该化疗时就化疗

化学药物治疗(简称化疗),在临床上我们常看到有患者迷信它,为了放心每年都做一次化疗,而有些患者因恐惧化疗的毒副反应而又排斥它.     

化疗及化疗患者的家庭护理

目前,治疗肿瘤的方法有多种,其中化疗是治疗肿瘤的重要方法.所谓化疗,简单的说就是使用化学药物去治疗肿瘤,它作用于全身,对原发及转移性肿瘤的细胞都具有杀伤作用.     

化疗脑

在临床工作中,常被患者问及化疗是否会使脑受损？化疗后记忆力明显下降,能否恢复？需多久才能恢复？遗憾的是由于以往对此研究甚少,文献中涉及的不多,我也知之不详,只能笼统答日：“可能会有影响,但影响的大小因人而异。”这种似是而非、模棱两可的解答,其实是无奈状况下的一时搪塞,自己也不满意,何况患者？如被进一步追问,是何种不良反应？其严重程度受何影响？能否加以预防或治疗？就无言以对了。所幸病友常是“点到为止”,给我留有余地,不再发问,我也就侥幸得以渡此困境。不过,此一疑问如鲠在喉,尤其在面对众多接受化疗的乳腺癌患者,总有内疚之感。     

走近化疗

化疗即用化学药物治疗肿瘤。化疗是肿瘤最重要的治疗手段之一,也是肿瘤综合治疗的关键组成部分。其历史可以追溯到20世纪40年代,高速发展于最近二十多年。时至今日,虽然靶向治疗已经成为目前研究和讨论的热点,化疗依然是肿瘤最常用的全身治疗手段。     

肝脏肿瘤介入化疗及靶向化疗研究

肝脏肿瘤是我国常见的恶性肿瘤之一。由于多合并肝硬化且早期伴有肝内扩散，故手术切除机会不多，对放射治疗不甚敏感，大多数有赖于化学药物治疗。术前化疗不仅能直接杀伤肿瘤细胞，而且加快诱导肿瘤细胞的凋亡，术后化疗可降低肿瘤的复发率。对不宜手术治疗者，有效的化疗是一种姑息治疗方法。特异性和选择性将药物传送至靶器官或靶细胞内是治疗的最终目标。     

新辅助化疗——乳腺癌化疗新选择

医生建议我先行＂新辅助化疗＂,什么是新辅助化疗？几乎所有的乳腺癌患者都经历过以下过程,在最早发现时,往往会经历一系列的心理变化过程,从最初的怀疑诊断,到逐步相信诊断,到心情烦躁、情绪低落,但是一旦看到带有＂癌＂这个字眼的报告单时,相信所有的患者除了情绪低落与悲观以外,脑子里随即浮现出来的一个念头就是：我要尽快手术!然而有时医生反而不主张尽早手术,建议在手术前先做化疗,尤其是在一些医疗条件较好,学术水平较高的医院,这让很多病人感到疑惑、焦急,甚至抵制。     

复发卵巢癌腹腔温热化疗联合全身化疗临床研究

目的探讨复发卵巢癌卡铂腹腔温热化疗联合多西他赛全身化疗的疗效和毒副作用。方法将70例Ⅲ～Ⅳ期复发卵巢癌患者按随机原则选择35例作为治疗组,采用卡铂腹腔温热化疗联合多西他赛全身化疗;35例作为对照组,采用卡铂联合多西他赛全身化疗,并对两组化疗后1,3,5年生存率及毒副作用对照研究,并经统计学χ2检验。结果治疗组1,3,5年生存率分别为88.6%（31/35）、65.7%（23/35）和37.1%（13/35）,对照组分别为80.0%（28/35）、51.4%（18/35）和22.9%（8/35）,两组比较差异无显著性（P〈0.05）。毒副作用主要是骨髓抑制,白细胞下降率（Ⅲ～Ⅳ度）分别为5.7%（2/35）和31.4%（11/35,P〈0.05）。结论复发卵巢癌卡铂腹腔温热化疗联合多西他赛全身化疗的疗效优于卡铂联合多西他赛全身化疗,且毒副作用轻,有利于提高患者的生存率及生存质量。     

化疗所致白细胞减少与化疗疗效关系研究进展

细胞毒药物化疗是恶性肿瘤的主要治疗手段之一，化疗所致白细胞减少（CIL）是影响化疗正常进行的主要限制性因素。也有研究显示，CIL可反映药物活性和患者的敏感性，预测化疗疗效，但尚无定论。本文介绍CIL与化疗疗效的关系及有关机制，探讨化疗所致白细胞减少对乳腺癌、肺癌等化疗疗效的影响及提高化疗疗效的途径。     

