含替尼泊甙联合化疗同时放疗治疗脑恶性胶质瘤

目的 :评价含替尼泊甙的联合化疗治疗恶性脑神经胶质瘤的治疗效果和毒副作用 ,探讨有效的辅助化疗方案 ,以期提高恶性脑神经胶质瘤的疗效 ,延长患者的生存期。方法 :不能手术、术后残留或复发的恶性脑神经胶质瘤 2 5例 ,其中大脑半球胶质瘤 15例 ,包括星形细胞瘤Ⅲ级 11例 ,Ⅳ级 4例 ;脑干胶质瘤 8例 ;小脑胶质瘤 2例。采用含替尼泊甙的联合化疗方案 :1)TV方案 :紫杉醇 135mg m2 ,静脉滴入d1;替尼泊甙 2 0 0mg m2 ,分 3天静脉滴入 ,(d1～d3) ,3周后可重复。 2 )MV方案 :司莫司汀 10 0mg m2 ,d1晚顿服 ,替尼泊甙 (用法同前 ) ,6周后重复。第 1周期化疗后常规局部外放疗 ,DT5 0～ 60Gy。结果 :2 5例患者有效 17例 ,总有效率 68 0 % ,其中大脑半球胶质瘤有效率 60 0 % (9 15 ) ,脑干胶质瘤有效率 87.5 % (7 8) ,小脑胶质瘤有效率 5 0 0 % (1 2 )。经χ2 检验 ,两种化疗方案有效率差异无显著性。主要毒性为骨髓抑制 ,特别是中性粒细胞减少 ,其中Ⅲ、Ⅳ度毒性反应 5例 ,占 2 0 0 % ,经对症处理均恢复正常。远期疗效正在观察中。结论 :替尼泊甙加紫杉醇或司莫司汀联合化疗同时放疗治疗恶性脑胶质瘤安全、有效 ,为脑瘤辅助化疗提供了新方案     

Primary CNS Lymphoma: Treatment with Combined Chemotherapy and Radiotherapy

Primary central nervous system lymphoma (PCNSL) is a relatively uncommon primary brain tumor, but it has become the focus of many clinical trials because of its rising incidence and unique sensitivity to systemic chemotherapeutic agents. Radiotherapy can achieve high response rates and remissions in most patients, but survival is usually only 12–18 months because disease recurs. The addition of systemic chemotherapy, particularly intravenous methotrexate, had markedly improved disease control and many patients can achieve a durable remission and occasionally cure of their disease. Conventional systemic lymphoma drug combinations such as cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) are ineffective. High-dose methotrexate is the single most active and important agent in the treatment of this disease. Whether improved disease control can be accomplished by adding other drugs to high-dose methotrexate or whether it is sufficient as a single agent has yet to be answered. High-dose methotrexate combined with cranial irradiation yields a median survival of at least 40 months and five year survival rates of 22%. However, neurotoxicity is substantial in a significant proportion of patients, particularly those over the age of 60 at the time of treatment. As many as 50% of such patients develop severe dementia. This is particularly important in a disease where approximately half of patients above the age of 60 had presentation. Efforts are now being directed towards not only improving disease control but also minimizing late neurotoxicity. Most efforts are currently directed towards using chemotherapy as the sole modality in the treatment of PCNSL, but both an optimal chemotherapy regimen, and the role of radiotherapy remain to be determined.     

Progress and Challenges in Childhood Brain Tumors

Summary Although many challenges lie ahead, there has been definite progress made in the management of childhood brain tumors. Some of these advances have increased progression-free and overall survival. Other advances, while not improving survival, have resulted in a better quality of life for long-term survivors. Probably the best example of progress is manifest in the outcome of children with medulloblastoma. Seventy percent, and in some subsets as high as 80% of children with this disease can be expected to be cured, compared to approximately 50% three decades ago. This improvement in disease control has been associated with a reduction in the dose of radiotherapy for many patients and possibly an improved quality of survival. For other tumor types, especially brain stem gliomas, there has been little progress made. A primary challenge in the years ahead will be how to integrate biologic discoveries into the care of children for brain tumors, with the hope that molecular biologically based therapy will be more effective and improve the quality of life for survivors.     

