点药物在晚期结直肠癌患者中的疗效。旨在对这些问题的综述来阐明奥沙利铂或伊立替康联合5-FU/LV优于5-FU/LV单药;FOLFOX或FOLFIRI联合方案均可作为晚期结直肠癌可耐受化疗患者的一线化疗方案,疾病进展后可互换作为二线方案;卡培他滨可代替5-FU/LV与奥沙利铂联合作为晚期结直肠癌患者的一线化疗方案,但卡培他滨与伊立替康联合不是一个理想的方案;在转移性结直肠癌的化疗中不建议完全停止化疗,可考虑使用5-FU/LV单药维持;贝伐单抗和西妥昔单抗这两种分子靶点药物联合化疗均可有效的提高生存期。从而概述晚期结直肠癌化疗的一些新进展。     

经门静脉和肝动脉灌注化疗治疗不可切除的结直肠癌肝转移的临床研究

[目的]探讨不可切除的结直肠癌肝转移患者的治疗方法.[方法] 97例不可切除的结直肠癌肝转移患者分为治疗组47例和对照组50例.对照组结直肠癌切除术后2周开始FOLFOX方案全身化疗.治疗组在结直肠癌切除术中及术后经门静脉和肝动脉化疗泵行5-Fu肝脏局部灌注化疗,全身化疗和其余治疗同对照组.[结果]两组治疗后病灶数目和大小均减小,CEA、CA199均降低,两组差异显著(P＜0.05).治疗组中位生存时间33.7个月,1、3、5年生存率分别为81.2％、42.8％和10.6％,对照组中位生存时间21.8个月,1、3、5年生存率分别为64.0％、19.7％和0,两组差异显著(P＜0.05);两组术后并发症及不良反应发生率无明显差异(P＞0.05).[结论]经门静脉和肝动脉灌注化疗对于不可切除的结直肠癌肝转移瘤是安全有效的,可以延长患者的生存期,改善患者预后.     

结直肠癌根治术后区域动脉灌注化疗的临床观察

目的：探讨大肠癌根治术后介入化疗对癌复发和预后的影响。方法：大肠癌根治术后一个月，根据癌灶位置，经股动脉插管进入肝总动脉、肠系膜上或肠系膜下动脉、髂内动脉，定期灌注抗癌药物。临床应用51例，平均40天进行一次，4-6次为一疗程，观察部复发和生存时间（观察组）。并对大肠癌根治术后49例全身化疗患者进行比较分析（对照组）。结果：观察组1、3、5年复发率为7.8％（4/51）、23.5％（12/51）、33.3％（17/51）；生存率98.0％（50/51）、86.3％（44/51）、72.4％（37/51）。对照组1、3、5年复发率为16.3％（8/49）、38.8％（19/49）、75.5％（37/49）；生存率87.8％（45/49）、63.3％（31/49）、43.0％（21/49）。两组比较差异具有显著性。结论：大肠癌根治术后区域动脉灌注化疗是预防癌复发和改善预后的有效手段。     

局部晚期直肠癌动脉灌注化疗配合同步放射治疗疗效分析

目的探讨动脉灌注化疗提高局部晚期直肠癌放射治疗疗效。方法56例局部晚期直肠癌随机分为动脉灌注化疗配合放射治疗组(综合组)28例,单纯放射治疗组(单放组)28例。动脉灌注化疗采取经肠系膜下动脉和髂内动脉灌注,放射治疗采用60Co照射。结果综合组有效率为85.7%,单放组有效率为57%(P<0.01)。结论放疗辅以动脉灌注化疗为局部晚期直肠癌的有效治疗方法。     

腹腔热灌注化疗治疗结直肠癌腹膜癌

结直肠癌局域性进展可形成腹膜癌，大约10％的患者初诊即发现腹膜癌，有4％～19％的患者在根治术后随访期发生腹膜癌，25％～35％的复发患者以腹膜癌为唯一表现。全身化疗对此类腹膜癌只是姑息性治疗，中位生存期不足6个月。缩瘤术加腹腔热灌注化疗则可清除宏观和微观癌细胞。荷兰癌症中心的Ⅰ、Ⅱ、Ⅲ期临床试验总结分析表明，接受完全缩瘤术加腹腔热灌注化疗者的中位生存期可达42．9个月，1、3、5年生存率分别是95％、56％和43％，明显高于传统治疗方法，已成为英国、法国、意大利、荷兰、西班牙和澳大利亚等国的标准治疗。     

进展期胃癌术中温热灌洗及置泵术后灌注化疗的临床研究

目的探讨进展期胃癌手术切除后腹腔及肝转移的防治方法。方法将282例进展期胃癌切除术后患者分成术中腹腔温热低渗灌洗化疗及术后动脉灌注化疗组169例(简称治疗组)和单纯术后静脉化疗组113例(简称对照组),并对其腹腔转移率、肝转移率及3年生存率进行对照研究。结果治疗组腹腔转移率为21.9%,肝脏转移率12.4%,3年生存率74.6%;对照组腹腔转移率46.0%,肝脏转移率27.4%,3年生存率46.8%。结论术中温热低渗灌洗化疗及术后动脉灌注化疗对进展期胃癌术后腹腔复发和肝转移有良好的防治作用。     

