显微手术切除联合瘤腔植入缓释氟尿嘧啶和^125I治疗胶质瘤的临床观察

目的：探讨外科显微手术切除联合瘤床内植入5-氟尿嘧啶（5-FU）多聚缓释体局部化疗和125I局部放疗治疗胶质瘤的疗效。方法：65例胶质瘤行开颅显微手术切除,术中瘤床周围植入5-FU多聚缓释体和125I粒子,术后每3个月立体定向引导再次植入1～2次。观察疗效和瘤周水肿情况及不良反应。结果：术后1周内头痛明显,脑脊液白细胞不同程度的升高,瘤周水肿较单纯手术明显,经治疗所有患者都顺利出院。随访6个月～5年,39例患者获完全随访;患者生存36例。结论：手术切除肿瘤联合瘤床内植入缓释5-FU多聚缓释体局部化疗和125I局部放疗,是治疗胶质瘤的一种有效地方法。     

显微手术切除后瘤腔植入缓释5-氟尿嘧啶化疗联合125I增敏放疗治疗恶性脑胶质瘤

 目的　探讨外科显微手术切除后瘤床内植入5-氟尿嘧啶（5-Fu）多聚缓释体局部化疗联合125I粒子局部增敏放疗治疗恶性脑胶质瘤的临床疗效。方法　对65例脑胶质瘤患者行开颅显微手术切除,术中于瘤床周围植入5-Fu多聚缓释体和125I粒子,术后（3个月～1年）立体定向引导下再次植入1～2次。随访6～36个月,观察疗效、瘤周水肿情况和患者不良反应。并与同时期经随访的40例接受显微镜下全切后常规放化疗的脑胶质瘤患者相比较。结果　术后1周内患者头痛明显,脑脊液WBC不同程度升高,瘤周水肿较单纯手术明显,经治疗所有患者都顺利出院。44例患者获完全随访,生存期明显延长,半年内复发4例（9.1 %）,无死亡;1年内复发14例（31.8 %）,无死亡;2年内复发20例（45.5 %）,死亡12例（27.6 %）;3年内复发29例（65.9 %）,死亡20例（45.5 %）。未发现明显的不良反应,患者生存质量得到明显改善。结论　显微镜下手术全切肿瘤是治疗的关键,术后于瘤床内植入5-Fu多聚缓释体局部化疗联合125I局部增敏放疗,是一种可供选择的治疗人类脑恶性胶质瘤的安全有效方法。     

手术切除联合间质内缓释化疗治疗复发性脑胶质瘤

目的 探讨外科手术切除与瘤床问质内缓释化疗治疗复发性脑胶质瘤的疗效。方法 对30例复发性恶性脑胶质瘤患者行开颅手术全切除,术中在瘤床植入Vp-16多聚缓释体,用量为100～150mg。随访3～24个月,观察肿瘤再次复发率和患者死亡率,并与以前随访的46例再次手术的恶性脑胶质瘤结果相对比。结果 30例患者均获随访,3个月复发5例(16．7％),死亡2例(6．7％);6个月复发9例(30．0％),死亡6例(20．0％);12个月复发15例(50．0％),死亡12例(40．0％);24个月复发25例(83．3％),死亡21例(70．0％);全部患者均无化疗不良反应。结论 力争手术全切除联合瘤床间质内缓释化疗,可提高药物在瘤灶处的浓度和作用时间,从而提高复发性脑胶质瘤的疗效。     

脑胶质瘤显微手术切除后植入缓释化疗药物联合增敏放疗的临床疗效

目的探究脑胶质瘤显微手术切除后植入缓释化疗药物联合增敏放疗的临床疗效。方法选择80例脑胶质瘤患者。根据患者病情、经济状况并结合患者自主意愿将患者分为观察组(43例)和对照组(37例)。两组患者手术方法相同,均给予常规治疗;在此基础上对照组患者给予全身化疗,术后两周给予普通放射、X刀、γ刀治疗;观察组患者在肿瘤切除后,在瘤床上植入缓释化疗粒子并配合全脑增敏放疗。随访6个月~3年,比较两组患者的肿瘤复发率、生存率、不良反应发生情况及生存质量。结果术后6个月及1年随访期间内,两组患者的肿瘤复发率比较,差异无统计学意义(P>0.05),术后2~3年,观察组患者的肿瘤复发率显著低于对照组(P<0.05)。术后1、2、3年,观察组患者生存率显著高于对照组患者(P<0.05);两组患者不良反应发生情况比较,差异无统计学意义(P>0.05);术后1个月两组患者KPS评分与手术前相比均显著增加,且观察组患者显著高于对照组患者(P<0.05)。结论脑胶质瘤显微手术切除后植入缓释化疗药物联合增敏放疗,临床效果较好,无明显的不良反应,在大样本量深入研究确认其疗效后,可扩大临床实践。     

