拉米呋定预防化疗中乙型肝炎活动的临床分析

目的:分析研究合并乙型肝炎病毒(HBV)感染的肿瘤患者预防应用拉米呋定是否减少化疗中乙型肝炎病毒再活化。方法:回顾性分析本科2000年2月～2005年8月收治的39例合并HBV感染的需化疗的乳腺癌、非小细胞肺癌、非霍杰金淋巴瘤(NHL)和骨肉瘤患者的治疗方法,按是否从化疗前1周开始口服拉米呋定分为:治疗组18例,对照组21例。前者口服拉米呋定,至化疗后6个月。比较化疗后肝功能损害、急性肝炎、HBV再活化和化疗延迟等指标的变化。结果:两组比较,治疗组肝功能损害发生率无显著性差异(55.6%vs.42.9%,P=0.429),急性肝炎发生率明显下降(11.1%vs.57.1%,P=0.006),HBV再活化发生率下降(5.6%vs.38.1%,P=0.023),而化疗延迟发生率下降(16.7%vs.61.9%,P=0.008)。结论:预防性口服拉米呋定可能可以有效抑制HBV复制和肝炎活动,值得进一步研究。     

大肠癌术后门静脉置泵灌注化疗预防肝转移临床疗效分析

目的：探讨大肠癌术后门静脉置泵灌注化疗预防肝转移的临床疗效。方法：46例大肠癌患者随机分成治疗组和对照组，治疗组术后自门静脉化疗泵注药（5-FU、MMC和EPI），对照组自周围静脉注药。结果：治疗组5年生存率55．00％（11／20），肝转移率12．50％（3／24）；对照组5年生存率33．33％（6／18）；肝转移率27．27％（6／22）；两组相比差异有统计学意义，P〈0．01。结论：大肠癌术后门静脉置泵灌注化疗预防肝转移效果好。5年生存率明显提高。     

思密达控制肿瘤化疗患者消化道反应的临床观察

恶心呕吐是肿瘤化疗患者的重要并发症,它的控制与否不仅关系到肿瘤患者生存质量的好坏,而且还会影响到患者能否完成规定的化疗,因此肿瘤化疗患者恶心呕吐等消化道反应的控制与否一直是临床医生十分关注的问题。我们于１９９６年５月—１９９７年１２月试用思密达于肿瘤...     

恶性肿瘤患者化疗后的生育力

越来越多的恶性肿瘤,如恶性淋巴瘤、急性白血病、男女生殖系统肿瘤等,随着治疗方法的改善,病人生存期和婚育的数量上都有增加。伴随而来的是那些生育年龄中的肿瘤患者,因为接受了细胞毒药物的治疗,其远期毒性——尤其是对生育力的影响,已引起学者和患者的普遍关注,作者对这方面的有关资料综述如下。     

大肠癌术后门静脉置泵灌注化疗预防肝转移临床疗效分析

目的:探讨大肠癌术后门静脉置泵灌注化疗预防肝转移的临床疗效。方法:46例大肠癌患者随机分成治疗组和对照组,治疗组术后自门静脉化疗泵注药(5-FU、MMC和EPI),对照组自周围静脉注药。结果:治疗组5年生存率55·00%(11/20),肝转移率12·50%(3/24);对照组5年生存率33·33%(6/18);肝转移率27·27%(6/22);两组相比差异有统计学意义,P<0·01。结论:大肠癌术后门静脉置泵灌注化疗预防肝转移效果好。5年生存率明显提高。     

