伊立替康或奥沙利铂联合氟尿嘧啶及亚叶酸钙治疗晚期大肠癌

 目的　观察并比较伊立替康联合5-氟尿嘧啶（5-Fu）及亚叶酸钙（CF）与奥沙利铂（L-OHP）联合5-Fu+CF治疗晚期大肠癌的疗效及患者不良反应。方法　随机将晚期大肠癌患者分为两组：伊立替康联合5-Fu+CF组（A组）24例，L-OHP联合5-Fu+CF（B组）25例。每例患者至少完成2个周期以上的化疗。结果　A组：有效（CR+PR）率33.3 %，中位缓解期5.0个月，中位生存期12.4个月。B组：有效率40.0 %，中位缓解期5.3个月，中位生存期14.4个月。A组的延迟性腹泻的发生率为32.0 %， B组周围神经毒性发生率为64.0 %；其他不良反应为骨髓抑制和恶心、呕吐等，两组发生率相近。 结论　伊立替康联合5-Fu+CF与L-OHP联合5-Fu+CF两方案治疗晚期大肠癌疗效相当，患者不良反应均可耐受。     

草酸铂联合氟尿嘧啶和亚叶酸钙治疗晚期大肠癌的疗效观察

目的:观察草酸铂(LOHP)联合氟尿嘧啶(5-Fu)和亚叶酸钙(CF)治疗晚期大肠癌的疗效及不良反应。方法:59例晚期大肠癌患者,随机分为两组,分别采用LOHP CF 5-Fu方案及CF 5-Fu方案,化疗两个周期以上,评价其疗效及毒性。结果:LOHP CF 5-Fu组总有效率为43.3%,明显高于CF 5-Fu组(17.2%,P<0.05)。主要副反应为骨髓抑制,恶心、呕吐和外周神经感觉异常。结论:草酸铂联合氟尿嘧啶和亚叶酸钙是治疗晚期大肠癌有效且毒性较小的化疗方案。     

奥沙利铂、紫杉醇分别联合5-氟脲嘧啶或亚叶酸钙治疗晚期胃癌的临床对照研究

目的比较奥沙利铂、紫杉醇分别联合5-氟脲嘧啶/亚叶酸钙组成的两组联合化疗方案治疗晚期胃癌的疗效与不良反应。方法84例患者分为A、B两组。A组43例，采用奥沙利铂联合5-氟脲嘧啶或亚叶酸钙治疗，B组41例，采用紫杉醇联合5-氟尿嘧啶或亚叶酸钙治疗。两组方案均以21天为1个周期，化疗至少2个周期。结果A组患者有效率、中位肿瘤进展时间、中位生存期、1年生存率分别是51.2%、5.9个月、9.3个月、28.1%，B组则分别是46.3%、6.1个月、9.1个月、26.5%。两组有效率与生存期比较无显著性差异（P〉0.05）。两组主要毒副反应为骨髓抑制，恶心呕吐，但不严重。结论奥沙利铂、紫杉醇分别联合5-氟脲嘧啶或亚叶酸钙治疗晚期胃癌，有较好疗效，且疗效相似，毒副反应均可耐受。     

奥沙利铂联合亚叶酸钙及5-氟尿嘧啶治疗晚期大肠癌的临床观察

目的观察奥沙利铂(L-OHP)联合亚叶酸钙(CF)及5-氟尿嘧啶(5-Fu)治疗晚期大肠癌的疗效及不良反应。方法将我院2002年10月~2005年10月收治的65例晚期大肠癌,随机分为A组和B组,A组奥沙利铂130mg/m2静脉滴注2小时,第1天;亚叶酸钙200mg/m2持续静滴24小时,第1~5天;5-氟尿嘧啶500mg/m2持续静滴24小时,第1~5天;每3周重复。B组羟基喜树碱(HCPT)8mg/m2静脉滴注,第1~5天;亚叶酸钙200mg/m2,静脉滴注2小时,第1~5天;5-氟尿嘧啶500mg/m2持续静滴24小时,第1~5天,每3周重复。所有病例均接受2周期化疗。结果A组CR2例,PR12例,SD11例,DD8例,总有效率42.4%,B组CR1例,PR5例,SD16例,PD10例,总有效率18.8%,A组的主要不良反应是周围神经炎及恶心呕吐、骨髓抑制。结论奥沙利铂联合亚叶酸钙及5-氟尿嘧啶疗效优于羟基喜树碱、亚叶酸钙、5-氟尿嘧啶联合化疗,不良反应轻,值得临床推广。     