正视化疗副反应

多数肿瘤患者需要接受内科治疗,即化学药物治疗,也就是我们通常所说的化疗。化疗作用于全身,随之而来的就是全身各个系统功能的抑制,患者最直观的表现就是脱发、呕吐、骨髓抑制等。这些不适给患者的身体以及生活带来了极大的不便,甚至给患者带来巨大的心理压力,因而导致有些患者抗拒化疗。     

大肠癌化疗进展

大肠癌初治时已转移率高，根治术后复发或转移率高，其中以肝转移最多见，同时近年大肠癌的发病率呈明显上升趋势。通过复习近年国内外大量的临床研究报告，阐述了大肠癌化疗药物研究进展、化疗方案演化、给药途径及方式更新以及化疗联合单克隆抗体等新疗法的临床应用与研究概况，展望进一步提高大肠癌内科治疗（尤其是化疗）水平的新药物及新方法。     

动脉持续灌注化疗与静脉全身化疗治疗中晚期胰腺癌的疗效分析

Objective: To compare the curative effectiveness of continuous transarterial infusion chemotherapy and systemic venous chemotherapy in treating patients with advanced pancreatic cancer, and to evaluate the value of selective continu-ous transarterial infusion chemotherapy in treating advanced pancreatic cancer. Methods: Of the 51 patients with advanced pancreatic cancer receiving chemotherapy with gemcitabine and 5-fluorouracil, 25 patients were treated with selective con-tinuous transarterial infusion chemotherapy, 26 were treated with systemic venous chemotherapy, and curative effective-ness was analyzed retrospectively. Curative effectiveness included tumor volume, clinical benefit response (CBR), acute and subacute toxic reactions of antitumor drugs, survival rate and median survival time. Results: The objective effective rate in transarterial group was 32.0% versus 23.1% in systemic group without any significant difference (P = 0.475). Clinical benefit rates in transarterial group and systemic group were 80.0% and 50.0% respectively (P = 0.025). The 6-, 9-and 12-month accumulated survival rates and median survival time in transarterial group were higher than those of the systemic group (P = 0.002), the differences were statistically significant. However, the adverse reactions between the two groups were not statistically significant. Conclusion: Compared with systemic chemotherapy, continuous transarterial infusion chemotherapy with gemcitabine and 5-fluorouracil could improve clinical benefit rate and survival time of patients with advanced pancreatic cancer, it is safe and reliable, and the adverse reactions is less.     

Continuous transarterial infusion chemotherapy with gemcitabine and 5-Fluorouracil for advanced pancreatic carcinoma

Purpose: Pancreatic carcinoma is one of the most malignant tumors of the alimentary system, with relativelyhigh incidence rates. The purpose of this study was to assess the efficacy and safety of two regimens for advancedpancreatic carcinoma: continuous transarterial infusion versus systemic venous chemotherapy with gemcitabineand 5-fluorouracil. Methods: Of the 48 patients with advanced pancreatic carcinoma receiving chemotherapy withgemcitabine and 5-fluorouracil, 24 received the selective transarterial infusion, and 24 the systemic chemotherapy.For the continuous transarterial infusion group (experimental group), all patients received gemcitabine 1000mg/m2,given by 30-minute transarterial infusion, on day 1 of a 4-week cycle for 2 cycles, and a dose of 600 mg/m2 5-fluorouracil was infused on days 1~5 of a 4-week cycle for 2 cycles. For the systemic venous group (controlgroup), gemcitabine and 5-fluorouracil were infused through a peripheral vein, a dose of 1000 mg/m2 gemcitabinebeing administrated over 30 min on days 1 and 8 of a 4-week cycle for 2 cycles, and a dose of 600 mg/m25-fluorouracil was infused on days 1~5 of a 4-week cycle for 2 cycles. The effectiveness and safety were evaluatedafter 2 cyclesaccording to WHO criteria. Results:The objective effective rate in transarterial group was 33.3%versus 25% in the systemic group, the difference not being significant (P=0.626). Clinical benefit rates(CBR) inthe transarterial and systemic groups were 83.3% and 58.3%, respectively (P=0.014). The means and mediansfor survival time in transarterial group were higher than those of the systemic group (P < 0.005). at the sametime, the adverse effects did not significantly differ between the two groups (P > 0.05). Conclusion: Continuoustransarterial infusion chemotherapy with gemcitabine and 5-fluorouracil could improve clinical benefit rate andsurvival time of patients with advanced pancreatic carcinoma, compared with systemic venous chemotherapy.Since adverse effects were limited in the transarterial group, the regimen of continuous transarterial infusionchemotherapy can be used more extensively in clinical practice. A CT and MRI conventional sequence can beused for efficacy evaluation after chemotherapy in pancreatic carcinoma.     