脑胶质瘤的显微手术治疗

目的 探讨显微手术治疗脑胶质瘤的效果.方法 回顾性分析2000年至2004年80例脑胶质瘤患者接受显微手术的临床资料.结果 62例行显微镜下全切除,18例行大部分或部分切除,术后常规行放疗及化疗.术后随访,Ⅰ～Ⅱ级星型细胞瘤术后3年生存率达74.29%.Ⅲ～Ⅳ级星型细胞瘤3年生存率为15.35%.结论 显微手术治疗脑胶质瘤,损伤小,全切除率高,临床疗效好,可提高患者的生存时间.     

手术联合^125I粒子及缓释化疗粒子靶向治疗胶质瘤的临床研究

目的探讨术中应用^125I粒子及化疗粒子联合植入法治疗胶质瘤的可行性和疗效。方法南阳医专附院自2003年12月至2007年12月,应用术中放、化疗粒子联合植入法治疗胶质瘤41例。治疗中交替植入卡莫司汀（BCNU）缓释化疗粒子和放射性^125I粒子。放射性粒子的肿瘤匹配周边剂量（MPD）为90～100Gy。结果41例患者均顺利完成治疗,术后3—6个月CT复查肿瘤变化,显示瘤体不同程度缩小,其中6例完全缓解,24例部分缓解,8例稳定,局部控制率为73％。随访6—28个月,最长1例随访时间为术后4年,现仍存活。1例术后6个月死于胶质瘤复发。结论手术联合放射性^125I粒子和BCNU缓释化疗粒子联合应用局部植入技术安全、副作用小、费用低及并发症发生率低,是综合治疗胶质瘤的有效手段之一。     

脑胶质瘤放射治疗现状

脑胶质瘤是最常见的一种颅内肿瘤,治疗遵循以手术为主的综合治疗原则.由于胶质瘤呈浸润性生长,手术难以全部切除干净,易复发,因此术后辅助放射治疗有重要意义.主要阐述脑胶质瘤术后放疗各种手段及放疗联合化疗的现状和进展.     

术中置入32P同位素球内放疗治疗肺癌的研究

目的研究肺癌Ⅱ、ⅢA期患者手术切除肿瘤后持续内放疗的适应证.方法将80例中心型肺鳞癌分为两组,其中治疗组40例于手术切除肿瘤的同时,在原瘤床或局部转移处置入 32 P同位素球持续内放疗;对照组40例单纯手术切除肿瘤.结果两组术后治疗相同,经5年随访,治疗组和对照组生存期比较,差异有极显著意义,t=8.07,P<0.01,取得了良好的手术综合治疗效果.结论对中心型肺鳞癌手术切除时,在瘤床或局部转移处置入 32 P同位素球持续内放疗值得临床推广应用.     

脑胶质瘤的显微手术治疗附47例临床总结

背景与目的:脑胶质瘤的治疗原则为以手术治疗为主的综合治疗,但手术切除的彻底与否与预后直接相关,本文探讨显微手术完全切除脑胶质瘤的疗效。方法:回顾性分析自1993年3月至2005年6月共47例脑胶质瘤患者接受显微切除手术的疗效及生存情况。结果:32例非功能区肿瘤达到全切,15例功能区肿瘤肉眼全切除,术后随访12～162个月,平均44.6个月,低级别(Ⅰ、Ⅱ级)星形细胞瘤5年生存率为(72%)13/18,最长14年,高级别(Ⅲ、Ⅳ级)星形细胞瘤5年生存率为(33.3%)4/12。结论:在保护神经功能的前提下,应运显微技术完全切除肿瘤,可提高患者生存时间。     

125Ⅰ粒子组织间永久植入在腹膜后肉瘤切除术中的应用

目的探讨125Ⅰ粒子组织间永久植入在腹膜后肉瘤切除术中的应用和疗效。方法回顾性分析了2003年5月-2006年12月7例腹膜后肉瘤切除联合术中在瘤床、肿瘤残存灶内植入125Ⅰ粒子，每颗粒子活度0．5～0．6mCi，共植入125Ⅰ粒子259颗，平均37颗。结果7例患者均顺利完成手术，术后未发生出血、感染、胃肠道穿孔、大血管穿孔、粒子移位等并发症。随访4～25个月，7例均存活。结论腹膜后肉瘤切除联合术中125Ⅰ粒子组织间永久植入治疗，使手术、放疗同步进行，可明显提高疗效，安全、易操作，是肿瘤综合治疗的有效手段之一。     

