紫杉醇腹腔灌注化疗治疗晚期卵巢癌临床研究

目的 探讨紫杉醇(PTX)腹腔灌注化疗联合顺铂(PDD)全身化疗治疗晚期卵巢癌患者的疗效和安全性.方法 2006年1月至2010年1月,给予33例TNMⅢ-Ⅳ期卵巢癌患者(Ⅲ期20例,Ⅳ期13例)PTX 60mg/m2 ip d1,5,10,PDD 40mg/m2 iv d1-2,每21天为1周期,共2-4个周期,每2周期评定疗效.结果 总有效率(RR,CR+PR)为78.79%,其中CR 60.61%、PR 18.18%.中位疾病进展时间(TTP)为22.3个月.2年生存率为81.82%.常见不良反应为骨髓抑制、腹痛、腹泻、胃肠道反应、脱发、口腔黏膜炎和肌肉关节痛等.结论 PTX 60mg/m2腹腔灌注d1,5,10联合PDD 40mg/m2静脉滴注d1,2方案治疗晚期卵巢癌疗效肯定,且不良反应可以耐受.     

多西紫杉醇腹腔灌注化疗治疗晚期胃癌Ⅱ期临床研究

目的:探讨多西紫杉醇(DOC)腹腔灌注化疗(intraperitoneal chemotherapy,IPC)联合亚叶酸钙(CF)/5-氟尿嘧啶(5-FU)/奥沙利铂(OXA)静脉用药治疗晚期胃癌的临床疗效和安全性。方法:2007年7月至2009年9月,给与43例TNMⅢb-Ⅳ期胃癌患者(Ⅲb期19例,Ⅳ24期例)DOC 40mg/m2腹腔灌注d1,8,CF200mg/m2静脉滴注d1-5,5-FU 375mg/m2静脉滴注d1-5,OXA 135mg/m2静脉滴注d1方案,每21天为一周期,共2-4个周期,每2周期评价疗效。结果:总有效率(CR+PR)为58.1%(25/43),其中CR6.9%(3/43)、PR51.2%(22/43)。中位疾病进展时间(mTTP)为7.5(2.3-14.2)个月。一年生存率为67.4%。常见不良反应为腹痛、腹泻、骨髓抑制、胃肠道反应、脱发、口腔黏膜炎和外周神经毒性等。结论:DOC 40mg/m2腹腔灌注d1,8,联合CF/5-FU/OXA方案静脉用药治疗晚期胃癌疗效肯定,且不良反应可以耐受。     

多西紫杉醇腹腔灌注化疗治疗晚期胃癌Ⅱ期临床研究

目的：探讨多西紫杉醇（DOC）腹腔灌注化疗（intraperitoneal chemotherapy,IPC）联合亚叶酸钙（CF）/5-氟尿嘧啶（5-FU）/奥沙利铂（OXA）静脉用药治疗晚期胃癌的临床疗效和安全性。方法：2007年7月至2009年9月,给与43例TNMⅢb-Ⅳ期胃癌患者（Ⅲb期19例,Ⅳ24期例）DOC 40mg/m^2腹腔灌注d1,8,CF200mg/m^2静脉滴注d1-5,5-FU 375mg/m^2静脉滴注d1-5,OXA 135mg/m^2静脉滴注d1方案,每21天为一周期,共2-4个周期,每2周期评价疗效。结果：总有效率（CR＋PR）为58.1%（25/43）,其中CR6.9%（3/43）、PR51.2%（22/43）。中位疾病进展时间（mTTP）为7.5（2.3-14.2）个月。一年生存率为67.4%。常见不良反应为腹痛、腹泻、骨髓抑制、胃肠道反应、脱发、口腔黏膜炎和外周神经毒性等。结论：DOC 40mg/m^2腹腔灌注d1,8,联合CF/5-FU/OXA方案静脉用药治疗晚期胃癌疗效肯定,且不良反应可以耐受。     

卡铂腹腔灌注联合多西紫杉醇全身化疗双途径治疗晚期卵巢癌

卵巢癌患者的病死率占妇科恶性肿瘤之首,手术是治疗卵巢癌的重要手段,而化疗则是治疗晚期卵巢癌的重要措施,多西紫杉醇应用于卵巢癌的治疗,并取得了较满意的疗效。我们从2003年2月～2005年3月采用卡铂联合多西紫杉醇经腹腔和静脉双途径治疗28例晚期卵巢癌,并取得较好疗效,现报告如下:1资料与方法1.1一般资料28例卵巢癌病例均为初治的晚期卵巢癌,年龄43～71岁(中位年龄48岁),均为Ⅲ～Ⅳ期病例,病理组织类型为浆液性乳头状囊腺癌12例,粘液性囊腺癌9例,子宫内膜样癌4例,腺癌3例,入院后B超、CT检查发现均有卵巢占位及大量腹水,腹水细胞学检查…     