经动脉持续灌注化疗治疗中晚期胰腺癌的临床分析

 目的 比较经动脉持续灌注化疗和全身静脉化疗治疗中晚期胰腺癌的临床疗效，探讨选择性动脉持续灌注化疗的临床应用价值。方法 51例中晚期胰腺癌，其中25例采用经动脉持续灌注吉西他滨和5-Fu方案，26例采用经外周静脉灌注吉西他滨和5-Fu方案。应用世界卫生组织实体瘤疗效评定标准评价疗效，肿瘤体积测量采用MRI或CT。使用临床受益反应（CBR）对疼痛、体力状况及体重改变情况作出综合评价。采用WH0抗肿瘤药物急性与亚急性毒性分级标准对不良反应进行评价。结果 动脉灌注化疗组的有效率（32．0％）高于外周静脉化疗组（23．1％），但差异无显著性。动脉灌注化疗组的临床受益率（80．0%）高于外周静脉化疗组（50．0％），差异有显著性。6个月、9个月、1年的累积生存率和中位生存时间，动脉灌注化疗组高于外周静脉化疗组，差异有显著性。按WHO分级标准，两组患者不良反应之间无显著性的差异。结论 经动脉持续灌注吉西他滨和5-Fu较外周静脉灌注吉西他滨和5-Fu能提高中晚期胰腺癌的临床受益率和生存期，其方法安全可靠，且不良反应少。     

经动脉灌注健择化疗联合三维适形放射治疗局部晚期胰腺癌的临床研究

Objective： To evaluate the clinical effect of transarterial infusion chemotherapy of gemcitabine plus three dimensional conformal radiotherapy on patients with local advanced pancreatic cancer. Methods： Fifty-one patients with local advanced pancreatic cancer from June 2002 to February 2004 were enrolled, twenty-four patients of combined group were treated with transarterial infusion chemotherapy of gemcitabine plus three dimensional conformal radiotherapy, while twenty-seven patients of control group were treated only with transarterial infusion chemotherapy of gemcitabine. Results： There were significant statistical differences between two groups in clinical benefit response （91.7% versus 74.1%, P 〈 0.01） and overall remission rate （70.8% versus 33.3%, P 〈 0.01）. The 6-month survival rate, 12-month survival rate and 24-month survival rate of combined group were 83.3%, 62.5% and 37.5% respectively, while that of control group were 55.6%, 33.3% and 11.1% respectively. This showed significant difference between the two groups. Conclusion： Transarterial infusion chemotherapy of gemcitabine plus three dimensional conformal radiotherapy may be better than single transarterial infusion chemotherapy of gemcitabine in improving survival rates and elongating survival time of patients with local advanced pancreatic cancer.     

经动脉灌注吉西他滨和5-氟尿嘧啶联合热疗治疗中晚期胰腺癌的临床分析

目的：探讨经动脉灌注吉西他滨（Gemcitabine,商品名健择）和5-氟尿嘧啶（5-FU）联合内生场热疗治疗中晚期胰腺癌的临床疗效。方法：18例中晚期胰腺癌患者,采用改良Seldinger技术,动脉插管后选择性置管于胰腺癌的供血动脉,灌注吉西他滨1000mg／m^2;之后行内生场热疗,热疗同时经动脉留置导管灌注卡铂400mg／m^2;热疗后,用输液泵经动脉留置管灌注5-FU 1g,连用2d。随访观察客观疗效、临床受益反应、患者的生存期及不良反应等。结果：18例患者的客观缓解率为22．20％,临床受益反应为44．40％,Kaplan-Meier法计算6、9和12个月的累积生存率分别为83．33％、66．67％和33．33％,频数分布法计算中位生存期为11个月。结论：经动脉灌注吉西他滨和5-FU联合内生场热疗治疗中晚期胰腺癌可获得较好的临床疗效,患者耐受良好,值得进一步研究。     

GP方案区域化疗与静脉化疗治疗进展期胰腺癌疗效的对比研究

目的:对比分析采用GP方案胰腺区域性动脉灌注与静脉化疗治疗晚期胰腺癌的临床疗效。方法:采用随机法将68例晚期胰腺癌分为胰腺区域性动脉灌注组36例和静脉化疗组32例,平均化疗2.5个周期。结果:胰腺区域性动脉灌注组有效率为25.0%,中位疾病进展时间为9个月,临床获益率为50.0%,中位生存期为12个月,6个月生存率为55.6%,9个月生存率为25.0%;静脉化疗组有效率为12.5%,中位进展时间为3个月,中位生存期为5.5个月,临床获益率为25.0%,6个月生存率为31.2%,9个月生存率为18.7%。胰腺区域性动脉灌注组有效率、临床获益率、中位进展时间、中位生存期及生存率均高于静脉化疗组,差异有统计学意义,P<0.05。胰腺区域性动脉灌注组白细胞及血小板减少发生率分别为27.8%和25.0%,静脉化疗组分别为71.9%和56.3%。两组比较差异均有统计学意义,χ2值分别为13.189和6.911,P值分别为0.000和0.009。结论:GP方案胰腺区域性动脉灌注是治疗进展期胰腺癌的有效方案,且毒副反应可耐受。     

