卡莫氟配合TACE治疗原发性肝癌的临床观察

目的探讨卡莫氟配合经肝动脉灌注化疗栓塞（TACE）治疗中晚期原发性肝癌的疗效。方法90例肝癌患者采用同期配对法分成两组,综合治疗组（试验组）45例,采用TACE＋卡莫氟,末次TACE术后2周口服卡莫氟,每次200 mg,每日3次,两周为1周期,间隔2周进行下一周期,共2-4周期;对照组45例,单纯采用TACE。TACE方案选择顺铂（DDP）60-100 mg、丝裂霉素（MMC）12-20 mg、5-Fu 1 000-1 500 mg,再将表柔比星（表阿霉素,EPI）50-70 mg与超液化碘油10-20 ml充分混合成乳剂缓缓注入,然后用1-2 mm的明胶海绵栓塞供血动脉,两组均行TACE2-3次。结果综合组（试验组）近期有效率91.1%,对照组60.0%,两组差异有非常显著性（χ2=11.79,P〈0.01）,综合组1,2,3,5年生存率分别为88.9%、55.6%、33.3%和20.0%,对照组分别为51.1%、37.8%、20.0%和0（χ2=6.65,P〈0.01）,中位生存期分别为27.3和16.7个月（χ2=4.75,P〈0.05）。肝功能A级和B级3年生存率分别为48.3%和6.3%（χ2=8.195,P〈0.01）;5年生存率分别为31．0％和0,χ2=4．42,P〈0．05）。结论 卡莫氟配合TACE为较好的治疗原发性肝癌的方法。     

肝动脉结扎加插管化疗结合外放射治疗肝癌25例

［目的］观察肝动脉结扎加插管化疗结合外放射（ＨＡＬ＋ ＨＡＩ＋ ＲＴ）治疗无法切除肝癌的疗效。［方法］２５例术中发现已无法切除的肝癌患者接受ＨＡＬ＋ＨＡＩ＋ＲＴ治疗。［结果］总有效率（ＣＲ＋ＰＲ）４８．０％,１、３、５年生存率分别为８０．０％、３３．２％、２４．３％。［结论］对于术中发现不能切除的肝癌,采用ＨＡＬ＋ＨＡＩ＋ＲＴ不失为一种较有效的治疗方法,值得推广与进一步研究。     

^125I组织问放疗联合介入治疗肝癌42例报告

目的探讨^125I放射性粒子组织间放疗联合肝动脉介入治疗肝肿瘤的疗效、可行性和安全性。方法2005年2月至2008年2月,对42例肝癌住院患者实施了放射性粒子^125I组织间放疗联合肝动脉介入治疗。其中肝细胞癌38例,胆管癌4例。病例均经CT、超声、MRI检查或病理穿刺活检证实。全部病灶在接受肝动脉介入治疗2周内,在CT、超声导向下将^125I放射性粒子植入肿瘤碘油栓塞区内及其周围,随之继续介入治疗1～2次。结果2个月后增强CT复查,完全缓解（CR）3例;部分缓解（PR）27例,无变化（NC）9例,进展（PD）3例,总有效率为71．4％。结论肝动脉介入治疗后联合CT导向下放射性粒子植入治疗肝脏肿瘤,并发症发生率低,治疗效果较二者单一治疗有所提高,是治疗肝脏肿瘤的一种有效方法。     

Angiographic findings of extrahepatic branches originating from hepatic artery and its clinical significance

Objective: To observe the presentation and variation of extrahepatic branches originating from hepatic artery by hepatic arteriography.Methods: Hepatic arteriogram of 200 cases with unresectable hepatic primary or metastatic tumors before interventional therapy were retrospectively analyzed. Two interventional radiologists independently reviewed the type, originating artery, distribution and variation of extrahepatic artery.Results: Five types of extrahepatic artery were found, with the most common type of the right gastric artery (n=156, 78%), followed by the cystic artery (n=126, 63%), accessory left gastric artery (n=19, 9.5%), hepatic falciform artery (n=5, 2.5%), and accessory left inferior phrenic artery (n=4, 2%). In 188 cases, there were extrahepatic arteries derived from hepatic proper artery or its branches, and the most frequent originating site was the right hepatic artery (130 extrahepatic branches), followed by the proper hepatic artery (103 branches), left hepatic artery (56 branches) and middle hepatic artery (3 branches). The left hepatic artery was the arising site with the multiple types of extrahepatic branches including all above branches except the cystic artery.Conclusion: Many types of extrahepatic branches usually derive from the hepatic artery or its distal branches, and its originating sites are not constant. It is important to avoid damage of extrahepatic tissue during interventional therapy for liver tumors.     