雷替曲塞联合奥沙利铂化疗治疗晚期大肠癌的临床观察

目的 探讨雷替曲塞联合奥沙利铂化疗治疗晚期大肠癌的疗效,以期为一线化疗方案失败的晚期大肠癌患者提供治疗方案.方法 将48例晚期大肠癌患者随机分为对照组和观察组,对照组进行奥沙利铂联合5-氟尿嘧啶及亚叶酸钙方案化疗,观察组进行雷替曲塞联合奥沙利铂化疗.对2组患者的近期疗效、不良反应发生率进行比较.结果 观察组患者治疗有效率明显高于对照组,白细胞减少、血小板减少、恶心、呕吐等不良反应的发生率明显低于对照组,差异均有统计学意义(P＜0.05).结论 雷替曲塞联合奥沙利铂治疗晚期大肠癌的临床疗效优于奥沙利铂联合5-氟尿嘧啶及亚叶酸钙化疗治疗,且不良反应发生率低.     

多西紫杉醇及氟尿嘧啶辅助化疗治疗BorrmannⅣ型胃癌的临床研究

目的观察多西紫杉醇联合顺铂及氟尿嘧啶/亚叶酸钙（5-Fu/CF）方案新辅助化疗治疗BorrmannⅣ型胃癌的疗效。方法自2002年7月至2004年7月，将55例BorrmannⅣ型胃癌分为两组，新辅助化疗组29例（NCT组），术前给予多西紫杉醇75mg/m^2，第1天，静脉点滴；顺铂30mg/m^2，第1-3天，静脉点滴；5-Fu500mg/m^2，第1-5天，静脉点滴；亚叶酸钙200mg/m^2于5-Fu前30min冲入，每3周为1个周期，共3个周期。术后又给予3个周期化疗。对照组26例（非NCT组），在术后给予6个周期的化疗。观察新辅助化疗后肿瘤原发病灶的缓解情况、手术根治切除率、术后病理缓解率、切缘癌残留以及淋巴结转移情况及毒性反应等。结果29例BorrmannⅣ型胃癌患者经新辅助化疗后，临床有效率RR（CR＋PR）为58.6%，病理缓解率为6.8%，临床表现为原发肿瘤缩小，淋巴转移减少，降低了临床分期，同对照组比，提高了手术根治切除率，并降低术后切缘癌残留率，延长了患者生存期。毒性反应轻，无严重感染和死亡病例。结论采用多西紫杉醇联合顺铂及氟尿嘧啶/亚叶酸钙（5-Fu/CF）的方案进行BorrmannⅣ型胃癌的新辅助化疗，疗效显著，患者耐受性良好。     

奥沙利铂辅助治疗大肠癌疗效观察

奥沙利铂(Oxaliplatin)系第三代铂类抗癌药，化学名为左旋反式二氨环已烷草酸铂，据报道对大肠癌有较好的疗效，我科对25例大肠癌术后患者使用国产奥沙利铂联合5-氟尿嘧啶(5-Fu)与甲酰四氢叶酸(CF)行辅助化疗，并与25例同期采用顺铂联合5-氟尿嘧啶与甲酰四氢呈酸治疗的大扬癌术后患者进行对比观察，以期进一步了解奥沙利铂对大肠癌的疗效。     

奥沙利铂联合5-Fu/LV治疗晚期大肠癌的临床观察

大肠癌是人类常见的恶性肿瘤之一,近几年在我国特别是大城市发病率有上升的趋势.其发生侵袭转移是患者死亡的主要原因,大肠癌化疗疗效不显著,5-Fu/LV为治疗大肠癌的标准方案,有效率可达28%(1),但对于治疗后出现复发、转移者,重复使用疗效不理想.奥沙利铂是继顺铂、卡铂类化合物后的第3代铂类抗癌药,与5-Fu/LV有协同作用.我们用奥沙利铂联合5-Fu/LV(5-氟脲嘧啶/甲酰四氢叶酸)治疗复发的晚期大肠癌患者28例,这些患者均为经含5-Fu/LV联合方案化疗后复发、转移者.     

