晚期乳腺癌的化学治疗及应用策略

乳腺癌是女性最常见的恶性肿瘤之一，在我国一些大城市，乳腺癌发病率占女性恶性肿瘤的第一位或第二位，病死率占第四位或第五位。虽然由于诊断和治疗水平的进步，乳腺癌患者的病死率逐年下降，但仍有大约30％的患者在术后五年内复发或转移。     

晚期乳腺癌的介入治疗

目的:研究晚期乳腺癌超选择内、外乳动脉插管的介入治疗。方法:通过Seld inger氏股动脉插管,超选择内、外乳动脉灌注化疗+明胶海绵栓塞治疗晚期乳腺癌。结果:4例患者乳腺肿块明显缩小,3例患者轻度缩小,1例无改变,其临床症状均减轻或消失。结论:通过本组患者治疗前、后对比分析,该方法是治疗晚期乳腺癌的较为理想的方法。     

节拍化疗在乳腺癌晚期治疗中的临床应用进展

目的:对节拍化疗在乳腺癌晚期治疗中的临床应用进展进行分析和探讨.方法:以我院2014年3月-2017年5月期间收治的100例乳腺癌晚期患者为研究对象,根据随机双盲原则将患者分为观察组和对照组两组,每组50例,观察组患者接受小剂量卡培他滨节拍化疗,对照组患者接受卡培他滨常规化疗,比较两组患者临床疗效和治疗安全性.结果:观察组和对照组两组患者的ORR、DCR相当(P>0.05);与此同时,维持治疗期间,观察组患者各项毒副总发生率以及严重程度均显著低于对照组患者(P<0.05).结论:节拍化疗是治疗晚期乳腺癌的有效途径,其不仅有着较常规化疗相当的治疗效果,同时还可有效减轻患者因化疗而出现的毒副反应,提高患者化疗安全性.     

晚期乳腺癌患者化疗前后血清VEGF变化的临床意义

目的:通过测定乳腺癌患者化疗前、后血清中血管上皮生长因子(VEGF)的浓度变化,以期观察血清VEGF与乳腺癌患者化疗疗效之间的相关性。方法:采用酶联免疫吸附法(ELISA)分别检测60例乳腺癌患者化疗前、后血清VEGF水平,以20名正常健康志愿者血清VEGF水平作为对照。结果:乳腺癌组化疗前血清VEGF含量明显高于对照组(P<0.01),化疗后血清VEGF显著下降(P<0.01)。结论:连续检测血清VEGF的表达水平能在一定程度上帮助临床判断化疗近期疗效及监测肿瘤的进展。     

晚期浸润性乳腺癌治疗策略

文章对晚期浸润性乳腺癌的诊疗策略及预后等进行介绍.     

晚期乳腺癌术前全身化疗和介入治疗的疗效差异性

目的探讨晚期乳腺癌术前全身化疗和介入治疗的疗效差异性。方法 2011年1月—2013年12月苏州大学附属第一医院共900例晚期乳腺癌患者,其中符合IIb、IIIa、IIIb的患者共200例。按随机数字表法分为2组,全身化疗组100例和介入治疗组100例。介入治疗组穿刺股动脉,送入5F单弯椎动脉导管到肿瘤供血主要动脉,将化疗药物表阿霉素（50 mg/m^2）、环磷酰胺（450 mg/m^2）、5-氟尿嘧啶（600 mg/m^2）分别溶解于40 m L的无菌生理盐水中,通过5F单弯椎动脉导管注入。共进行3个疗程。全身化疗组化疗药物表阿霉素（50 mg/m^2）、环磷酰胺（450 mg/m^2）、5-氟尿嘧啶（600 mg/m^2）加入100 m L的无菌生理盐水中,缓慢通过静脉滴注,共进行4个疗程。评价全身化疗组和介入治疗组：1术前TNM分期。2化疗前和化疗后肿块大小变化（肿块在B超下最大长径乘以最大宽径）、不良反应发生情况。结果全身化疗组和介入治疗组术前IIb、IIIa、IIIb比例分别为34、50、26;36、50、24,差异无统计学意义（P〉0.05）,全身化疗组和介入治疗组化疗前肿块大小分别为（21.3±8.4）、（22.8±7.9）,差异无统计学意义（P〉0.05）;全身化疗组和介入治疗组化疗后肿块大小分别为（20.7±7.2）、（9.5±4.1）,差异有统计学意义（P〈0.05）,全身化疗组和介入治疗组化疗期间不良反应发生率分别为4%、5%,差异无统计学意义（P〉0.05）。结论晚期乳腺癌患者术前行介入治疗比全身化疗缩小肿瘤大小效果更好,不良反应两者无差异,为手术提供较好的条件。     