磁导向载体阿霉素介入治疗原发性肝癌的临床研究

目的：观察磁导向载体阿霉素(MTC-DOX)肝动脉介入治疗原发性肝癌的有效性和安全性。方法：将Seldinger导管超选择插入肿瘤供血肝动脉，以脉冲给药的方式注入MTC-DOX，21天为一周期，连续用药2周期以上按照WHO标准进行评价。结果：不能手术的原发性肝癌患共11例入组，10例可以评价疗效，治疗后NC7例，PD3例，中位肿瘤进展时间(TTP)为182天，有3例临床症状减轻，有4例生活质量改善，1年生存率达到54．5％；11例可以评价毒性，毒副反应均较轻，主要为轻中度的肝区疼痛和发热，少数患有胃肠道反应和一过性转氨酶升高。结论：采用磁导向载体阿霉素介入治疗原发性肝癌靶向性特别好，疗效明显，同时毒性反应轻微，值得进一步研究。     

原发性肝癌的介入综合治疗及其预后影响因素

目的评价原发性肝细胞肝癌肝动脉化疗栓塞（TACE）为主的综合治疗,分析、筛选与预后相关的因素。方法141例原发性肝细胞肝癌分别采用TACE治疗、TACE＋手术切除、TACE＋PEI治疗和TAI治疗。根据多因素回归模型,对患者年龄、性别、血清AFP、ALT、HBsAg、肝功能Child分级、治疗方式、肿瘤大小及数目、血清白蛋白水平、门静脉癌栓、肿瘤病理类型和血清HBeAg进行预后分析。结果本组患者的总体中位生存时间为19个月,平均生存23,59个月。1、2、3、5年生存率分别为63．9％、44．5％、25．8％和7．4％。多因素分析显示,患者年龄、肝功能Child分级、治疗方式、门静脉癌栓和肿瘤病理类型与TACE综合治疗预后有关（X^2=45．993,P=0．0001）。结论原发性肝细胞肝癌介入综合治疗安全、有效。患者年龄、肝功能Child分级、门静脉癌栓和肿瘤病理类型是影响介入综合治疗预后的危险因素,治疗方式是影响预后的保护性因素。     

经药盒系统对晚期肿瘤行化疗栓塞的临床研究

目的：采用介入技术经锁骨下动脉入路皮下植入药盒系统。研究经药盒系统对晚期肿瘤行化疗栓塞的临床疗效。方法：随机分成A、B两组。A组选择化疗栓塞的给药方案，B组选择单纯灌注化疗的给药方案，各20例。结果：两组有效率（CR＋PR）A组为45％，B组为20％（P＜0．05）。1年生存率A组为50％，B组为30％（P＜0．05）。结论：晚期肝癌患者，采用介入技术经锁骨下动脉入路皮下植入药盒系统行化疗栓塞是有效、可行的。     

新城疫病毒处理瘤细胞的免疫实验研究

目的：观察新城疫病毒（简称ＮＤＶ）对体外培养的肿瘤细胞免疫原性的影响。方法：将经新城疫病毒处理的小鼠肝癌细胞Ｈ２２为活瘤进行免疫接种。结果：ＮＤＶ处理瘤细胞制备的瘤苗可完全排斥再次接种未经病毒处理瘤细胞的生长,瘤苗能增强小鼠体内细胞免疫。结论：ＮＤＶ处理后的瘤细胞能使肿瘤生长减慢、荷瘤生存期明显延长。     

Dose as a function of liver volume and planning target volume in helical tomotherapy, intensity-modulated radiation therapy-based stereotactic body radiation therapy for hepatic metastasis