放疗联合同步化疗治疗食管癌的临床研究

 目的 研究放疗联合DF方案治疗食管癌临床疗效。方法 68例食管癌患者随机分为两组，综合组36例，采用放疗联合化疗；对照组32例，单纯行常规外照射治疗。结果 综合组总有效率88．89％，对照组总有效率是62．5％，两组间差异有显著性(P<0．05)。综合组与对照组1、2、3年生存率分别为：63．9％、50％、27．8%和59．3％、34．3％、18．8％。综合组生存率高于对照组。结论 放疗配合化疗能提高中晚期食管癌疗效。     

268例儿童脑肿瘤的临床及病理特点分析

  目的  探讨儿童脑肿瘤的诊治经验, 以利于早期诊断、合理治疗、改善预后。  方法  对2005年7月~2010年7月间重庆医科大学附属儿童医院神经外科收治的268例儿童脑肿瘤进行回顾性分析。  结果  268例儿童脑肿瘤中病理类型前5位依次是: 星形细胞瘤87例(32.5%), 髓母细胞瘤50例(18.7%), 室管膜瘤42例(15.7%), 颅咽管瘤32例(12.0%), 生殖细胞肿瘤14例(5.4%)。主要临床表现为头痛、呕吐、肢体瘫痪、步态不稳、抽搐、视力下降, 其中首诊误诊率达19.8%。肿瘤全切230例(85.8%), 次全切29例(10.8%), 大部分切除6例(2.4%), 254例术后治愈出院。术后放射治疗109例, 占手术病例的40.6%;化疗55例, 占手术病例的20.5%。  结论  儿童脑肿瘤临床表现不典型, 病程较长, 误诊率较高, 头颅CT和MRI是诊断的首选方法。手术为治疗首选, Ommaya储液囊外引流治疗脑肿瘤梗阻性脑积水效果较肯定。术后进行放化疗, 对于延长儿童的生存期有效。      

High Dose-Intense Chemotherapy Alone or in Combination with Interleukin-2 for Small Cell Lung Cancer: A Pilot Study

Given the antitumor activity of interleukin-2 (IL-2) against some drug-resistant cancer cells, 17 previously untreated patients with small cell lung cancer entered a pilot study to evaluate the feasibility, efficacy, and immunological effects of combining 12-week high dose-intense chemotherapy based on a modified Evans regimen (CAV/PE) with different IL-2 schedules (6-12 MU/m² week as a 48-72-h infusion using the same cumulative dose, 72 MU/m²). Despite significant myelotoxicity, up to 70% of the intended dose intensity was delivered, showing no differences with regard to the IL-2 schedule used. Immunotherapy-induced toxicity was usually mild and manageable. No limiting effects were observed in patients receiving immunotherapy except for a very poor compliance to the 12-week IL-2 regimen. The low-dose 72-h infusion was the optimal IL-2 schedule. As given in this study, neither of the alternating CAV/PE regimens abrogated the effects of IL-2 on T-cell and NK-cell subsets, showing typical kinetics with rebound in lymphocytes following each discontinuation of the IL-2. While immunological changes cannot predict the antitumor effect of IL-2, they are consistent with those described for IL-2 alone, suggesting its compatibility with high dose-intense chemotherapy. Although no definite advantages have been demonstrated in this small pilot study with significant unbalanced prognostic factors (12% 2-year survival), both the preserved immunostimulatory effects and the lack of limiting overlapping toxicity make this combined approach promising and worthy of further clinical investigation.     

食管癌患者三维适形放疗联合化疗的疗效分析

[目的]分析联合化疗对食管癌三维适形放疗(3D-CRT)疗效的影响。[方法]回顾性分析351例经病理确诊的食管癌患者临床资料,其中258例接受3D-CRT,93例接受3D-CRT联合化疗,比较这两种方法对食管癌的治疗效果。全组总放疗剂量40～72Gy,中位剂量66Gy,常规分割。3D-CRT联合化疗组放疗期间接受PF方案化疗2个周期,部分患者再接受1～2个周期PF方案辅助化疗。[结果]3D-CRT联合化疗组和3D-CRT组的1、2、3年总生存率分别为77.7%、55.4%、44.4%和68.4%、41.4%、32.7%(χ2=5.777,P=0.016),1、2、3年疾病相关生存率分别为79.8%、58.1%、46.5%和70.6%、44.4%、36.0%(χ2=4.445,P=0.035),1、2、3年无复发生存率分别为66.9%、48.3%、41.3%和57.6%、36.9%、29.9%(χ2=4.043,P=0.044)。单因素和因素分析均显示性别、病灶部位和联合化疗是影响预后的重要因素。3D-CRT联合化疗组治疗急性毒性高于3D-CRT组,但均不影响治疗进程,无治疗相关性死亡。[结论]联合化疗能显著提高食管癌患者3D-CRT的总生存率、疾病相关生存率和无复发生存率。女性患者、病灶位于颈段或胸上段和接受联合化疗者有较好的预后。     