核苷类似物防治乙型肝炎表面抗原阳性的肿瘤患者化疗后乙型肝炎病毒再激活的临床分析

目的 探讨应用核苷类似物防治乙型肝炎表面抗原(HBsAg)阳性的非肝脏肿瘤患者化学治疗后乙型肝炎病毒(HBV)再激活的疗效.方法 回顾性分析58例HBsAg阳性肿瘤患者的治疗及结果 .58例患者分为预防组和对照组,预防组于化疗前预防性使用核苷类似物抗HBV治疗,比较两组HBV再激活的发生情况;对照组根据化疗后使用抗HBV药物与否及使用时段,比较未用抗HBV药物者(A组)、HBV再激活后方使用抗HBV药物者(B组)和尚未发生HBV再激活即使用抗HBV药物者(C组)之间的病情发展、转归及疗效等.结果 预防组22例患者中,仅3例(13.6%)发生HBV再激活,且肝炎发病程度明显轻于对照组,无重型肝炎及死亡病例.对照组36例患者中,22例(61.1%)发生HBV再激活,重型肝炎发病率(27.8%)和死亡率(16.7%)均高于预防组,肝功能损害程度亦高于预防组.在对照组中,A组5例患者均因肝功能衰竭死亡;B组13例患者中,4例发展为重型肝炎,其中1例死亡;C组18例患者中,4例出现HBV再激活,但其肝炎发病程度、病情转归、疗效均优于B组.结论 HBsAg阳性的肿瘤患者接受化疗前即预防性使用核苷类似物抗HBV治疗可有效减少HBV再激活概率.若已行化疗,及时加用核苷类似物抗HBV治疗,仍可在很大程度上减少HBV再激活的概率.即使已经出现HBV再激活,加用核苷类似物也有助于患者肝功能的恢复,改善预后.     

核苷类似物防治乙型肝炎表面抗原阳性的肿瘤患者化疗后乙型肝炎病毒再激活的临床分析

目的 探讨应用核苷类似物防治乙型肝炎表面抗原(HBsAg)阳性的非肝脏肿瘤患者化学治疗后乙型肝炎病毒(HBV)再激活的疗效.方法 回顾性分析58例HBsAg阳性肿瘤患者的治疗及结果 .58例患者分为预防组和对照组,预防组于化疗前预防性使用核苷类似物抗HBV治疗,比较两组HBV再激活的发生情况;对照组根据化疗后使用抗HBV药物与否及使用时段,比较未用抗HBV药物者(A组)、HBV再激活后方使用抗HBV药物者(B组)和尚未发生HBV再激活即使用抗HBV药物者(C组)之间的病情发展、转归及疗效等.结果 预防组22例患者中,仅3例(13.6%)发生HBV再激活,且肝炎发病程度明显轻于对照组,无重型肝炎及死亡病例.对照组36例患者中,22例(61.1%)发生HBV再激活,重型肝炎发病率(27.8%)和死亡率(16.7%)均高于预防组,肝功能损害程度亦高于预防组.在对照组中,A组5例患者均因肝功能衰竭死亡;B组13例患者中,4例发展为重型肝炎,其中1例死亡;C组18例患者中,4例出现HBV再激活,但其肝炎发病程度、病情转归、疗效均优于B组.结论 HBsAg阳性的肿瘤患者接受化疗前即预防性使用核苷类似物抗HBV治疗可有效减少HBV再激活概率.若已行化疗,及时加用核苷类似物抗HBV治疗,仍可在很大程度上减少HBV再激活的概率.即使已经出现HBV再激活,加用核苷类似物也有助于患者肝功能的恢复,改善预后.     

化疗致乙肝病毒再激活研究进展

全世界超过1/3人感染过乙型肝炎病毒,保守估计,约有3.5亿的携带者,其中75%人生活在东南亚和西太平洋地区,超过8%人为慢性携带者[1].我国人群乙肝病毒表面抗原(HBsAg)携带率为9.72%.高HBsAg 携带率的地区在东南沿海一带, 包括广东、广西、福建、浙江、海南、江西以及内陆的西藏等地区.     