PURPOSE: Stereotactic body radiation therapy (SBRT) has been shown to be an effective, well-tolerated treatment for local control of tumors metastatic to the liver. Multi-institutional Phase II trials are examining 60 Gy in 3 fractions delivered by linac-based, 3D-conformal IMRT. HiArt Helical TomoTherapy is a treatment unit that delivers co-planar helical IMRT that is capable of image-guided SBRT. We hypothesized that the maximum tolerable dose (MTD) delivered to a lesion by Helical TomoTherapy-based SBRT could be predicted based on the planning target volume (PTV) and liver volume. METHODS AND MATERIALS: To test this, we performed inverse treatment planning and analyzed the dosimetry for multiple hypothetical liver gross tumor volumes (GTV) with conventional PTV expansions. Inverse planning was carried out to find the maximum tolerated SBRT dose up to 60 Gy to be delivered in 3 fractions based on the dose constraint that 700 cc of normal liver would receive less than 15 Gy. RESULTS: Regression analysis indicated a linear relationship between the MTD, the PTV and the liver volume, supporting our hypothesis. A predictive equation was generated, which was found to have an accuracy of +/-3 Gy. In addition, dose constraints based on proximity to other normal tissues were tested. Inverse planning for PTVs located at varying distances from the heart, small bowel, and spinal cord revealed a predictable decrease in the MTD as the PTV increased in size or approached normal organs. CONCLUSIONS: These data provide a framework for predicting the likely MTD for patients considered for Helical TomoTherapy liver SBRT.     

Current treatment options for patients with initially unresectable isolated colorectal liver metastases

The development of liver metastases is a common clinical entity in the clinical course of colorectal cancer. For patients with isolated liver involvement, surgical resection is the only treatment that can provide a chance of prolonged survival and cure. However, most of these patients are not initially eligible for the surgery. Selected patients with initially considered to have unresectable disease may become resectable after systemic (chemotherapy ± biological therapy) and loco-regional treatment modalities including hepatic arterial infusion. Patients who have colorectal liver metastases ideally should be referred to a multidisciplinary cancer care team in order to identify the most optimal management approach.     

介入联合肿瘤间质对肝癌患者外周血细胞免疫指标的影响分析

肝癌发病率居高不下,隐蔽性强,死亡率高。肝癌治疗仍以手术为主,但中晚期肝癌患者手术风险较大,效果欠佳,因此多采用化疗治疗㈦。我们针对介入联合肿瘤间质综合治疗后肝癌患者的外周血细胞免疫指标变化进行研究,现将结果报告如下。     

Hepatic trisegmentectomy for metastatic colorectal cancer

Radical hepatic resections for metastatic liver disease have been infrequently done and widely criticized. Seven patients are evaluated who had trisegmentectomies performed for extensive liver metastases from colorectal primaries. There was 1 postoperative death. Of the 6 evaluable patients. 4 (66%) were alive at 12 months. Mean survival currently exceeds 20 months with the longest survivor alive at 41 months. Radical hepatic resections may offer this group of "hopeless' patients many months of productive life.     

肝转移瘤动静脉双途径联合化疗的临床研究

 目的　观察动静脉双途径联合化疗治疗肝转移瘤的临床疗效及不良反应。方法　根据原发肿瘤病理类型、化疗药物作用特点及代谢特征 ,将每一化疗方案中细胞周期非特异性药物 (环磷酰胺、异环磷酰胺除外 )经肝动脉灌注或栓塞 ,细胞周期特异性药物经外周静脉给药。静脉给药于动脉给药后第 3天开始 ,4周为 1周期 ,至少进行 3周期。每周期治疗前重点复查肝脏CT及相关肿瘤标志物 ,随访时间从治疗结束至死亡。结果　总有效率与平均生存期分别为肺鳞癌 6 0 .0 %、13.2月 ,肺腺癌 5 5 .5 %、10 .8月 ,肺小细胞癌 75 .0 %、31.4月 ,胃癌 5 3.3%、17.6月 ,胆囊癌 33.3%、10 .9月 ,大肠癌 6 3.3%、18.8月 ,乳腺癌 6 6 .6 %、2 1.7月 ,卵巢癌 6 6 .6 %、2 3.4月 ;5 6例肝转移瘤治疗前相关肿瘤标志物值均高于正常值 ,治疗结束后均显著降低 ,P <0 .0 1。该治疗方法不良反应与单一静脉化疗基本相同。结论　动静脉双途径联合化疗是众多肝转移瘤治疗方法中较为理想的一种可行手段。     

