髂内动脉热灌注治疗中晚期宫颈癌

目的以介入性常温药物灌注为对照,证实髂内动脉内药物热灌注治疗中晚期宫颈癌的临床效果.方法选择16例失去手术机会或术后、放疗后复发的中晚期宫颈癌患者行髂内动脉热灌注治疗,同时设立相同病例常温药物灌注治疗组,在临床症状改善,肿瘤缩小率、生存率、局部复发率方面加以比较.结果经治疗后观察、比较证实,髂内动脉热灌注治疗在临床症状改善、肿块缩率小、生存率、局部复发率方面均优于常温药物灌注组.结论两组疗效对比结果提示,局部动脉内热灌注治疗中晚期宫颈癌是一种方法简便、疗效显著、实用可行的治疗技术.     

Antitumor effects and clinical problems of transcatheter intraarterial infusion for uterine cervical cancer

Several studies have confirmed that neoadjuvant chemotherapy and concurrent chemoradiation improved survival compared with standard therapy for uterine cervical cancer. There have been many reports on the use of transcatheter intraarterial infusion (TAI) with anticancer drugs, but there are no randomized controlled trials in Japan. Our study of transcatheter arterial infusion before operation or radiotherapy for uterine cervical cancer was performed for 49 patients,and the number of patients with stage Ib (bulky tumor>3 cm), II, III, or IVa disease were 15, 18, 11, and 5, respectively. The drugs infused were cisplatin (100 mg/m(2)) or carboplatin (300 mg/m(2)). The median survival time, 2-and 5-year survival rates were 62 months, 81.6%, and 70.6%, respectively. There were no grade 4 acute toxicities. As a late complication, ileus occurred in 8.2%. TAI may improve the prognosis of patients who underwent a radical operation after TAI.     

双侧子宫动脉灌注化疗栓塞术治疗局部晚期宫颈癌的疗效观察

目的探讨双侧子宫动脉灌注化疗栓塞术在宫颈癌患者中的临床效果及对肿瘤标志物的影响。方法选取2015年1月至2019年1月间湖北省武汉市商职医院收治的拟行新辅助化疗的114例局部晚期宫颈癌患者,采用双侧子宫动脉灌注化疗栓塞术治疗的57例患者纳入A组,采用静脉全身化疗的57例患者纳入B组。观察两组患者临床疗效、手术前后肿瘤标志物水平和不良反应发生率。结果 A组患者临床缓解率为77. 2%,高于B组患者的57. 9%,差异有统计学意义(P <0. 05)。A组患者骨髓抑制和胃肠反应发生率均低于B组患者,差异均有统计学意义(均P <0. 05)。两组患者肝功能损害和末梢神经毒性发病率比较,差异无统计学意义(P> 0. 05)。治疗前,两组患者的血清癌胚抗原(CEA)、糖类抗原125(CA125)和鳞状上皮细胞癌抗原(SCC-Ag)比较,差异无统计学意义(P> 0. 05)。治疗后,两组患者CEA、CA125和SCC-Ag水平与治疗前比较均降低,且A组均低于B组,差异均有统计学意义(均P <0. 05)。结论采用双侧子宫动脉灌注化疗栓塞术治疗局部晚期宫颈癌患者,可降低肿瘤标志物水平,提高临床疗效,减少不良反应发生率,值得临床推广应用。     

经导管子宫动脉栓塞术治疗症状性子宫肌瘤的临床应用

目的:探讨经导管子宫动脉栓塞术治疗症状性子宫肌瘤的临床应用价值.方法:33例症状性子宫肌瘤,采用双侧子宫动脉插管造影和栓塞治疗.随访资料完整,并对造影所见、治疗后反应、症状变化和肌瘤大小改变进行总结和分析.结果:造影表现为子宫动脉增粗、扭曲及肿瘤染色;治疗后(6.5±3.0)个月肌瘤由术前(8.7±1.2)cm缩小至(2.1±0.8)cm;贫血病例,血红蛋白由术前(79±13)g/L升至(137±19)g/L,无严重并发症发生.结论:经导管子宫动脉栓塞术对控制症状、缩小肌瘤体积有显著作用,是一种安全、有效的治疗症状性子宫肌瘤的方法.     