Stereotaxic implantation of 5-fluorouracil-releasing microspheres in malignant glioma

BACKGROUND: The authors developed a new method of drug delivery into the brain using implantable, biodegradable microspheres. The strategy was evaluated initially to provide localized and sustained delivery of the radiosensitizer 5-fluorouracil (5-FU) after patients underwent surgical resection of malignant glioma. In this study, the microspheres were implanted by stereotaxy into deeply situated and inoperable brain tumors. METHODS: Ten patients with newly diagnosed, inoperable, malignant gliomas were included in the study, and 1 dose of 5-FU was studied (132 mg). After histologic confirmation, a suspension of poly(D-L lactide-co-glycolide) 5-FU-loaded microspheres was implanted by stereotaxy into the tumor in one or several trajectories with one to seven deposits per trajectory. External beam radiation (59.4 grays) was started before postoperative Day 7. Patients were followed by clinical examination, computed tomography scanning, magnetic resonance imaging, and 5-FU assays in blood and cerebrospinal fluid (CSF). RESULTS: The number of trajectories was adapted to the size and shape of the tumor. Microsphere implantation was tolerated well, except in four patients who received a single trajectory and experienced a transitory worsening of preexisting neurologic symptoms. There were no episodes of edema or hematologic complications. 5-FU was detected in CSF and blood in some patients at very low concentrations. The median overall survival was 40 weeks, with 2 patients who had longer survival (71 weeks and 89 weeks, respectively). CONCLUSIONS: In this study, the authors demonstrated that biodegradable microspheres could be implanted by stereotaxy and were efficient systems for drug delivery into brain tumors. This method may have future applications in the treatment of patients other malignancies.     

Interstitial Docetaxel (Taxotere), Carmustine and Combined Interstitial Therapy: a Novel Treatment for Experimental Malignant Glioma

Docetaxel (Taxotere) is a hemisynthetic, anti-cancer compound with good preclinical and clinical activity in a variety of systemic neoplasms. We tested its activity against malignant gliomas using local delivery methods. Antitumor activity was assessed in vitro against human (U87 and U80 glioma) and rat brain-tumor (9L gliosarcoma and F98 glioma) cell lines. For in vivo evaluation, we incorporated docetaxel into a biodegradable polymer matrix, determined associated toxicity in the rat brain, and measured efficacy at extending survival in a rat model of malignant glioma. Also, we examined the combined local delivery of docetaxel with carmustine (BCNU) against the experimental intracranial glioma. Rats bearing intracranial 9L gliosarcomas were treated 5 days after tumor implantation with various polymers (placebo, 5% docetaxel, 3.8% BCNU, or 5% docetaxel and 3.8% BCNU combination). Animals receiving docetaxel polymers (n = 15, median survival 39.1 days) had significantly improved survival over control animals (n = 12, median survival 22.5 days, P = 0.01). Similarly, animals receiving BCNU polymers (n = 15, median survival 39.3 days, 13.3% long-term survivors) demonstrated an increase in survival compared to the controls (P = 0.04). Animals receiving the combination polymers demonstrated a modest increase in survival compared to either chemotherapeutic agent alone (n = 14, median survival 54.9 days, 28.6% long-term survivors) with markedly improved survival over controls (P = 0.003). We conclude that locally delivered docetaxel shows promise as a novel anti-glioma therapy and that the combination of drug regimens via biodegradable polymers may be a great therapeutic benefit to patients with malignant glioma.     