新辅助化疗应用于局部晚期乳腺癌的疗效分析

目的探讨术前新辅助化疗对乳腺癌的疗效及提高患者术后生存率的作用.方法采用CMF和CAF两种化疗方案对50例Ⅲ期乳腺癌术前患者(A组)进行化疗,评价其疗效;与术后化疗(B组)进行总疗效对照比较.结果术前新辅助化疗组经化疗肿瘤全消和部分消退合计总有效率为58.0%;术后随访5 a生存率、无瘤存活率明显高于对照B组,两组无瘤存活率比较χ2＝9.07,P＜0.01.结论术前全身治疗(化疗)作为乳腺癌第一步治疗可能是首先使已存在的临床小转移灶得以控制,进而获得更多治疗成功的机会.     

PICC导管在乳腺癌术后化疗中的应用及护理

目的 应用PICC导管(经外周静脉插入中心静脉导管)为乳腺癌术后化疗患者建立深静脉通道,观察其临床效果.方法 经患者健侧上肢静脉、肘正中静脉、头静脉,将PICC导管置入上腔静脉或锁骨下静脉行静脉化疗.结果 78例患者全部置管一次成功,留置时间均为首次和大剂量化疗,导管留置20周以上,无1例发生药物渗漏性血管和皮肤损伤及导管护理并发症,全部顺利完成化疗.结论 行PICC置管化疗并进行正确的导管护理,可以避免化疗药物产生的局部不良反应,为患者减轻痛苦,操作方便,安全可靠,保留时间长,值得临床广泛推广应用.     

紫杉醇+DDP新辅助化疗治疗局部晚期乳腺癌疗效观察

目的探讨新辅助化疗在局部晚期乳腺癌治疗中的应用.方法回顾性分析32例局部晚期乳腺癌患者进行新辅助化疗的临床资料.结果32例患者中30例经辅助化疗后病情缓解,可以手术.结论大多数局部晚期乳腺癌患者可以在2～3个疗程的新辅助化疗后病情缓解便于手术治疗,从而改善预后.     

吡柔比星为主的新辅助化疗治疗局部晚期乳腺癌疗效观察

目的:探讨吡柔比星为主的新辅助化疗治疗局部晚期乳腺癌临床治疗效果。方法:采用回顾性分析的方法,分析收治的局部晚期乳腺癌患者临床资料,依据治疗方式不同分为对照组30例和观察组(吡柔比星为主的新辅助化疗治疗组)30例。结果:观察组局部晚期乳腺癌患者总缓解率明显高于对照组,观察组恶心呕吐、皮疹、腹泻、中性粒细胞减少、贫血、口腔溃疡、血小板计数减少、肝功能异常等不良反应均低于对照组,差异均有统计学意义(P<0.05)。结论:吡柔比星为主的新辅助化疗治疗局部晚期乳腺癌病灶缓解率明显,不良反应较少,值得临床推广应用。     

晚期膀胱移行细胞癌的化疗进展

膀胱癌是最常见的泌尿生殖系肿瘤之一.其中移行细胞癌占90%～95%,余下的肿瘤中鳞状细胞癌约占3%,腺癌约占2%,小细胞癌约占1%[1].移行细胞癌的生物学行为不同于其他类型的膀胱肿瘤,属于化疗敏感性肿瘤[2].膀胱移行细胞癌患者中25%在就诊时已属浸润性肿瘤,另外75%就诊时的浅表性肿瘤经积极治疗后,仍有5%～20%会发展为浸润性肿瘤.     