选择性动脉插管持续灌注化疗治疗晚期胰腺癌的疗效分析

背景与目的：晚期胰腺癌化学治疗效果差。本研究目的是探讨选择性动脉插管持续灌注化疗治疗晚期胰腺癌的临床疗效与应用价值。方法：20例晚期胰腺癌经选择性动脉插管持续灌注化疗。采用Seldinger技术经股动脉插管留置导管12例,经左锁骨下动脉插管植入药盒导管系统8例。导管选择至肿瘤供血动脉持续灌注化疗药物。9例采用THP-ADM HCPT 5-FU／CF方案,11例采用GEM CBP 5-FU／CF方案,4天为一疗程。4～6周重复1次疗程。治疗后观察客观缓解率、临床受益疗效(CBR)和病人的生存时间。结果：客观缓解率10％(CR、PR各1例),临床受益疗效70．0％,6个月及9个月生存率分别为58．8％和39．2％,中位生存期8．8个月。无出现插管合并症。结论：选择性动脉插管持续灌注化疗治疗晚期胰腺癌安全可靠。临床受益疗效良好,可提高患者的生存质量和生存期。值得临床进一步观察研究。     

经动脉灌注健择化疗联合三维适形放射治疗局部晚期胰腺癌的临床疗效分析

目的评价经动脉灌注健择化疗结合三维适形放射治疗局部晚期胰腺癌的疗效。方法51例局部晚期胰腺癌患者，其中24例采用经动脉灌注健择化疗结合三维适形放射治疗（综合治疗组），27例单纯应用经动脉灌注健择化疗（对照组）。结果综合治疗组和对照组临床获益反应有效率分别为91．7％和74．1％，两者差异有统计学意义（P〈0．01）；综合治疗组总有效率（CR＋PR）为70．8％，对照组总有效率（CR＋PR）为33．3％，两组差异有统计学意义（P〈0．01）；综合治疗组和对照组的6、12和24个月生存率分别为83．3％、62．5％、37．5％和55．6％、33．3％、11．1％，两组差异均有统计学意义（P（0．05）。结论经动脉灌注健择联合三维适形放射治疗局部晚期胰腺癌，在提高生存率、延长生存期方面优于单纯经动脉灌注健择化疗。     

动脉灌注结合全身静脉化疗治疗中晚期胰腺癌的临床观察

目的:观察动脉灌注结合全身静脉化疗治疗中晚期胰腺癌的疗效。方法:对12例中晚期胰腺癌患者选择性给予腹腔干动脉和/或肠系膜上动脉灌注吉西他滨和5-氟尿嘧啶,第8天再给予吉西他滨全身静脉化疗。3周为1个治疗周期,完成两个周期后复查CT评价疗效,观察临床受益反应、有效率、生存期及毒副反应。结果:全组患者临床受益率66.7%,有效率(CR PR)16.7%,中位生存时间6.7个月,6个月及9个月累积生存率分别为59.4%、29.6%。毒副反应多为Ⅰ°～Ⅱ°均能耐受。结论:动脉灌注结合全身静脉化疗治疗中晚期胰腺癌可获得较好的疗效,提高生存质量,毒副反应较小,值得临床推广应用。     

经PCS区域动脉灌注健择和5-氟尿嘧啶治疗中晚期胰腺癌的疗效观察

 目的　评价经PCS区域动脉灌注健择和 5 氟尿嘧啶治疗中晚期胰腺癌的疗效和安全性。方法　 36例中晚期胰腺癌患者分为 2组 ,16例行经PCS区域动脉灌注化疗 (B组 ) ,另 2 0例行外周静脉全身化疗 (A组 )。结果　B组临床受益反应有效率为 75 .0 % (12 / 16 ) ,A组为 4 5 .0 % (9/ 2 0 ) (P <0 .0 5 ) ,A组和B组 6个月、1年生存率和中位生存期分别为 35 .0 %、15 .0 %、6 .8个月和 6 8.7%、37.5 %、11.4个月 ,P<0 .0 5。结论　经PCS区域动脉灌注化疗较外周静脉化疗能提高中晚期胰腺癌的临床受益反应、改善生活质量 ,提高远期生存率。