奥沙利铂在治疗晚期胃肠道肿瘤中的应用

目的 观察奥沙利铂联合氟尿嘧啶亚叶酸钙治疗晚期胃肠道肿瘤的疗效、不良反应及探索合适的给药方式.方法将30例胃癌病例、33例结肠癌病例、32例直肠癌病例随机分为氟尿嘧啶亚叶酸钙联合顺铂组(对照组)、氟尿嘧啶亚叶酸钙联合单次大剂量奥沙利铂治疗组(处理组1)及氟尿嘧啶亚叶酸钙联合分次小剂量奥沙利铂治疗组(处理组2).各组中,化疗药物用法分别为:对照组:CF 100 mg/m2d1～5,5-Fu 350 mg/m2d1～5,DDP 25 mg/m2d1～3;处理组1:CF 100 mg/m2d1～5,5-Fu 350 mg/m2d1～5,L-OHP 100 mg/m2d1;处理组2:CF 100 mg/m2d1～5,5-Fu 350 mg/m2d1～5,L-OHP 35 mg/m2d1～4,均21天重复,使用4～6周期后评价疗效及不良反应.结果奥沙利铂联合氟尿嘧啶亚叶酸钙治疗晚期胃癌、结肠癌、直肠癌的有效率分别可达40%±、55%±、50%±.奥沙利铂分次给药较单次给药的疗效相同但毒副作用明显降低.结论奥沙利铂分次给药联合氟尿嘧啶亚叶酸钙是治疗晚期胃肠道肿瘤的毒性小、有效率高的方案.     

奥沙利铂联合亚叶酸钙和氟尿嘧啶治疗大肠癌肝转移40例近期疗效观察

目的观察奥沙利铂联合亚叶酸钙和氟尿嘧啶治疗大肠癌肝转移患者的近期疗效及不良反应。方法对40例患者应用奥沙利铂 亚叶酸钙 氟尿嘧啶联合治疗2周期,评价疗效。结果有效率(CR PR)37.5%,不良反应少,外周神经毒性可以耐受且可逆。结论奥沙利铂联合亚叶酸钙和氟尿嘧啶是一种安全、有效的治疗晚期大肠癌的药物。     

全身热疗联合奥沙利铂方案治疗晚期结直肠癌

[目的]评价全身热疗(whole body hyperthermia,WBH)联合奥沙利铂、氟尿嘧啶(5-Fu)、醛氢叶酸(CF)治疗晚期结直肠癌的近期疗效和不良反应.[方法]实验组22例既往单纯化疗方案治疗效果不佳的晚期结直肠癌患者采用全身热疗联合奥沙利铂、5-Fu、CF进行治疗1周期后,再采用奥沙利铂联合5-Fu、CF化疗1周期;对照组27例为同时期就诊患者中随机抽取的未经治疗的晚期结直肠癌患者,采用奥沙利铂联合5-Fu和CF化疗2周期.3周为一个周期,完成2周期化疗后4周评价疗效.[结果]实验组有效率为63.6%,对照组有效率为33.3%;常见毒副反应为胃肠道反应、神经毒性及白细胞减少,但均较轻微.[结论]WBH联合奥沙利铂、5-Fu、CF治疗晚期结直肠癌具有显著的治疗效果,并且毒性可耐受.     

Colorectal cancer

Recent advances in chemotherapy and chemoradiation therapy for colorectal cancer have made neoadjuvant treatment an eligible therapeutic option for selected cases of marginally resectable colorectal cancer. However, marginally resectable colorectal cancer is not well defined. The authors suggest that a primary lesion is marginally resectable if extended resection such as pelvic exenteration and pancreaticoduedenectomy are not completely curative. Even if the lesion itself is resectable, it is marginally resectable if it has unfavorable prognostic factors such as numerous metastases to the regional lymph nodes. Rectal cancer invading beyond mesorectal fascia, or having bilateral or multiple lateral lymph node metastasis, may also be marginally resectable. All locally recurrent lesions may be marginally resectable because the prognosis after surgical resection is poor. Multiple liver metastases, liver metastasis for which resection requires vascular reconstruction, and technically resectable liver metastasis with unfavorable prognostic factors, are also thought to be marginally resectable. Neoadjuvant chemotherapy regimens including oxaliplatin and irinotecan combined with bevacizumab, cetuximab and panitumumab may be effective for hastening the curability of such marginally resectable tumors. For primary advanced rectal cancer and locally recurrent rectal cancer, neoadjuvant radiation combined with chemotherapy using oxaliplatin and irinotecan are being explored. A number of clinical trials are currently ongoing, and are expected to clarify the effectiveness of neoajuvant treatment for marginally resectable colorectal cancer.     