Intra-arterial infusion chemotherapy and transcatheter arterial chemo-embolization for patients with simultaneous bilateral breast cancer

We have treated 2 cases of simultaneous bilateral breast cancer by intra-arterial infusion chemotherapy (IA) and transcatheter arterial chemo-embolization (TAC-E), respectively. In the former case treated by I. A., both the treated tumor and the contralateral mass were remarkably regressed and necrotized. However, serious systemic side effects due to the intraarterially infused drug were observed. In the latter case treated by TAC-E, chemo-embolic effects were selectively observed in the treated tumor, and side effects were slight. On the other hand, a non-treated mass showed no changes. From these findings, we concluded that I. A. serves as a semisystemic therapy, and that TAC-E, at least in our subjects, works as a loco-regional cancer chemotherapy.     

经导管子宫动脉栓塞术治疗子宫肌瘤的临床应用

目的探讨经导管子宫动脉栓塞术(TUAE)治疗子宫肌瘤的疗效及安全性。方法对69例子宫肌瘤患者采用Seldinger's技术经导管子宫动脉注射碘海醇-真丝线段或聚乙烯醇-抗生素乳剂行TUAE治疗,随访6~24个月,观察术后临床症状改善情况、肌瘤和子宫变化情况。结果行TUAE治疗后,69例患者临床症状缓解,月经量减少至术前的(56.3±14.4)%,合并继发性贫血的子宫肌瘤患者,血红蛋白由术前的(81.2±17.1)g/l恢复至(112.7±15.3)g/l。治疗后6个月、12个月、18个月、24个月肌瘤体积分别缩小62.7%、82.9%、90.6%、94.0%,子宫体积分别缩小53.2%、65.8%、67.9%、69.0%。结论TUAE是治疗子宫肌瘤的一种新方法,疗效显著、安全性好。     

复发性子宫颈癌调强放射治疗的临床观察

目的探讨调强放射治疗（IMRT）治疗复发性宫颈癌的近期疗效及并发症的发生情况。方法回顾性分析38例盆腔复发和腹膜后淋巴结转移的宫颈癌患者采用IMRT放疗的临床资料,其中复发前接受单纯手术20例、单纯放疗8例、手术后辅助放疗者10例,采用6my—X线5～9野照射,曾经接受放疗的患者给予处方剂量95％PTV50GY,无放疗史患者给予处方剂量95％PTV70GY,分割2GY／次,每周5次,共25～35次完成,放疗后3个月评估疗效,并将曾经接受放疗的患者（18例）与单纯手术患者（20例）进行对比,观察两组患者的近期疗效和放疗并发症的发生情况。结果下肢水肿、腰腿疼痛症状缓解率100％,肾盂积水缓解率75％（9／12）,3个月疗效评估：完全缓解率65．8％（25／38）,部分缓解率13．1％（5／38）,稳定率10．5％（4／38）,进展率10．5％（4／38）,有效率78．9％（30／38）。曾经接受根治性放疗和术后放疗与单纯手术比较有效率分别为61％（11／18）（P=0．016）和95％（19／20）,近期毒副作用主要为骨髓抑制,≥Ⅲ度31．6％（12／38）,胃肠道和泌尿系反应均为I～Ⅱ度。结论IMRT放疗治疗复发性宫颈癌,能很好地缓解症状,近期疗效高,对于复发性宫颈癌IMRT放疗是一种有效的方法。     