经皮植入药盒肝动脉持续灌注治疗肝转移瘤

目的 探讨5－氟脲嘧啶（5－Fu)和甲酰四氢叶酸钙（CF）经肝动脉持续性灌注治疗肝转移瘤的临床疗效。方法 对68例无外科手术指征的肝转移瘤患者（其原发病灶均已做根除术）,采取经皮经股动脉或左锁骨下动脉肝动脉内植入药盒,术后经药盒每个月连续5d持续灌注5－Fu 500mg/m^2、CF100mg/m^2及地塞米松10mg(d1-5),并选择顺铂、丝裂霉素、表阿霉素、环磷酰胺联合化疗。结果 总有效率（完全缓 部分缓解）为47．1％。肿瘤负荷＜25％者的有效为60．6％,明显高于肿瘤负荷＞25％者（34．3％,P＜0．05）。在随访的54例中,中位生存期为15．2个月,1、2年生存率分别为61．1％和35．2％。来源于胃肠癌肝转移者疗效较好,其中位生存期为17．6个月,1,2年生存率分别为68．4％和39．5％。全组无严重毒副作用或并发症,胃肠道及肝胆毒性较低。结论 经药盒肝动脉持续性灌注5－Fu、CF及地塞米松是治疗肝转移瘤的较好方法,可明显提高疗效,改善患者的生存质量。     

Efficacy and Tolerability of Selective Internal Radiotherapy With Yttrium-90 as Consolidation Treatment After Chemotherapy in Metastatic Colorectal Cancer

BackgroundSelective internal radiotherapy (SIRT) with yttrium-90 (Y-90)-labeled resin microspheres may have a role in consolidating the response to chemotherapy in patients with metastatic colorectal cancer unamenable to resection after assessment of the best response to first-line chemotherapy.Patients and MethodsThis was a retrospective analysis of outcomes in patients who had received SIRT as consolidation therapy after one or more lines of chemotherapy. Eligible patients were 18 years or older, had confirmed colorectal liver metastases, and had disease unsuitable for surgical resection or local ablation with curative intent. The primary endpoint was progression-free survival.ResultsSixty-eight patients with colorectal liver metastases were treated with at least one SIRT procedure after receiving one or more lines of chemotherapy. Median progression-free survival was significantly longer in patients who received SIRT after prior first-line chemotherapy compared to those who received SIRT after two or more lines of chemotherapy (9 vs. 3 months, respectively; hazard ratio = 0.07; 95% confidence interval, 0.02854‒0.2039; P < .001), and in patients with liver-only disease compared to those who had extrahepatic metastases (6.4 vs. 4.1 months, respectively; hazard ratio = 0.57; 95% confidence interval, 0.34-0.95; P = .0318). There were no grade 3 or higher adverse events.ConclusionSIRT represents a valid option for the treatment of colorectal liver metastases. Earlier use of SIRT may provide a greater survival benefit compared to that afforded by the procedure when used in salvage settings.     

Atezolizumab plus bevacizumab versus sorafenib or atezolizumab alone for unresectable hepatocellular carcinoma: A systematic review