经腹腔和静脉双途径应用紫杉醇化疗治疗晚期卵巢癌

目的：观察并评价紫杉醇(泰素)加顺铂经腹腔和静脉化疗治疗晚期卵巢癌的近期疗效及其毒副反应。方法：8例Ⅲ或Ⅳ期卵巢癌患接受泰素40mg／m^2 顺铂20～40mg／m^2腹腔注入，泰素40mg／m^2静脉滴注，每周1次，连用3周为一疗程，2个疗程后进行评价。结果：全组8例患中获得PR4例，总有效率50％；控制腹水的有效率达100％。结论：泰素和顺铂经腹腔和静脉化疗治疗晚期卵巢癌疗效肯定，毒副反应轻，值得临床进一步研究和应用。     

双周剂量紫杉醇联合腹腔灌注治疗晚期卵巢癌临床研究

目的研究双周剂量紫杉醇联合腹腔灌注顺铂和白细胞介素Ⅱ(IL-2)治疗晚期卵巢癌的疗效和毒副反应。方法对56例晚期卵巢癌采用紫杉醇90mg／次，静滴3h，d1.8；顺铂50～60mg／次，IL-2100万单位／次，腹腔灌注，d2.9。21天为一周期，治疗2周期后评价。结果56例患者共化疗130周期，总有效率73．2％，其中42例合并腹腔积液，有效率98．2％，1，3年生存率分别为92．8％和82．1％，中位生存期32．2个月。主要毒性为白细胞减少，其中Ⅰ～Ⅱ度占53．6％，Ⅲ～Ⅲ度占17．9％，恶心、呕吐、脱发、神经毒性较常见。结论该方案有效率高，患者可耐受。     

晚期卵巢癌术后早期顺铂腹腔热灌注化疗临床研究

目的：评价卵巢癌术后早期腹腔热灌注化疗疗效。方法：将2002年1月-2005年12月我科收治晚期上皮性卵巢癌减瘤术后患者80例,随机单盲分成实验组40例（紫三醇联合卡铂方案静脉全身化疗联合腹腔热灌注顺铂化疗组）与对照组40例（紫三醇联合卡铂方案静脉全身化疗组）。分析两组生存率、复发情况及不良反应。结果：80例病人均完成全部6周期静脉全身化疗,实验组静脉全身化疗期间同期完成腹腔热灌注化疗6次。实验组患者术后3年生存率,5年生存率70%,55%,高于静脉全身化疗组42.5%,32.5%,不良反应可耐受。结论：术后早期腹腔热灌注化疗是晚期卵巢癌减瘤术后的有效辅助化疗,不良反应可耐受,可提高晚期卵巢癌病人的生存率和生活质量。     

紫杉醇为主腹腔灌注和静脉联合化疗治疗晚期卵巢癌疗效

目的:评价卵巢上皮性癌患者术后行紫杉醇和卡铂腹腔灌注 静脉联合化疗的疗效及副反应。方法:32例晚期卵巢上皮性癌术后患者,紫杉醇60mg 卡铂200mg 生理盐水2000ml腹腔灌注(每周1次,连用3次),1周后紫杉醇210mg 卡铂200mg静脉滴注(3周为1疗程,共6个疗程)。结果:Ⅲ期总有效率为75.00%,Ⅳ期为25.00%。结论:紫杉醇静脉和卡铂腹腔灌注联合化疗近期疗效好,毒副反应轻。     

晚期卵巢癌术后早期顺铂腹腔热灌注化疗临床研究

目的:评价卵巢癌术后早期腹腔热灌注化疗疗效。方法:将2002年1月-2005年12月我科收治晚期上皮性卵巢癌减瘤术后患者80例,随机单盲分成实验组40例(紫三醇联合卡铂方案静脉全身化疗联合腹腔热灌注顺铂化疗组)与对照组40例(紫三醇联合卡铂方案静脉全身化疗组)。分析两组生存率、复发情况及不良反应。结果:80例病人均完成全部6周期静脉全身化疗,实验组静脉全身化疗期间同期完成腹腔热灌注化疗6次。实验组患者术后3年生存率,5年生存率70%,55%,高于静脉全身化疗组42.5%,32.5%,不良反应可耐受。结论:术后早期腹腔热灌注化疗是晚期卵巢癌减瘤术后的有效辅助化疗,不良反应可耐受,可提高晚期卵巢癌病人的生存率和生活质量。     