子宫动脉化疗栓塞与髂内动脉灌注化疗在局部晚期宫颈癌综合治疗中的疗效对比

背景与目的：子宫动脉化疗栓塞与髂内动脉灌注化疗是临床治疗宫颈癌的重要方法．两者疗效有无差异尚无定论。本研究比较子宫动脉化疗栓塞和髂内动脉灌注化疗在局部晚期宫颈癌综合治疗中的疗效。方法：将1997年4月至2007年11月间收治的175例局部晚期宫颈癌患者分为两组。子宫动脉化疗栓塞组92例,双侧子宫动脉插管注药后行双侧子宫动脉栓塞,65例行子宫颈癌根治术,其中37例术前采用^192Ir高剂量率腔内后装放疗。髂内动脉灌注化疗组83例,采用双侧髂内动脉插管注药,70例行子宫颈癌根治术,其中34例术前采用同样的腔内后装放疗。两组化疗方案均为以铂类为主的联合方案。根据术后病理结果,对51例有病理危险因素的患者加用外放射治疗。结果：子宫动脉化疗栓塞组总有效率为64．1％,明显高于髂内动脉灌注化疗组（47．0％,P=0．023）。子宫动脉化疗栓塞组IB期患者的肿瘤缩小有效率（77．8％）明显高于髂内动脉灌注化疗组（41．2％,P=0．037）,两组Ⅱ、Ⅲ期患者的总有效率差异无统计学意义（P=0．137和P=0．524）。术后病理结果显示,子宫动脉化疗栓塞组癌细胞阴性率、盆腔淋巴结转移阴性率、无复发率均略高于髂内动脉灌注化疗组,但差异无统计学意义（P〉0．05）;而脉管癌栓阴性率略低于髂内动脉灌注化疗组（P=0．072）。子宫动脉化疗栓塞组1、3、5年总生存率与髂内动脉灌注化疗组相比差异无统计学意义（P=0．665）。结论：子宫动脉化疗栓塞联合术前放疗可有效缩小局部晚期宫颈癌的肿瘤体积,但不能增加病理完全缓解率、不能减少淋巴结转移和术后复发,控制脉管癌栓略差于髂内动脉灌注化疗,对远期生存率尚未显示出优势,有待进一步长期随访。     

子宫动脉灌注新辅助化疗在Ⅱ期子宫颈癌临床治疗中的应用

目的探讨针对Ⅱ期子宫颈癌患者采用子宫动脉灌注新辅助化疗的临床应用效果。方法选取本院2010年7月至2012年7月收治的63例Ⅱ期子宫颈癌患者作为研究组,所有患者均在手术与放疗前给予子宫动脉灌注新辅助化疗,同期选择仅行常规手术的50例患者作为对照组,观察两组患者的预后效果,并综合比较研究组中Ⅱa期与Ⅱb期病例的治疗效果。结果研究组患者治疗后总有效率为68．3％,对照组总有效率为48．0％,组间比较具有统计学意义（P〈0．05）,但研究组中Ⅱa期与Ⅱb期病例的治疗结果比较无统计学意义（P〉0．05）。两组患者的深部间质浸润率比较存在统计学意义（P〈0．05）,但Ⅱa期与Ⅱb期患者的预后影响因素比较无统计学意义（P〉0．05）。化疗后毒副反应较为轻微,未对持续治疗产生影响。结论针对Ⅱ期子宫颈癌患者采用子宫动脉灌注新辅助化疗能够提高临床治疗效果,保证手术实施的可行性,提高肿瘤组织清除率。     

132例原发性肝癌灌注化疗及栓塞治疗疗效观察

目的 探讨影响肝动脉灌注化疗＋栓塞治疗疗效的因素。方法 １９９３年１月￣１９９７年１０月,对１３２例不能切除的原发性肝癌行选择性插管灌注化疗及栓塞治疗５９７次,肝动脉灌注化疗＋栓塞者１２２例,单纯灌注化疗１０例。结果 １,２,３年生存率分别为８１．８％、３６．４％和１８．２％,疗效较治疗初期有显著提高。肿瘤分期、栓塞剂及其用量、侧支循环的形成以及肝动脉超选择性插管是影响疗效的主要因素。结论 合理施     

A devised method of hepatic and splenic arterial infusion chemotherapy after transcatheter peripancreatic arterial embolization for patients with advanced pancreatic cancer