恶性肿瘤化疗与乙肝病毒再激活及相关高危因素的临床分析

目的探讨HBV感染的恶性肿瘤患者化疗后,乙型肝炎病毒(HBV)再激活及肝功能损害的发生情况及其与预后的关系。方法选择经组织学或细胞学检查确诊为恶性肿瘤且需化疗的患者80例,其中观察组40例,HbsAg阳性;对照组40例,HbsAg阴性,HBV-DNA阴性。结果观察组20.0%(8/40)患者出现乙肝病毒激活,化疗后HBV-DNA水平较化疗前增高(P<0.001);观察组化疗后肝功能损害发生率达57.5%(23/40),明显较对照组[27.0%(10/40)]高,P=0.033。化疗后HBV激活者肝功能损害较HBV非激活者明显,P<0.001。激素和蒽环类的应用,是乙肝病毒激活的高危因素。结论 HBV感染的癌症患者接受化疗时存在HBV激活,肝功能损害较非HBV感染者严重,激素与蒽环类的应用是HBV再激活的高危因素。     

Oral Chemotherapy for the Older Patient with Cancer

Oral chemotherapy presents a number of theoretical advantages in older cancer patients, including convenience of administration and dosage flexibility. Of the oral fluorinated pyrimidines, capecitabine is the most promising, because it minimizes the exposure of normal tissue to the active drug and substantially reduces the risk of mucositis, that is particularly common and severe in the aged. Despite promising initial results, oral etoposide does not offer any special advantage over the intravenous formulation for older patients, while oral temozolomide may have a role in the palliation of malignant melanoma and primary and secondary brain tumors. Of the experimental agents, oral platinum (satraplatin) and oral taxane formulations appear to be the most promising for minimization of the toxicity of the corresponding intravenous drug. Of special interest are tumor-specific agents, including inhibitors of tyrosine phosphokinase (e.g. imatinib mesylate) and angiogenesis. In conclusion, oral chemotherapy of cancer appears to be a very promising option for older patients.     

HBsAg阴性HBcAb阳性肿瘤患者化疗后HBV再激活3例报道并文献复习

目的：探讨乙肝表面抗原（HBsAg）（-）核心抗体（HBcAb）（+）肿瘤患者化疗后引起乙型肝炎病毒（HBV）再激活的治疗与监控。方法：报道3例HBsAg（-）HBsAg（+）的肿瘤患者化疗过程中出现HBV再激活的病例,针对可行的治疗监控措施进行文献复习。结果：1例最初乙肝表面抗体（HBsAb）（+）、HBcAb（+）的非霍奇金淋巴瘤（NHL）患者经过多次化疗后转变为HBsAg（+）、e抗原（HBeAg）(+)、HBcAb（+）;1例乙肝e抗体（HBsAb）（+）、HBcAb(+)的霍奇金淋巴瘤（NL）患者化疗后乙肝模式未改变,乙肝病毒载量（HBV-NDA）定量结果增高;1例HBsAb(+)、HBeAb(+)、HBcAb(+)的肝癌患者性肝动脉化疗栓塞术（TACE）后出现HBV-DNA定量结果增高。3例HBsAg(-)患者化疗后均出现HBV再激活,经抗病毒治疗后获得良好转归。结论：不仅对于HBsAg（+）的患者,对于即使处于康复期的既往有急性或慢性乙肝病史的HBsAg(-)、HBcAb（+）患者,在应用化疗或免疫抑制剂治疗时均需严密监测血清HBsAg、肝功能及HBV-DNA定量的动态变化,必要时实施预防性抗病毒治疗,以免中止原有治疗计划延误病情。     

Major Clinical Impact of Platinum-Based Chemotherapy in a Patient with a Borderline Ovarian Cancer