HIFU合并化疗治疗腹盆腔复发或转移癌的临床观察

目的:探讨高能聚焦超声刀(Highintensityfocusedultrasound,HIFU)合并化疗治疗腹盆腔复发或转移癌的疗效及不良反应。方法:选取既往病史有过手术和/或放、化疗史,病理诊断明确的腹盆腔复发或转移癌68例,随机分为治疗组(36例)和对照组(32例),前者采用HIFU 化疗,后者单纯用化疗,均在完成2周期化疗后评价其有效率、临床受益反应,并至少随访1年。结果:治疗组完全缓解(CR)1例,部分缓解(PR)24例,总有效率69.4%(25/36),临床受益率(CBR)为83.3%(30/36),平均生存期为9.1±3.1个月;对照组CR0例,PR10例,总有效率31.3%(10/32),CBR为56.3%(18/32),平均生存期为6.8±2.4个月;两组比较有显著性意义(P<0.01、P<0.05、P<0.01),主要不良反应为骨髓抑制和消化道反应,两组间比较无统计学差异,治疗组无脏器穿孔、大出血、胰漏、腹膜炎等并发症发生。结论:HIFU合并化疗治疗腹盆腔复发或转移癌可取得较高的局控率和临床受益率,并能延长其生存期,对于无手术和(或)放疗适应症的晚期腹盆腔恶性肿瘤不失为一种安全、有效的高姑息治疗手段。     

卡培他滨单药与联合化疗治疗老年女性晚期乳腺癌的临床研究

[目的]观察老年女性晚期乳腺癌应用卡培他滨单药与联合化疗疗效与耐受性的差别。[方法]65岁以上晚期老年女性乳腺癌患者分为卡培他滨单药组34例和联合化疗组23例，单药组给予卡培他滨1250mg/m^2，每日2次，服2周停1周：联合化疗组给予下列二联药物，如紫杉醇135mg／m^2（d1）、多西他赛75mg／m^2（d1）、长春瑞滨25mg/m^2（d1.8）、吉西他滨800mg／m^2（d1.8）或卡培他滨800mg／m^2，每日2次，单药组与联合化疗组完成疗程数分别为4．2±0．9和2．5±0．7。[结果]卡培他滨单药组和联合化疗组有效率（CR＋PR）分别为28．2％和31．8％，TTP分别为7．7±2．1个月和8．2±1.8个月，总生存期分别为13．7±3．9个月和15．0±4．5个月。联合化疗组3／4度毒性反应明显，如白细胞降低（P=0．03）、G—CSF支持治疗增加（P=0．0009）和乏力（P=0．005）等，卡培他滨单药组3度手足综合征比联合组略多（P=0．07）。[结论]卡培他滨单药对老年女性晚期乳腺癌疗效与耐受性好。     

32P内放疗加VM26灌注联合治疗55例脑肿瘤的疗效观察

目的：探讨内放疗联合动脉内灌注化疗治疗颅内肿瘤的效果。方法：采用立体定向^32P注入加动脉内灌注VM26化疗的方法，对55例颅内肿瘤进行治疗。结果：随访时间为6个月－5年。CT扫描复查，8例肿瘤消失，43例肿瘤体积缩小，其中25例肿瘤体积缩小＞75％，11例缩小50％－75％，8例缩小25％－49％，4例无变化。结论：采用立体定向^32P间质内放疗加选择动脉灌注VM26化疗，联合治疗颅内肿瘤是有效的。     

Combination Fusion Protein Therapy of Refractory Brain Tumors: Demonstration of Efficacy in Cell Culture

Primary brain tumors including anaplastic astrocytomas and glioblastoma multiforme are difficult to treat because of their locally invasive nature and relative resistance to chemotherapy and radiation therapy. Novel agents that can kill multi-drug resistant tumor cells and reach tumor cells at distant sites in the brain are needed. One such class of agents is fusion proteins which consist of brain-tumor-selective peptide ligands fused to peptide toxins. The ligand directs the protein to the glioma cell surface; the peptide toxin is then internalized into the cell, translocates to the cytosol and catalytically inactivates protein synthesis leading to cell death. Fusion proteins are toxic to multi-drug resistant brain tumor cells. Because of the large molecular weight of these molecules, a unique delivery system has been developed – convection-enhanced delivery (CED). The method creates a bulk flow which supplements diffusion and achieves drug concentrations in the brain parenchyma orders of magnitude greater than by systemic administration. Patients with recurrent glioma treated with individual fusion protein CED have obtained clinical remissions lasting years. However, toxicities to normal brain have been observed and relapses ultimately occurred. To address the clinical need of these patients and improve upon the therapeutic index observed to date with single fusion protein CED, we generated a novel fusion protein DAB₃₈₉EGF and tested it in combination with another active fusion protein, IL13PE38QQR. We observed potent glioma cytotoxicity with each fusion protein and synergistic toxicity with the combination. Further, brain tumor cells showed heterogeneous expression of individual receptors suggesting that the combination – DAB₃₈₉EGF and IL13PE38QQR may show improved efficacy and should undergo further preclinical development for therapy of patients with relapsed high-grade gliomas.     