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。     

晚期结直肠癌的化疗进展

手术切除是结直肠癌的根治手段,但术后复发率和转移率高。近年来,随着新药、新方法不断研发和改进,给晚期结直肠癌患者带来新的希望。现综述晚期结直肠癌的化疗进展。     

大肠癌新辅助化疗

新辅助化疗在大肠癌综合治疗中的作用已得到广泛共识,尤其对于进展期、复发和远处转移的大肠癌患者,在降低肿瘤分期,提高手术切除率方面已显示出越来越重要的地位。现综述近年来新辅助化疗在大肠癌中的研究进展。     

Neoadjuvant chemotherapy for colorectal cancer

Surgery continues to play an important role in the curative treatment of gastrointestinal cancer. Recently, considerable progress has been made in chemotherapy and radiotherapy. In particular, chemotherapy with FOLFIRI and FOLFOX has prolonged survival in patients with colorectal cancer. Molecular-targeted agents have also enhanced the effectiveness of chemotherapy. However, radical resection offers the potential for a cure and is unsurpassed by any other treatments. Nonetheless, further improvement in survival is unlikely to be achieved by surgery alone. Studying how treatment regimens highly effective against unresectable or recurrent colorectal cancer can be adapted to patients with resectable disease is thus an important issue.     

An update on hepatic arterial infusion chemotherapy for colorectal cancer

Hepatic metastases are a frequent complication of colorectal cancer (CRC), affecting over half of all CRC patients. Resection of isolated metastases can result in long-term survival, but the majority of patients relapse, and most have unresectable disease. Hepatic arterial infusion (HAI) chemotherapy delivers high concentrations of cytotoxic agents directly to liver metastases with minimal systemic toxicities. Advances in surgical techniques, development of fully implantable pumps, and modification of drug regimens have decreased complications and improved patient tolerability. Randomized trials comparing HAI with systemic chemotherapy have demonstrated superior response rates and times to hepatic progression for unresectable disease, and have shown better times to progression and overall survival rates in the adjuvant setting following hepatic resection. HAI chemotherapy has unique toxicities, including chemical hepatitis and biliary sclerosis, which can be mitigated by the addition of dexamethasone to therapy. In an attempt to prevent extrahepatic progression, combinations of HAI with systemic chemotherapy, including newer agents such as irinotecan and oxaliplatin, are currently being investigated, with promising early results.     

Hepatic arterial infusion chemotherapy for liver metastases from colorectal cancer

After randomized studies of hepatic arterial infusion chemotherapy (HAIC) versus systemic chemotherapy for liver metastases from colorectal cancer in the 1980s, the role of HAIC has been unclear and there is still no evidence to support it as the treatment of choice. The high local control, the differences in techniques between Japan and Western countries, the difficulty of detecting pre-treatment extra-hepatic metastases and the fact that HAIC does not control extra-hepatic lesions are the most important points in considering clinical trials of HAIC. Clinical studies on the combination of HAIC using 5-FU and systemic chemotherapy using CPT-11, and then randomized trial of systemic chemotherapy with/without HAIC is required in Japan to reveal the role of HAIC in the management of liver metastases from colorectal cancer. We should understand the importance of our role in this field.     

Hepatic arterial infusion of chemotherapy for hepatic metastases from colorectal cancer.

BACKGROUND: Sixty percent of colon cancer patients develop liver metastasis. Only 25% of those have potentially resectable hepatic metastases, and approximately 58% of those patients relapse. METHODS: We review the indications and the technical aspects of hepatic artery infusion (HAI) of chemotherapy, as well as the efficacy, morbidity, and outcomes. RESULTS: HAI of chemotherapy has been used following hepatic metastasectomy, in patients with unresectable metastases, or in combination with other agents. Floxuridine, the chemotherapeutic agent most studied, is administered through an implantable subcutaneous infusion pump connected to a surgically placed hepatic artery catheter, which delivers the chemotherapeutic agents at a slow fixed rate. Treatment-related toxicities include chemical hepatitis, biliary sclerosis, and peptic ulceration. Some trials report a survival benefit for HAI over systemic chemotherapy with acceptable toxicity. CONCLUSIONS: Regional perfusion chemotherapy can be logistically and technically complicated to deliver. The development of newer systemic agents with superior efficacy in the treatment of metastatic colorectal cancer will likely diminish the role of regional perfusion therapy in the future.     