草酸铂和伊立替康、氟尿嘧啶联合方案治疗晚期肠癌

目的 :总结探讨草酸铂和伊立替康、氟尿嘧啶联合方案治疗晚期肠癌近期疗效及毒副反应。方法 :2 5例晚期肠癌 ,用草酸铂、伊立替康和氟尿嘧啶 亚叶酸联合方案静脉应用或动脉介入 静脉用药 ,治疗两周期评价疗效及相关症状改善 (DRSI)及毒副反应。结果 :经治疗动脉介入 静脉用药组 15例 ,CR 1例 ,PR 9例 ,有效率 6 6 .6 %。静脉用药组 10例 ,PR 4例 ,有效率 4 0 .0 % ,两组疗效无显著差异 (P >0 .0 5 )。总有效率为 5 6 .0 %。 18例相关症状改善 ,毒副反应可耐受 ,未见严重不可逆反应。结论 :草酸铂和伊立替康和氟尿嘧啶联合方案治疗晚期肠癌复发或转移患者 ,疗效明确 ,安全有效 ,毒副作用小 ,无叠加毒性 ,可明显改善患者症状 ,提高生存质量。     

Outcome following sentinel lymph node biopsy-guided decisions in breast cancer patients with conversion from positive to negative axillary lymph nodes after neoadjuvant chemotherapy

Purpose

Many breast cancer patients with positive axillary lymph nodes achieve complete node remission after neoadjuvant chemotherapy. The usefulness of sentinel lymph node biopsy in this situation is uncertain. This study evaluated the outcomes of sentinel biopsy-guided decisions in patients who had conversion of axillary nodes from clinically positive to negative following neoadjuvant chemotherapy.

Methods

We reviewed the records of 1247 patients from five hospitals in Korea who had breast cancer with clinically axillary lymph node-positive status and negative conversion after neoadjuvant chemotherapy, between 2005 and 2012. Patients who underwent axillary operations with sentinel biopsy-guided decisions (Group A) were compared with patients who underwent complete axillary lymph node dissection without sentinel lymph node biopsy (Group B). Axillary node recurrence and distant recurrence-free survival were compared.

Results

There were 428 cases in Group A and 819 in Group B. Kaplan–Meier analysis showed that recurrence-free survivals were not significantly different between Groups A and B (4-year axillary recurrence-free survival: 97.8 vs. 99.0%; p = 0.148). Multivariate analysis also indicated the two groups had no significant difference in axillary and distant recurrence-free survival.

Conclusions

For breast cancer patients who had clinical conversion of axillary lymph nodes from positive to negative following neoadjuvant chemotherapy, sentinel biopsy-guided axillary surgery, and axillary lymph node dissection without sentinel lymph node biopsy had similar rates of recurrence. Thus, sentinel biopsy-guided axillary operation in breast cancer patients who have clinically axillary lymph node positive to negative conversion following neoadjuvant chemotherapy is a useful strategy.

     

18FDG-PET evaluation correlates better than CT with pathological response in a metastatic colon cancer patient treated with bevacizumab-based therapy

Around 20-30% of patients with hepatic metastasis from colorectal cancer can undergo liver resection, but the increased response rate obtained with the addition of monoclonal antibodies to chemotherapy regimens could result in a higher rate of liver surgery. In this report we describe the case of a patient who underwent a liver resection after neoadjuvant treatment with capecitabine, oxaliplatin and bevacizumab and who achieved a complete pathological response of the liver metastasis. A preoperative CT scan demonstrated a partial response to the treatment while 18FDG-PET scan correctly evaluated the complete pathological response in the liver and detected an active interaortocaval lymph node metastasis. New specific studies are required to evaluate the imaging response in metastatic colorectal cancer patients especially after treatment with new, targeted agents.     

乳腺癌新辅助化疗后腋窝淋巴结转移综合预测模型的建立

目的:建立乳腺癌新辅助化疗后淋巴结转移的综合预测模型,评估新辅助化疗后淋巴结转移情况,指导临床手术方案选择。方法:回顾分析2015年1月至2018年12月143例乳腺癌新辅助化疗患者的临床、病理及影像资料,并根据术后淋巴结病理分为转移组与无转移组。采用χ2/t检验对两组指标进行单因素分析;将P<0.05的指标纳入多因素Logistic回归分析。用多因素分析有统计学意义(P<0.05)的指标构建乳腺癌新辅助化疗后淋巴结转移综合预测模型的列线图,并应用受试者工作特征（receiver operation characteristic,ROC)曲线评价此模型的性能。结果:单因素分析表明化疗方案、化疗前淋巴结穿刺病理、术前查体、术前彩超、术前CT/MRI、RECIST分级对腋窝淋巴结转移有预测作用;多因素分析表明,化疗前淋巴结穿刺病理、术前彩超、RECIST分级是新辅助化疗后腋窝淋巴结转移的独立预测因素。乳腺癌新辅助化疗后淋巴结转移的预测模型的曲线下面积为0.785,特异度为85.4%,敏感度为59.8%。结论:乳腺癌新辅助化疗后淋巴结转移的综合预测模型对腋窝淋巴结有较好的预测能力,可为选择合适的手术方式提供临床指导。     