介入化疗治疗进展期乳腺癌的意义

目的探讨介入化疗在进展期乳腺癌治疗中的意义.方法随机将236例Ⅲ、Ⅳ期乳腺癌病人分为三组介入化疗单一用药组11人,联合用药组24人,未介入化疗201人,随访观察疗效.结果联合用药CR+PR=75%,单一用药CR+PR=27.3%,总有效率为60%,二者有显著差异(P＜0.01),其中介入化疗病人局部复发率5.7%,局部复发率低于未介入化疗对照组25.6%.结论术前介入化疗可有效缩小原发灶,降低局部复发率,为进展期乳腺癌病人创造了手术条件,提高了手术治愈率.     

Chemotherapy and radiotherapy of bronchial carcinoma

The treatment of lung cancer is important as it represents a global health burden. Many therapies are used including surgery, radiotherapy, chemotherapy, laser therapy, stenting, supportive care and biological agents. Treatment for individual patients is best assessed by a multidisciplinary approach. This article focuses on treatment with chemotherapy and radiotherapy.     

The hematopoietic growth factor GM-CSF in chemotherapy for advanced breast carcinoma

A non-randomized study was carried out in the Free University Hospital, Amsterdam, to investigate the (hematologic) toxicity and antitumor response of patients with advanced breast cancer treated with intensive chemotherapy in combination with granulocyte-macrophage colony-stimulating factor (GM-CSF). Of 11 patients with an inoperable or metastasized breast cancer, 5 were treated with doxorubicin 75 mg/m2 + cyclophosphamide 750 mg/m2 intravenously every 3 weeks and 6 patients with 90 and 1000 mg/m2 respectively. When in a preceding cycle a significant hematologic toxicity was observed, this patient was treated in the subsequent cycle with the same dose of chemotherapy in combination with GM-CSF 250 micrograms/m2/day from day 2-12 as a continuous infusion. Bone marrow depression was diminished in the presence of GM-CSF. This was apparent from a milder decline of the number of neutrophilic granulocytes, reduction of the neutropenic period and a more rapid recovery of the neutrophil number. A transient eosinophilia and a mild monocytosis were also observed. GM-CSF did not improve erythrocyte and thrombocyte counts. The efficacy of GM-CSF was less pronounced in the group of patients with the highest dose of chemotherapy. GM-CSF was associated with malaise, fever and a small decrease of blood pressure, which in combination with a frequently occurring anemia and the side-effects of high dose chemotherapy, resulted in a substantial toxicity. In 9/11 patients an objective tumor regression was noted. GM-CSF stimulated the recovery of granulocytes after intensive chemotherapy. Treatment of a small group of patients with advanced breast cancer with intensive chemotherapy resulted in a high antitumor response.     

Chemotherapy of patients with colorectal carcinoma

Colorectal cancer is a frequently occurring malignancy in the western world. In the Netherlands, there are more than 9000 new patients annually. Approximately half of the patients die of their disease within 5 years. In 2004, several therapeutic studies were presented, the results of which may have a positive impact on the prognosis of a large proportion of patients. This concerns the adjuvant treatment of stage II and III colon carcinoma and the palliative systemic treatment of distant metastases of colorectal carcinoma. In stage II colon carcinoma, the absolute benefit of adjuvant treatment is 3-4%. This must be balanced against the burden of such treatment. Adjuvant treatment with fluorouracil-folinic acid-oxaliplatin is indicated in stage III colon carcinoma and should be considered for patients with stage II colon cancer in whom the prognosis is unfavourable. For patients for whom treatment with fluorouracil-folinic acid-oxaliplatin does not seem suitable, adjuvant treatment with capecitabine is indicated. Treatment with bevacizumab, a monoclonal antibody against vascular endothelial growth factor, in combination with chemotherapy is considered to be standard practice in first-line treatment. Together with the expected rise in the incidence of colorectal cancer, these developments will have a significant impact on healthcare, both in terms of organization and budget.     

Locally advanced and inflammatory breast cancer

This tenth article in our series on breast disease focuses on locally advanced breast cancer and inflammatory breast cancer -- both associated with a high risk of subsequent distant metastases.