BACKGROUNDDespite the use of current standard therapy, the prognosis of patients with unresectable hepatocellular carcinoma (HCC) is poor, with median survival times of 40 mo for intermediate HCC (Barcelona Clinic Liver Cancer [BCLC] stage B) and 6–8 mo for advanced HCC (BCLC stage C). Although patients with early-stage HCC are usually suitable for therapies with curative intention, up to 70% of patients experience relapse within 5 years. In the past decade, the United States Food and Drug Administration has approved different immunogenic treatment options for advanced HCC, the most common type of liver cancer among adults. Nevertheless, no treatment is useful in the adjuvant setting. Since 2007, the multi-kinase inhibitor sorafenib has been used as a first-line targeted drug to address the increased mortality and incidence rates of HCC. However, in 2020, the IMbrave150 trial demonstrated that combination therapy of atezolizumab (anti-programmed death-ligand 1 [PD-L1]) and bevacizumab (anti-vascular endothelial growth factor [VEGF]) is superior to sorafenib, a single anti-programmed death 1/PD-L1 antibody inhibitor used as an anti-cancer monotherapy for HCC treatment.AIMTo conduct a systematic literature review to evaluate the evidence supporting the efficacy and safety of atezolizumab/bevacizumab as preferred first-line drug therapy over the conventional sorafenib or atezolizumab monotherapies, which are used to improve survival outcomes and reduce disease progression in patients with unresectable HCC and non-decompensated liver disease. METHODSA comprehensive literature review was conducted using the PubMed, Scopus, ScienceDirect, clinicaltrials.gov, PubMed Central, Embase, EuropePMC, and CINAHL databases to identify studies that met the inclusion criteria using relevant MeSH terms. This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines and risk of bias (RoB) were assessed using the Cochrane RoB 2 tool and Sevis.RESULTSIn the atezolizumab/bevacizumab group, an improvement in overall tumor response, reduction of disease progression, and longer progression-free survival were observed compared to monotherapy with either sorafenib or atezolizumab. Hypertension and proteinuria were the most common adverse events, and the rates of adverse events were comparable to those with the monotherapy. Of the studies, there were two completed trials and two ongoing trials analyzed using high quality and low bias. A more thorough analysis was only performed on the completed trials.CONCLUSIONTreatment of HCC with atezolizumab/bevacizumab combination therapy was confirmed to be an effective first-line treatment to improve survival in patients with unresectable HCC and non-decompensated liver disease compared to monotherapy with either sorafenib or atezolizumab.     

超常规剂量碘油超选择栓塞肝动脉治疗原发性肝癌

目的：探讨应用超常规剂量碘油超选择栓塞肝动脉治疗原发性肝癌的疗效。方法：1987年8月-1999年12月12年间167例原发性肝癌,应用常规导管或球囊导管超选择至肿瘤供血动脉,阴断其血流,使注射碘油时不产生逆流。将全部动脉肿瘤血管、病变周围正常的小动脉及肝实质和门静脉分支栓塞。结果：栓塞全部动脉肿瘤血管、病变周围正常的小动脉及肝实质167例,门静脉分支栓塞109例。1、2、3、4、5年生存率分别为98.8%(165/167)、79.9%(107/134)、48.0%(47/98)、36.6%(26/71)、25.5%(12/47)。没有严重并发症发生。结论：应用超常规剂量碘油超选择栓塞肝动脉治疗原发性肝癌效果良好,安全。     

局部治疗在乳腺癌局限性肝转移中的作用

肝脏是乳腺癌远处转移最常见的部位之一。全身治疗是乳腺癌肝转移的标准治疗,但结果并不理想。转移性乳腺癌中存在一类特殊的亚群,即局限性转移。局部治疗,包括转移灶切除术、射频消融、放射治疗等,结合全身治疗可给该部分患者带来生存获益。现就近年来有关乳腺癌局限性肝转移局部治疗的研究结果作一综述。     

高聚生素联合肝动脉插管灌注术治疗中晚期肝癌的临床研究

目的探讨肝动脉插管灌注化疗栓塞与高聚生素联合治疗中晚期肝癌的效果.方法对32例中晚期原发性肝癌采用经肝动脉插管灌注化疗栓塞(TACE)联合高聚生素进行治疗(A组);同时对32例对照患者单纯进行肝动脉插管灌注化疗栓塞治疗(B组).结果①A组部分缓解率为71.8%(23/32),高于B组部分缓解率50.0%(16/32)两组比较有差异(P＜0.05)②A组中位生存期为22.3月,B组为15.7月,两组比较有显著差异(P＜0.01).1年、2年生存率A组分别为68.8%(22/32)和53.1%(17/32);均高于B组的46.9%(15/32)和31.2%(10/32)两组比较有差异(P＜0.05)③A组CD3、CD4、CD4/CD8比值均有不同程度升高,sIL-2R水平下降,而B组则相反.结论TACE与高聚生素有协同治疗中晚期肝癌的作用,不但显著提高治疗效果,而且明显提高患者的免疫功能.