Thin-section CT evaluation and pathologic correlation of therapeutic effect of neoadjuvant chemotherapy for axillary lymph nodes of clinically node-positive breast cancer patients

In breast cancer patients, the number of surgically resected metastatic axillary lymph nodes has been considered to correlate closely with patient prognosis. Therefore, if metastatic lymph nodes could be controlled by neoadjuvant chemotherapy pre-operatively, we would be able to select a more appropriate regimen of post-operative chemotherapy for the individual patient and expect prognostic advantages of each patient with node-positive breast cancer. In this study, we aimed to evaluate the therapeutic effect of neoadjuvant chemotherapy for metastatic lymph nodes of node-positive breast cancer patients, using thin-section (5 mm) helical CT (prone-position) with bolus injection of contrast agent. Between April 1994 and March 2002, 49 patients with node-positive breast cancer who had undergone thin-section CT study both before and following neoadjuvant chemotherapy enrolled in the study. The mean age of the patients was 48.9 years and all were female. Concerning metastatic lymph nodes status, 45 patients were classified as N1, 2 patients as N2, and another 2 as N3. In the evaluation, if at least one lymph node of >5 mm in the short diameter was detected on the CT study, the case was classified as node-positive. For lymph nodes of >1 cm in short diameter, fine-needle aspiration biopsy guided by ultrasonography was performed in order to obtain pathological confirmation of the existence of cancer metastasis. The diagnostic results of the CT study were compared with the pathologic findings of the resected specimen operatively. The neoadjuvant chemotherapy consisted of 3 to 4 times of CAF chemotherapy and an anti-estrogen agent, and intra-arterial infusion chemotherapy was also performed in patients with lymph node status of N2 or N3. The axillary status of 15 (30.6%) out of the 49 patients was evaluated as N0 after neoadjuvant chemotherapy, and 14 out of the 15 patients were confirmed as node-negative based on the pathological results. Therefore, the diagnostic accuracy of the second CT study performed following the neoadjuvant chemotherapy was 85.7%, with a sensitivity of 96.6%, a specificity of 70.0%, a positive predictive value of 82.4%, and a negative predictive value of 93.3%. The results described above demonstrate that such a sophisticated and precise CT study performed following neoadjuvant chemotherapy and evaluating the therapeutic effect on metastatic lymph nodes following the neoadjuvant chemotherapy can help to determine an appropriate regimen of post-operative chemotherapy and be of prognostic advantage in patients with node-positive breast cancer.     

Prognostic role of p‐mTOR expression in cancer tissues and metastatic lymph nodes in pT2b gastric cancer

Despite the great interest in mammalian target of rapamycin (mTOR) as a potential anticancer therapy target, the prognostic role of mTOR in gastric cancer has not been elucidated. In this study, we investigated mTOR expression in gastric cancer tissues and in metastatic lymph nodes and examined its association with clinical outcome. A total of 290 patients with pT2b gastric cancer were enrolled in this study. Patients were divided into 3 groups according to metastatic lymph node status: Group 1 contained 96 patients without lymph node metastasis, Group 2 contained 102 patients with a few (1–2) metastatic lymph nodes and Group 3 contained 92 patients with extensive (>16) lymph node metastasis. Phosphorylated mTOR expression was determined immunohistochemically using tissue microarrays. p‐mTOR expression was observed in 36.5% of the gastric cancer tissues in Group 1, 39.2% in Group 2 and 60.9% in Group 3. A significant correlation was found between p‐mTOR expression in gastric cancer tissues and in metastatic lymph nodes. The Borrmann type in Group 1, perineural invasion and p‐mTOR expression in metastatic lymph nodes in Group 2 and p‐mTOR expression in metastatic lymph nodes in Group 3 were found to be independent prognostic factors of disease‐free survival. The 5‐year disease free survival rate of Group 2 patients was 84.4% in negative p‐mTOR and 66.1% in positive p‐mTOR expression in metastatic lymph nodes (p = 0.015). The 5‐year disease free survival rate of Group 3 patients was 37.3% in negative p‐mTOR and 14.9% in positive p‐mTOR expression in metastatic lymph nodes (p = 0.037). There was a linear correlation between the rate of tumor recurrence and mTOR expression scores in metastatic lymph nodes. In pT2b gastric cancer, p‐mTOR expression in gastric cancer is associated with the extent of lymph node metastasis, and p‐mTOR expression in metastatic lymph nodes is correlated with poor disease‐free survival. mTOR may harbor significant potential for a prognostic biomarker and therapeutic target for gastric cancer treatment.