We previously reported the clinical efficacy based on hepatic and splenic arterial infusion chemotherapy (HSAIC) for patients with advanced pancreatic cancer after transcatheter peripancreatic arterial embolization (TPPAE). However, this medical treatment pointed out a few problems in which the method had its complexity and a limited use of embolus micro-coil numbers. Then, we tried to improve the method in solving those problems. In order to reduce the embolus micro-coil numbers for TPPAE, we divided the micro-coil into several parts. We also devised the method of HSAIC. We used one catheter with a side hole, so that the catheter was able to supply a therapeutic drug for arterial infusion chemotherapy, both to the common hepatic artery and splenic artery. The effective rate for eleven cases was 72.7%, and there were no significant differences from the cases treated with the conventional method of TPPAE-HSAIC. Therefore, the devised treatment was considered to be an easy and useful method for TPPAE and HSAIC.     

微导管超选择化疗栓塞治疗肝癌的临床研究

目的评估微导管超选择化疗栓塞在原发性肝癌(hepatocellular carcinoma,HCC)治疗中的价值。方法回顾分析2010年1月至2011年3月收治的行普通选择性化疗栓塞和微导管超选择性化疗栓塞的141例HCC患者的临床资料,比较两组的疗效及不良反应的发生情况。结果微导管栓塞组提高了插管成功率(P<0.05),减轻了化疗栓塞不良反应及肝功能损害(P<0.05),患者的6个月、1年带瘤生存率明显提高(P<0.05)。结论微导管超选择性化疗栓塞术优势显著,有望替代经普通导管肝内动脉化疗栓塞术,是肝癌综合治疗中不可缺少的治疗手段。     

Therapeutic results of the internal iliac arterial chemotherapy in uterine cervical and endometrial cancers

As the treatment of inoperable, radioresistant or recurrent cases of uterine cancer (cervical or endometrial) whose lesions were restricted to the pelvis, internal iliac arterial chemotherapy was carried out and its therapeutic results were evaluated. Thirty three cases including 22 primary and 11 recurrent ones were dealt with this study. Among 33 cases, catheter was introduced to the internal iliac artery via superior gluteal artery in 9, inferior gluteal artery in 22 and lateral umbilical artery in 2 cases. Oncostatics, including mainly cisplatin, adriamycin and pepleomycin, were administered via artery daily or once or three times a week with indwelling of the catheter as long as 7 months in average. Eight patients out of 33 were living with average survival time of 18.2 months following the initiation of intra-arterial chemotherapy. Among 27 cases whose therapeutic effects were evaluable histologically, tumor cells had disappeared as long as at least 4 months in 23, within 4 months in 3 cases and tumor cells continued to be present in one case. In 22 primary cases, 3 were living without evidence of disease, one was living with disease and remaining 18 cases were dead due to other diseases in two cases, distant metastasis in 7 cases, troubles of the primary site in 8 cases and unknown reason (septic shock?) in one case. Four of 11 recurrent cases were living with one case of tumor bearing state. Complete response (CR) was obtained in 5 cases and partial response (PR) in 4 among 9 evaluable recurrent cases. As for the recurrent cases whose main therapy was intra-arterial chemotherapy only, CR was gained in 3 and PR was got in 4 out of 7 cases. Severe side effects were observed in 11, moderate one in 15 and mild one in 6 cases.     

经肝动脉灌注榄香烯联合肝动脉化疗栓塞术治疗不可切除肝癌的疗效观察

目的:观察经肝动脉灌注榄香烯联合肝动脉化疗栓塞术(TACE)治疗不可切除肝癌的近期疗效及不良反应.方法:选取我院2015年1月至2016年10月收治的48例不可切除的肝癌患者,将其随机分为观察组24例和对照组24例,对照组给予TACE治疗(雷替曲塞3 mg/m2、奥沙利铂100 mg/m2、表柔比星40 mg/m2),...     