Hepatic arterial infusion chemotherapy for colorectal liver metastases

Hepatic metastases are a frequent complication of colorectal cancer. Resection of liver metastases can result in long-term survival. However, the majority of patients have unresectable disease. Alternative methods in Japan for treating these patients are hepatic arterial infusion (HAI) chemotherapy with administration of 1,000 mg/m2 of 5-FU over 5 hours. We summarize the status of HAI chemotherapy in terms of colorectal hepatic metastases today. HAI chemotherapy produced higher response rates compared with systemic chemotherapy, but did not demonstrate elongation of survival time in many trials. Important problems remaining to be solved are the technical aspects of percutaneous implantation of intraarterial catheters connected to a subcutaneous infusion reservoir and studies of combined therapy with systemic chemotherapy. Furthermore, in order to finally determine the position of HAI for colorectal liver metastases, it is necessary to conduct a comparative study versus systemic chemotherapy, using the survival time as the primary end point.     

Hepatic arterial infusion chemotherapy for metastatic colorectal cancer: a concise overview

Patients with colorectal cancer commonly succumb to the sequelae of hepatic metastases. Response to systemic therapy is inadequate. Hepatic arterial infusion (HAI) exposes liver metastases to high local concentrations of drug. Herein, we review the randomized trials of HAI in colorectal cancer. Data for this review were identified by searches of MEDLINE and references from relevant articles using the search terms "infusion intra-arterial" and "colorectal cancer." Abstracts and reports from meetings were included only when they related directly to previously published work. Only papers published in English between 1966 and 2003 were included. Randomized trials (5-fluorouracil- (5-FU-) or fluordeoxyuridine- (FUDR-) based regimens) often demonstrated superior response rates for HAI as compared to systemic chemotherapy (primary treatment or post-resection). Enhanced survival has, however, shown only when HAI was combined with systemic chemotherapy in the post-resection setting. For 5-FU-based and perhaps other regimens, randomized trials of combined regional and systemic therapy versus systemic treatment alone may be needed in order to determine whether or not there is a survival advantage after HAI in unresectable patients, as has been recently demonstrated in resectable patients. A variety of agents other than 5-FU have also been given by HAI to patients with liver metastases from diverse cancers. Such regional therapy often yields encouraging response rates and impact on survival therefore merits investigation.     

Current strategies using hepatic arterial infusion chemotherapy for the treatment of colorectal cancer

In recent years, a number of phase III clinical trials have reported median survival times approaching 20 months using modern combination chemotherapy for metastatic colorectal cancer (CRC). Despite the advances in systemic therapy, this approach is still considered palliative because long-term survival or cure is extremely rare. Surgery or the use of ablative techniques may result in prolonged survival for patients with liver metastases, but only a minority of cases are suitable for local therapy. Hepatic arterial infusion (HAI) therapy involves local delivery of drug to liver metastases, resulting in higher intrahepatic drug levels and a consequent doubling in response rates compared with systemic chemotherapy. Despite higher response rates, demonstrating a survival advantage for HAI has been more challenging. Recently, a number of studies have been published that appear to address some of the inadequacies of earlier trials and have demonstrated encouraging results. This review assimilates the current data on HAI for CRC and includes an assessment of new chemotherapeutic agents delivered via HAI, neoadjuvant HAI, HAI combined with systemic chemotherapy, the use of HAI for early-stage colorectal cancer, and future trials. Continued progress in the field of HAI therapy may reduce the morbidity and mortality associated with CRC, so continued research in this area should be encouraged.     

Complications related to hepatic arterial infusion chemotherapy for liver metastasis from colorectal cancer

We evaluated the complications of hepatic arterial infusion (HAI) chemotherapy in patients (pts) with hepatic metastasis from colorectal cancer. The subjects consisted of 61 pts with hepatic metastasis from colorectal cancer, who were treated by combined chemotherapy with 5-FU and CDDP weekly or continuously. Indwelling route of catheter: 30 via gastroduodenal artery (GDA) at the time of laparotomy ('LP'), 21 via femoral artery (FA) and catheter tip in PHA ('PHA'), 10 via FA and catheter tip is inserted with steel coil into the GDA ('GDA-coil'). Complications resulting in interruption of therapy occurred in 19 pts (31%), and the 'GDA-coil' method had a lower rate of complication than others. There was no difference in the incidence rate of complications between the two chemotherapy regimens. The complications of this therapy were: 8 (13%) cases of hepatic arterial occlusion, 3 (5%) cases of duodenal ulcer, 4 (7%) cases of catheter tip dislocation, 2 (3%) cases of catheter tip dislocation to the duodenal bulb, and 1 (2%) case of liver abscess. Hepatic arterial occlusion occurred frequently in LP. Up to 67% of patients with duodenal ulcer had hepatic arterial occlusion at the same time. All pts with catheter tip dislocation were 'PHA', and all pts with catheter tip dislocation to the duodenal bulb were 'LP'. In conclusion: 1. The best indwelling route for the catheter is by the 'GDA-coil' method. 2. To diagnose complications soon, regular CTA or DSA is necessary.