A patient with extensive and painful chest wall involvement from a metastatic borderline cancer of the ovary was treated with a carboplatin plus paclitaxel chemotherapy regimen. She achieved a rather dramatic improvement of pain control, a significant biochemical response with 75% reduction of the CA-125 antigen level, but only limited radiographic tumor regression. This experience emphasizes the potential clinical utility of platinum-based cytotoxic chemotherapy in the setting of symptomatic advanced borderline ovarian cancer.Key Words: Borderline ovarian cancer, Chemotherapy of ovarian cancer, CarboplatinEpithelial ovarian cancer is among the most chemotherapy sensitive solid tumors with anticipated major objective response rates of 70-80% to several primary platinum-based combination chemotherapy regimens [1]. Even in the setting of recurrent disease, patients who have not received chemotherapy for more than 18 to 24 months may be anticipated to achieve partial remission rates of more than 60% following reintroduction of this class of cytotoxic drugs [2,3,4]. Further, available data document the biological and clinical activity of a number of non-platinum-based strategies in both the recurrent and platinum-resistant settings, as well as the favorable impact of such treatment on overall survival [5,6,7,8].However, for one group of epithelial ovarian malignancies there remains uncertainty regarding the benefits associated with the administration of cytotoxic anti-neoplastic agents, including the platinum drugs.Most borderline ovarian cancers present at an early stage where surgical treatment alone is curative in the large majority of cases [9,10,11]. However, this malignancy can progress in a manner essentially identical to that observed with the higher-grade epithelial cancers involving this organ, despite the fact that patients with this condition generally exhibit a far more indolent natural history even when initially presenting at an advanced stage [10,11,12,13].Although limited evidence to the contrary exists [14], considerable published literature has questioned the clinical utility associated with the administration of chemotherapy to women with borderline ovarian cancers [14,15,16]. The essential argument is that the anticipated very low objective response rate and uncertain impact of anti-neoplastic drug treatment on survival leads to the suggestion that patients are unlikely to benefit from cytotoxic chemotherapy [14,15,16]. These conclusions are supported by data demonstrating the quite modest activity of current chemotherapy in low-grade serous ovarian cancer [17].A recently managed patient with extensive chest wall involvement from a metastatic borderline ovarian tumor challenges this negative perspective, at least as regards the potential favorable impact of cytotoxic chemotherapy in the provision of symptomatic relief and substantially influencing overall clinical management.     

胃癌围手术期FM方案化疗的临床研究

为探讨胃癌围手术期保驾化疗的可行性及临床意义,421例胃癌手术病人随机分成2组,试验组在围手术期施行FM方案化疗3周,另一组为对照组.结果显示胃癌病人能耐受围手术期化疗,两组对比围手术期化疗未增加术后并发症及危险性.试验组与对照组根治术后病人1、3、5年生存率分别为78.2%、51.2%、34.0%及64.7%,39.7%,24.8%(P<0.05).     

Effect of Prophylactic Sucralfate Suspension on Stomatitis Induced by Cancer Chemotherapy a Randomized, Double-Blind Cross-Over Study

We have studied whether mouth-swishing with sucralfate, a well-known gastric mucosal protective agent, may be used as prophylaxis against chemotherapy-induced stomatitis. Using ra-dioactively labelled sucralfate we found that 20-30% was still bound to the oral mucosal lining 2 1/2 h after mouth-swishing. Forty patients receiving cisplatin and continuous infusion with 5-fluorouracil (5-FU) for 5 days entered a double-blind placebo-controlled cross-over study. Among 23 evaluable patients a significant reduction (p=0.04) in an objective score of edema, erythema, erosion and ulcerations was seen during treatment with sucralfate. Patient preference favored sucralfate, but this preference failed to reach statistical significance (p=0.06). Seven patients were inevaluable for reasons not associated with the studied treatment. However, ten patients did not complete the study since the swishing procedure aggravated chemotherapy-induced nausea. An equal rate of non-compliance was seen with sucralfate and placebo. To overcome this problem, the oral medication should have a neutral taste, the solution should not be swallowed after the swishing, which should not be started until the nausea had ceased.     