腹腔热灌注联合静脉化疗治疗晚期卵巢癌的疗效观察

目的:探讨晚期卵巢癌行腹腔热灌注联合静脉化疗的临床疗效及不良反应。方法:2008年12月-2012年12月收治 的100例晚期卵巢癌并大、中量腹腔积液患者采用信封法随机分为治疗组和对照组。治疗组60例,行腹腔热灌注联合静脉化疗;对照组40例,行单纯的静脉化疗。治疗组采用顺铂腹腔热灌注联合紫杉醇静脉化疗,对照组采用紫杉醇联合顺铂 静脉化疗,观察两组的腹水控制率及不良反应。结果:治疗组的腹水控制率为78.3%,对照组为42.5%,差异具有统计学 意义（P＜0.01）。两组的不良反应比较无统计学差异（P＞0.05）。结论:腹腔热灌注联合静脉化疗可有效的控制卵巢 癌患者恶性腹腔积液,不良反应能够耐受。     

多西他赛联合腹腔热灌注化疗加热疗治疗晚期卵巢癌

  目的  观察多西他赛联合腹腔内顺铂热灌注化疗加热疗治疗晚期卵巢癌的疗效与不良反应。   方法  无法手术及复发晚期卵巢癌患者83例,随机分成两组:热疗组42例,行多西他赛静脉化疗后即刻行腹腔内顺铂热灌注化疗并加腹部局部射频热疗;对照组41例,单纯给予多西他赛静脉化疗加腹腔内顺铂热灌注化疗。   结果  热疗组和对照组的总有效率分别是81.0%和58.1%,其中总有效率显著提高（P < 0.05）,腹水控制率分别为78.3%和66.7%,CA125下降率分别为84.2%和61.5%（P < 0.05）,主要不良反应为消化道不良反应及骨髓抑制,无显著性差异。   结论  多西他赛联合顺铂腹腔内灌注加热疗明显提高晚期卵巢癌的疗效,不增加不良反应,值得进一步推广。      

Ifosfamide and paclitaxel salvage chemotherapy for advanced epithelial ovarian cancer

Objective: To evaluate the efficacy and toxicity of the combinationof ifosfamide (1.5 g/m² i.v. on days 1, 2, 3) and paclitaxel(135 mg/m² i.v. over 3 hours on day 3) with G-CSF (5µg/kg/d subcutaneously, days 7–11) administered every 3 weeks onan outpatient basis in patients with advanced epithelial ovarian cancerpreviously treated with platinum-based chemotherapy.Patients and methods: Thirty-five consecutive patients were treated,12 of whom had previously received two regimens. Twelve of the 35 were definedas platinum-resistant and 23 as potentially platinum-sensitive.Results: Fifteen patients (43%; 95% CI:26%–61%) achieved objective responses, five of themcomplete and ten partial. Objective responses occurred in 17% of theplatinum-resistant patients and in 57% of those with potentiallyplatinum-sensitive disease. The median duration of response was seven monthsand the median overall survival 11 months. The treatment was well toleratedand only 15% of the patients developed grade 3 or 4 neutropenia. Withthe exception of alopecia there were no other grade 3 or 4 toxicities.Conclusions: The combination of ifosfamide and paclitaxel was welltolerated and showed activity in patients with ovarian cancer who hadpreviously undergone platinum-based chemotherapy.     

Efficacy assessment of sustained intraperitoneal paclitaxel therapy in a murine model of ovarian cancer using bioluminescent imaging

We evaluated the pre-clinical efficacy of a novel intraperitoneal (i.p.) sustained-release paclitaxel formulation (PTX_ePC) using bioluminescent imaging (BLI) in the treatment of ovarian cancer. Human ovarian carcinoma cells stably expressing the firefly luciferase gene (SKOV3^Luc) were injected i.p. into SCID mice. Tumour growth was evaluated during sustained or intermittent courses of i.p. treatment with paclitaxel (PTX). In vitro bioluminescence strongly correlated with cell survival and cytotoxicity. Bioluminescent imaging detected tumours before their macroscopic appearance and strongly correlated with tumour weight and survival. As compared with intermittent therapy with Taxol®, sustained PTX_ePC therapy resulted in significant reduction of tumour proliferation, weight and BLI signal intensity, enhanced apoptosis and increased survival times. Our results demonstrate that BLI is a useful tool in the pre-clinical evaluation of therapeutic interventions for ovarian cancer. Moreover, these results provide evidence of enhanced therapeutic efficacy with the sustained PTX_ePC implant system, which could potentially translate into successful clinical outcomes.     