13例脑干肿瘤临床病理分析

 介绍我院1992～1993年间手术切除脑干肿瘤13例，常规切片，HW染色，按kernohan分类法分类，计星形细胞瘤9例，蛛网膜囊肿1例，毛状型星形细胞瘤4例。结合文献着重对毛状型星形细胞瘤进行讨论，认为本型脑干肿瘤并不少见，应引起重视，其本质是星形细胞瘤，只是为适应脑干的解剖学特点而形成特有组织学图象，属低度恶性肿瘤，预后好。     

全脑放疗联合替莫唑胺同期化疗在脑转移瘤治疗中的疗效观察

目的 探讨联合使用全脑放疗和替莫唑胺治疗脑转移瘤的疗效.方法 将160例脑转移瘤患者随机分为对照组和观察组,每组各80例.对照组使用全脑放疗进行治疗.使用6mV-X线全脑放射治疗,全脑两侧对穿野等中心放射治疗,DT 30 Gy/10次,5次/周.观察组在全脑放射治疗的基础上使用替莫唑胺75 mg/m2/d进行治疗,连续口服14 d进行.观察2组患者治疗后的近远期疗效以及治疗过程中出现的副作用.结果 观察组总有效率为87.50%,显著高于对照组中的53.75%.对照组和观察组在3个月的生存期上没有统计学差异(P>0.05);在6个月生存率和1年生存率上,观察组显著高于对照组(P<0.05).中位生存期的比较上,观察组显著优于对照组(11.8 v.s.6.4,P<0.05).2组患者治疗过程中均没有出现无法耐受的严重副作用(Ⅳ级);在白细胞、血红蛋白和血小板等骨髓抑制的指标中,观察组出现副作用的发生率显著高于对照组,但是经过对症治疗后,患者均可以耐受;在恶心呕吐和头疼的副作用发生率和等级分布上,2组患者没有统计学差异(P>0.05).结论 全脑放疗联合使用替莫唑胺治疗脑转移瘤,可以显著提高患者总的缓解率,并能够显著延长患者的生存期和提高生存率,且副作用均可耐受,值得临床推荐使用.     

化放疗、放疗和化疗治疗肺癌脑转移的疗效评价

目的评价化放疗、放疗和化疗治疗肺癌脑转移的疗效。方法化疗加放疗32例,放疗19例,化疗11例。结果化放疗组、放疗组和化疗组的中位生存期分别为6．9月、5．8月、3．6月;1年生存率分别为28．1％、21．1％、0％。化放疗组的疗效虽稍优于放疗组,但在统计学上差异无显著性（P＞0．05）。而化放疗组及放疗组明显好于化疗组（P＜0．05）。结论化放疗及放疗特别是化放疗是治疗肺癌脑转移的有效治疗方案。     

力尔凡合并化、放疗治疗恶性肿瘤的多中心临床研究

目的：评价力尔凡合并化、放疗治疗肿瘤患者的初步疗效和安全性,同时观察对患者免疫功能的影响。方法：157例恶性肿瘤患者,男84例,女73例;分小细胞肺癌（SCLC）、晚期乳腺癌（ABC）和非霍奇金淋巴瘤（NHL）化疗组及非小细胞肺癌（NSCLC）放疗组等4组,每组再随机分为力尔凡治疗组和对照组。结果：近期疗效：小细胞肺癌、晚期乳腺癌和非霍奇金淋巴瘤化疗治疗组的有效率分别为63.2%、71.4?.7%;对照组分别为41.2%、42.1%和63.2%,各化疗治疗组与对照组之间均有显著性差异。放疗治疗组有效率为57.1%,而对照组为20%,两组亦有显著性差异。免疫功能：力尔凡治疗组疗后PPD试验阳性率、NK细胞数、T细胞总数均有明显上升,T8细胞数治疗组疗后则下降,CD4/CD8治疗组疗后亦有一定程度地升高。力尔凡治疗组白细胞下降幅度时显低于对照组。发热、消化道等毒副反应治疗组与对照组之间无显著性差异。结论：本组资料说明力尔凡在一定程度上可增强化、放疗的抗肿瘤作用,提高患者的免疫功能,对抗化、放疗所致的白细胞下降,临床使用耐受性良好。     