A phase II trial of transcatheter arterial infusion chemotherapy with an epirubicin-Lipiodol emulsion for advanced hepatocellular carcinoma refractory to transcatheter arterial embolization

Introduction Transcatheter arterial embolization (TAE) has been recognized as an effective palliative treatment option for advanced hepatocellular carcinoma (HCC). However, no effective alternative treatments for TAE-refractory HCC have yet been established. The aim of this study was to evaluate the antitumor activity and toxicity of transcatheter arterial infusion chemotherapy using an epirubicin-Lipiodol emulsion in patients with TAE-refractory HCC. Methods Patients with TAE-refractory HCC were enrolled. A dose of 60 mg/m² epirubicin emulsified in Lipiodol and contrast medium was administered from the feeding artery of the HCC. Treatment was repeated every 4 to 12 weeks if there was no evidence of tumor progression or unacceptable toxicity. Results Twenty patients were enrolled in this trial. The median number of treatment courses was 1 (range 1–4). Among the enrolled patients, one (5%) achieved a partial response, and three (15%) showed a minor response. Five (25%) patients had no change and 11 (55%) showed progressive disease. The median survival time, 1-year survival rate and median progression-free survival time for the patients as a whole were 12.4 months, 52.6%, and 1.1 months, respectively. The main grade 3 and 4 toxicities were leukocytopenia (35%), neutropenia (65%), thrombocytopenia (30%), and elevations of the aspartate aminotransferase (45%) and alanine aminotransferase (35%) levels. These toxicities were generally brief and reversible. Conclusion Transcatheter arterial infusion chemotherapy with an epirubicin-Lipiodol emulsion appears to have only modest activity with moderate toxicity for treatment of patients with TAE-refractory HCC. These findings do not support its use in practice, and further studies with the same regimen in patients with TAE-refractory HCC are not recommended.     

Hepatic arterial infusion therapy for pancreatic cancer

INTRODUCTION: One of the most difficult factors in curing pancreatic carcinoma is hepatic metastases. Many patients who undergo curative resection have hepatic recurrence, and unresected patients with hepatic metastases have terribly poor prognosis. AIM: In this study, we evaluated the efficacy of hepatic arterial infusion therapy for pancreatic carcinoma. PATIENTS AND METHOD: The subjects were 42 patients who underwent curative surgery, and 75 who were treated without resection over the past 10 years. A catheter was inserted from the femoral artery to the proper hepatic artery using the interventional technique. The main drug of this therapy was 5-fluorouracil. RESULT: The prophylactic therapy for curative resected cases was effective for pathologically mild venous permeation cases but not effective for severe venous permeation cases. Prophylactic hepatic arterial infusion therapy to prevent hepatic metastasis was not effective for unresected cases; however, for the patients with hepatic metastases this therapy was one of the factors for prolonging survival time.     

经导管动脉免疫化疗栓塞治疗晚期肝癌的应用效果

目的探讨经导管动脉免疫化疗栓塞(TAICE)治疗晚期肝癌患者的临床疗效。方法选取2013年8月至2015年8月间收治的60例晚期肝癌患者,按照随机数字表法随机分为观察组和对照组,每组30例。观察组患者给予TAICE治疗,对照组给予经导管动脉化疗栓塞(TACE)治疗,比较两组患者的临床疗效、免疫功能和不良反应发生率。结果观察组患者治疗有效率显著高于对照组,差异有统计学意义(P<0.05)。观察组患者血常规和肝功能检查结果与对照组比较,差异无统计学意义(P>0.05)。观察组患者CD3+、CD4+和CD4+/CD8+比值均显著高于对照组,差异均有统计学意义(均P<0.01)。两组患者不良反应发生率差异均无统计学意义(均P>0.05)。结论 TAICE治疗晚期肝癌临床疗效更优,且免疫功能更佳,具有临床应用价值。     

Clinical outcome of intra-hepatic arterial infusion therapy for multiple liver metastases from colorectal cancer

Weekly infusion of high-dose 5-FU through the hepatic artery after resection of colorectal cancer was compared with resection alone in patients with multiple liver metastases. Twenty-seven patients (Group I) underwent hepatic artery infusion chemotherapy and 74 patients (Group II) underwent resection alone. The average survival time was 17.9 months in Group I and 8.5 months in Group II. One CR and 7 PR were achieved with arterial infusion therapy and the response rate was 29.6%. One- to three-year survivals were better in Group I than Group II.