腹腔穿刺与腹腔输液港在卵巢癌患者腹腔化疗中的应用比较

目的:探讨腹腔穿刺与腹腔输液港在卵巢癌患者腹腔化疗中的应用效果。方法:选择2017年1月至2018年12月住院行腹腔化疗的卵巢癌患者90例,其中腹腔穿刺组患者45例,腹腔输液港组患者45例。对比2组患者的治疗效果、导管相关并发症发生情况、穿刺时疼痛评分、一次性穿刺成功率以及疗程完成情况。结果:两组患者治疗效果比较差异无统计学意义（P>0.05）;导管相关并发症发生情况,两组比较差异无统计学意义（P>0.05）;腹腔输液港组患者穿刺疼痛评分低于腹腔穿刺组,两组M(P25,P75)评分分别为2.00（1.40,2.50）和5.33（5.00,5.67）,差异具有统计学意义（P<0.05）,腹腔输液港组患者有18例主诉在留置期间存在腹部异物感;腹腔穿刺组患者一次性穿刺成功率为87.44%（181/207）,腹腔输液港组患者为95.04%（249/262）,两组比较差异具有统计学意义（P<0.05）;腹腔穿刺组患者疗程完成率为82.22%（37/45）,腹腔输液港组为95.56%（43/45）,差异具有统计学意义（P<0.05）。结论:腹腔输液港相较于腹腔穿刺应用于腹腔化疗中,其一次性穿刺成功率更高,疗程完成度更好,故在经济条件允许且化疗周期较长、腹部穿刺困难或对疼痛不耐受的患者可考虑置入腹腔输液港。     

Phase I/II study of the combination of carboplatin and paclitaxel as first-line chemotherapy in patients with advanced epithelial ovarian cancer

Purpose: We performed a phase I/II study evaluating the combination ofpaclitaxel and carboplatin as first-line chemotherapy in patients withadvanced ovarian cancer. The aim of this study was to define a feasible andsafe combination regimen that could be recommended for future phase IIIstudies.Design: This study was a parallel two-arm, non-randomized, open trial. Ina first step, carboplatin was administered at a fixed dose of AUC 5 andpaclitaxel was escalated in 25 mg/m² steps starting at 135mg/m². Paclitaxel was given as a three-hour infusion.Carboplatin was administered on day 1 following paclitaxel in one study armand 24 hours after paclitaxel infusion on day 2 in the other study arm.Carboplatin was escalated to AUC 6 and AUC 7.5 after the MTD for paclitaxelhad been defined. Treatment was repeated every three weeks.Patients: Sixty-one patients with untreated histologically confirmedepithelial ovarian cancer were recruited of whom 59 were found eligible andevaluable for toxicity. Thirty-three patients with bidimensionally measurabledisease were evaluable for tumor response.Results: We could not detect any advantage of the two-day schedule comparedwith the more convenient one-day schedule. Dose limiting toxicities wereneutropenia, thrombocytopenia, and neurotoxicity. Except for two patients,toxicity was acceptable and clinically managable. One patient died ofneutropenic sepsis and one further patient developed grade III peripheralneurotoxicity that did not resolve within two months after chemotherapy hadbeen terminated. Overall objective response rate was 70%. The MTD forpaclitaxel was 185 mg/m² and AUC 6 for carboplatin,respectively. Secondary prophylaxis with G-CSF did not allow further doseescalation and therefore is not generally recommended.Conclusions: Paclitaxel 185 mg/m² given as three-hourinfusion followed by carboplatin AUC 6 is a feasible and safe regimen and canbe recommended for phase III trials. Observed response rates justify furtherevaluation of this combination. A randomized phase III trial comparing athree-hour infusion of paclitaxel 185 mg/m² combined witheither carboplatin AUC 6 or cisplatin 75 mg/m² as first-linechemotherapy of advanced ovarian cancer has recently been initiated by ourgroup.