CT引导下放射性125I粒子植入治疗恶性肿瘤的临床研究

目的:探讨CT引导下放射性125I粒子植入治疗恶性肿瘤的疗效。方法:回顾性分析2007年7月至2008年12月恶性肿瘤68例,均行125I粒子植入治疗。植入前用三维治疗计划系统计算术中所需125I粒子的总活度及粒子的数量,CT引导下植入病灶中,粒子活度为0.6-0.8mCi,处方剂量90-110Gy,术后验证粒子植入剂量分布。植入后复查并随访,统计有效率、局部控制率及不良反应等情况。结果:68例患者粒子植入均顺利完成。6个月有效率(包括完全缓解及部分缓解)88.2%。术后随访6-24个月,局部控制率为76.5%,术中4例出现气胸,经治疗好转,术后出现粒子迁移3例,无严重并发症发生。结论:CT导向125I粒子植入治疗恶性肿瘤是一种安全而有效的方法。     

腹腔镜引导下125I粒子植入治疗复发性妇科恶性肿瘤的临床观察

目的:探讨腹腔镜下手术切除及125I粒子植入治疗复发妇科恶性肿瘤的可行性及价值。方法:5例复发妇科恶性肿瘤患者在腹腔镜下切除复发癌灶并于切除病灶周边植入125I粒子。结果:随访5～11个月,4例患者血CA125恢复正常,检查肿瘤消失,并且未出现新的病灶;1例患者血CA125异常,原切除及植入粒子的部位肿块消失,其他部位出现新的复发灶。未见急性或严重的并发症,所有患者均有一过性CA125升高、肿块切除部位及粒子植入部位隐痛及短期会阴部水肿。结论:腹腔镜下手术切除及125I粒子植入是治疗复发妇科恶性肿瘤可行和有效的方法,但结论尚有待长期随访。     

转移及复发性骨肿瘤的放射性125I粒子植入治疗初探

目的探讨放射性^125I粒子组织间种植治疗转移及复发性骨肿瘤的技术方法和疗效。方法对14例转移及复发性骨肿瘤患者行肿瘤内^125I粒子植入治疗，粒子植入数目为3～145颗，粒子活度为18．5～29．6MBq（0．5～0．8mCi），肿瘤匹配周边剂量为115～145Gy。术后行质量验证并观察患者临床指标改善情况。结果随访7～29个月（平均12．4个月）。^125I粒子治疗90％肿瘤靶体积接受的最小剂量（D90）中位值为108．12Gy（27～166Gy），10例脊柱或椎旁肿瘤患者脊髓的中位D90为31．9Gy（6．2～74．0Gy）。粒子植入前伴有疼痛的12例患者，术后疼痛完全缓解率达82％，止痛有效率为92％。10例脊柱或椎旁肿瘤患者中，70％的患者疗后行走能力改善或恢复正常。1年局部控制率为82％，1年生存率为53％，围手术期无3级以上严重并发症发生。结论放射性^125I粒子植入安全、高效，是治疗转移及复发性骨肿瘤的一种有前途的新方法。     

胃肠道肿瘤化疗药物缓释粒子内镜植入的疗效观察

目的初步评价化疗缓释粒子肿瘤部位植入治疗胃肠恶性肿瘤的临床疗效和不良反应。方法选择31例隆起型病变的胃肠道恶性肿瘤患者,在消化内镜直视下将5-FU、顺铂的缓释粒子植入到肿瘤间质。结果全部病例均顺利完成治疗,完全缓解10例,部分缓解12例,病情稳定6例,3例无缓解,平均有效率为70.9%。患者疼痛缓解率为70.9%,体重增加21例占67.7%。不良反应除因术中操作出血外仅有WBC轻度下降、轻度恶心、腹泻,无肝肾功能损害。结论胃肠道恶性肿瘤化疗缓释粒子内镜植入突出了局部靶向治疗,具有微创、安全、有效及并发症发生率低的特点,是综合治疗胃肠道恶性肿瘤新的有效手段之一。     

Application of I(125) brachytherapy combined artificial joint prosthesis in malignant osteo- and soft-tissue sarcoma

OBJECTIVES: The aim of this study was to evaluate the brachytherapy effectiveness of I(125) seeds combined with artificial prosthesis in malignant sarcoma therapy. METHODS: The combination of I(125) seeds and artificial prosthesis was implanted to replace tumor section for three clinical cases-2 malignant osteosarcoma patients and 1 malignant soft-tissue tumor patient- through the direct operation. RESULTS: Approximately 14-18 months after the operation, the results of our post-operational investigation showed that the tumor tissues of 3 patients had been completely removed. The limb functions recovered well. The brachytherapy of the combination of I(125) seeds and artificial prosthesis in malignant tumor improved the curative effect. No tumor existed, and no infection occurred. CONCLUSIONS: It was demonstrated that this method was safe and easy. No side-effect was observed after the implantation of I(125) seeds. The brachytherapy was proven to be a potential method for patients who were at high risk to recrudesce the malignant osteosarcoma of tumors after the tumor excision.