宫颈癌局部化疗+ 放疗的临床与病理研究

 目的　提高宫颈癌对放射线的敏感性 ,改善晚期患者的生存率。方法　对 5 4例晚期宫颈癌采用小剂量顺铂宫颈局部化疗加放疗 ,对照组 5 2例常规放疗。观察临床疗效、组织学改变。结果　放疗达总量 1 /7及 1 /2时 ,二组肿瘤消除 ,均有显著性差异 ( P<0 .0 1 )。组织学观察局部化疗前后有显著性变化 ,癌组织明显坏死 ,癌细胞变性坏死 ,凋亡细胞增多、组织学分级提高等。结论　小剂量顺铂宫颈局部化疗是一种理想的放射增敏剂及其方法 ,为晚期宫颈癌患者的预后带来新的希望。     

Intermediate and High-Grade Gastric Non-Hodgkin's Lymphoma: A Prospective Study of Non-Surgical Treatment with Primary Chemotherapy, with or without Radiotherapy

The role of surgery as initial treatment in gastric lymphoma remains controversial. We have prospectively evaluated a stomach conservation strategy in histologically aggressive gastric lymphoma, using primary adriamycin-containing chemotherapy, followed by involved-field radiotherapy in patients with limited disease. Twenty-six patients (median age 69 years) were entered in this study; 15 had stage I disease, 7 had stage II disease and 4 had stage IV disease. The chemotherapy combinations were CHOP (18 patients) and ProMACE/MOPP (8 patients). Radiotherapy was given to 11 patients. Of the 24 patients evaluated for response, 18 (75%) achieved endoscopically-confirmed complete response and 4 (17%) partial response. During follow-up (median 22 months), none of the complete responders developed recurrent lymphoma. Gastric resection was performed in 1/26 patients who did not respond to primary chemotherapy. There were no cases of perforation, but three patients (12%) developed acute gastro-intestinal bleeding a few days after the onset of chemotherapy, one of whom required a surgical devascularization procedure. There was no treatment-related mortality. These data further support the non-surgical approach in histologically aggressive gastric lymphoma, using primary chemotherapy with or without radiation therapy.     

38例肺源性脑转移瘤临床病理分析

目的 肺源性脑转移瘤临床病理特征。方法 研究38例肺源性脑转移瘤的临床和病理特点,男性27例,女性11例;年龄在30-74岁之间。其中5例转移性癌作免疫组织化学染色和电镜观察。结果 20例为腺癌,12/20为乳头状腺癌;5例为腺鳞癌,7例为鳞形细胞癌,4例为燕麦细胞癌,2例为不典型类癌;5例乳头状腺癌作免疫组织化学染色示CK(5/5)和CEA(4/5)为阳性;电镜显示转移性乳头状腺癌具有肺泡Ⅱ型上皮细胞分化潜能。结论 肺癌中腺癌更易发生脑转移,免疫组织化学在鉴别诊断中有一定的辅助作用,转移性乳头状腺癌具有异质性。     

Desmoplastic Small Round Cell Tumor: Report of 2 Cases Treated with Chemotherapy Alone or in Combination with Bevacizumab

Here, we present 2 case reports of patients with desmoplastic small round cell tumor (DSRCT), a very rare and aggressive mesenchymal cancer, and we discuss 2therapeutic options for this sarcoma. This report focuses on men aged 22 and 37 years, respectively. The first patient presented with an abdominopelvic mass which was not suitable for surgery. He underwent chemotherapy (adriblastina and cisplatin) with a brief partial remission and survival time of 13 months. The second patient presented with an abdominal mass and underwent partial resection. He received chemotherapy and bevacizumab, resulting in a partial remission and a survival time of 34 months. The extent of surgery and monoclonal antibody use probably had a positive impact on survival. It is necessary to include specific targeted therapies in an attempt to improve survival. Surprisingly, positron emission tomography was not effective in restaging of the second patient, emphasizing the importance of computed tomography or magnetic resonance in DSRCT.Key words: Desmoplastic small round cell tumor, Chemotherapy, Abdominal tumor, Bevacizumab