Hepatitis B Virus Reactivation during Treatment with Multi-Tyrosine Kinase Inhibitor for Hepatocellular Carcinoma

Hepatitis B virus (HBV) reactivation is well documented in individuals with cancer who receive certain cytotoxic or immunosuppressive therapies including rituximab treatment. As a general rule, the risk is greatest upon withdrawal of chemotherapy. The risk ranges from approximately 20 to 50% among HBsAg-positive carriers. A 67-year-old man was diagnosed with inoperable multiple hepatocellular carcinoma accompanied by an increase in alpha-fetoprotein and protein induced by vitamin K absence or antagonist II level. Eighteen weeks after starting on the oral multi-tyrosine kinase inhibitor TSU-68, laboratory investigations showed a substantial increase in serum transaminase levels (AST: 302 IU/l; ALT: 324 IU/l) and an elevation of the HBV-DNA level (6.9 log copies/ml). The diagnosis was that the cause of the acute hepatitis was HBV reactivation and we immediately administered entecavir. Two months after the initiation of daily entecavir treatment, laboratory findings showed that the serum levels of transaminases and ALP had improved (AST: 18 IU/l; ALT: 10 IU/l; ALP: 197 U/l). When the HBV markers were examined 4 months later, they were altered: HBeAg was negative and HBeAb was positive. Entecavir treatment was discontinued after 6 months. Although reactivation with rituximab has been reported, reactivation with a tyrosine kinase inhibitor is extremely unusual in a patient who is HBsAg negative but anti-HBc positive. This is the first report describing HBV reactivation with an increasing HBV-DNA level in a HBsAg-negative/HBcAb-positive/HBsAb-positive patient who was treated with TSU-68 for hepatocellular carcinoma.Key words: Hepatitis B virus reactivation, Hepatocellular carcinoma, Multi-tyrosine kinase inhibitor     

TACE联合恩替卡韦治疗乙型肝炎相关的原发性肝癌的疗效分析

目的 探讨TACE联合恩替卡韦治疗乙型肝炎相关的原发性肝癌的疗效.方法 按照入院顺序抽签后随机将97例原发性肝癌患者分为实验组和对照组,对照组给予TACE治疗,实验组给予TACE联合恩替卡韦治疗,对比2组近期和远期疗效.结果 实验组治疗后ALT、HBV DNA水平均明显低于治疗前和对照组,有统计学差异(P＜0.05);对照组治疗前后,ALT、HBV DNA水平变化,无统计学差异(P＞0.05).实验组HBeAg转阴率和转换率明显高于对照组,差异有统计学意义(P＜0.05).实验组治疗后ORR、DCR明显高于对照组(P＜0.05);实验组患者中位总生存时间(OS)和中位无进展生存时间(PFS)均明显高于对照组,有统计学差异(P＜0.05).结论 TACE联合恩替卡韦治疗乙型肝炎相关的原发性肝癌效果较好,患者ALT、HBV DNA水平改善较好,HBeAg转阴率和转换率较高,ORR、DCR较高,患者中位总生存时间和中位无进展生存时间均较高,临床应用价值较高.     

小细胞肺癌术后化疗或放化疗后预防性脑照射的临床观察

目的:探讨小细胞肺癌术后化疗或放化疗后预防性脑照射(PCI)能否降低脑转移率,提高生存率。方法:1990年6月～1995年7月我院治疗小细胞肺癌术后化疗或放化疗后预防性脑照射30例(PCI组),男22例,女8例。临床分期分别为Ⅰ、Ⅱ和Ⅲa期各9、15和6例,化疗方案为CAE方案(C:环磷酰胺,A:阿霉素,E:依托铂甙)或EP方案(E:依托铂甙,P:顺铂),预防性脑照射剂量为30Gy/15次,1.8～2.0Gy/次;同期术后化疗或放化疗40例(对照组),男28例,女12例,Ⅰ、Ⅱ和Ⅲa期各10、20和10例。结果:脑转移率PCI组10.0%,对照组52.5%,两组间有显著的统计学意义(χ²=13.73,P<0.001)。PCI组1、3、5年生存率分别为83.3%、60.0%和20.0%,对照组1、3、5年生存率分别为80.0%、47.5%和15.0%,PCI组和对照组Ⅰ、Ⅱ和Ⅲa期5年生存率分别为60.0%和55.6%;、42.9%和38.5%;25.0%和10.0%,两组均无统计学差异。结论:小细胞肺癌术后化疗或放化疗后预防性脑照射可以降低脑转移率,是否能提高生存率,因例数较少难下确切的结论。