奥沙利铂临床应用58例分析

目的：探讨奥沙利铂的临床疗效及其不良反应。方法：58例不同类型恶性肿瘤患者，皆给予奥沙利铂单药或联合化疗1个-14个周期，定期进行B超、CT、MKI等检查，观察其病灶及转移灶情况，分析不良反应。结果：27例复发或转移病例中CR2例，PR7例(有效率25.9％)，SD10例，PD8例。不良反应中胃肠道反应、感觉神经毒性较多，无Ⅳ度毒性反应。结论：奥沙利铂不良反应轻，对多种肿瘤有效。     

奥沙利铂致过敏反应的临床分析

1资料与方法 1．1一般资料 本组患者男性2例，女性1例。2例男性中，1例年龄75岁，直肠癌伴肝转移；1例年龄72岁，胃癌伴肝转移。1例女性年龄65岁，胃癌术后。3例均经胃镜、肠镜及术后病理证实诊断。3例患者发生过敏反应，均曾接受过含奥沙利铂的治疗方案治疗，既往未曾应用过其他铂类化疗药。     

奥沙利铂致急性血小板减少1例

<正>一、临床资料患者,63岁,男性,于2011年8月初体检时发现肝脏肿物,查相关抗原示CEA增高,后行PET/CT检查示乙状结肠不规则结节状高代谢病灶,考虑乙状结肠癌可能,病灶周围多发淋巴结转移,肝脏多发转移。肠镜检查示乙状结肠距肛门26²9cm见一大小约3×4cm菜花样肿物,病理活检示结肠低分化腺癌,KRAS基因检测野生型。后入组临床研究,行FOLFOX4方案化疗,用药方案:奥沙利铂85mg/m2,静脉滴     

奥沙利铂过敏性休克1例

患者,女,54岁,2009年5月14日以"直肠癌术后21 d"为主诉收入我科.2009年2月患者出现无明显诱因的大便带血,暗红色,伴里急后重,大便3次/d,不成形,无腹痛、粘液脓血便.2009年4月18日在我院行结肠镜检查,结果显示:距肛门3～10 cm处可见溃疡型新生物,表面充血,糜烂,质硬.     

奥沙利铂过敏性休克1例

患者,女,54岁,2009年5月14日以“直肠癌术后21d”为主诉收入我科。2009年2月患者出现无明显诱因的大便带血,暗红色,伴里急后重,大便3次／d,不成形,无腹痛、粘液脓血便。2009年4月18日在我院行结肠镜检查,结果显示：距肛门3～10cm处可见溃疡型新生物,表面充血,糜烂,质硬。     

奥沙利铂过敏2 例

奥沙利铂主要副反应为剂量相关性的蓄积性的可逆转的外周神经毒性反应等,罕见过敏反应,过敏反应发生率约0.5%.我科使用奥沙利铂致过敏反应2例,现报道如下.     

含奥沙利铂方案ＴＡＣＥ治疗原发性肝癌的临床观察

目的　观察含奥沙利铂方案经皮肝动脉化疗栓塞术（ＴＡＣＥ）治疗中晚期原发性肝癌的疗效和不良反应。方法　２００８年４月至２０１０年４月,３７例患者经手术或活检组织病理诊断以及临床诊断为中晚期原发性肝癌,接受ＴＡＣＥ治疗。动脉灌注药物包括奥沙利铂１３０ｍｇ／ｍ^２,替加氟１５～２０ｍｇ／ｋｇ,肿瘤血管栓塞药物为吡柔比星２５～４０ｍｇ／ｍ^２＋１０～２０ｍｌ进口超液态碘化油乳化剂,部分患者加用明胶海绵栓塞。间隔４～６周复查血常规、肝肾功能、ＡＦＰ、ＣＴ或ＭＲＩ。疗效和不良反应分别按照ＷＨＯ实体瘤近期疗效和抗癌药物急性及亚急性毒性反应分度标准评价。结果　全组３７例患者均顺利完成至少１次ＴＡＣＥ治疗并可评价疗效,获ＣＲ３例（８.１％）,ＰＲ２０例（５４.０％）,ＮＣ１２例（３２.４％）,ＰＤ２例（５.４％）,有效率为６２.２％（２３／３７）,中位无进展生存时间为１３２天（９５％ＣＩ：８９～１７４天）。３７例患者治疗１疗程后肝区疼痛、食欲不振、腹水、黄疸改善率分别为９７.１％、８６.５％、１００.０％和５７.１％。。主要不良反应为发热、恶心、呕吐及骨髓抑制（白细胞减少为主）,大部分均为１～２级,仅５例发生１级神经毒性。结论　含奥沙利铂方案ＴＡＣＥ治疗中晚期原发性肝癌的疗效较好,临床症状显著改善,不良反应轻。     

结直肠癌患者奥沙利铂过敏反应的临床分析

[目的]研究结直肠癌患者使用奥沙利铂后出现过敏反应的特点,分析结直肠癌患者发生过敏反应的危险因素.[方法]回顾性收集139例采用奥沙利铂化疗的结直肠癌患者的临床资料,分析奥沙利铂过敏反应的发生特征及危险因素.[结果] 139例结直肠癌患者接受奥沙利铂静脉化疗,14例(10.07％)患者发生过敏反应.过敏反应以一般症状和皮肤症状多见,主要表现为颜面潮红、皮疹、胸闷气急、心悸等.Logistic回归分析显示接受奥沙利铂姑息化疗的患者更容易发生过敏反应(OR=5.186,95％ CI:1.240～21.697).化疗次数大于6次的患者较化疗次数≤6次的患者发生过敏反应的风险增高(OR=4.130,95％CI:1.132～15.073).[结论]10.07％的接受奥沙利铂化疗的结直肠癌患者发生过敏反应,过敏反应症状一般较轻,主要表现为皮肤潮红和皮疹.接受奥沙利铂化疗次数6次以上及以姑息化疗为目的的患者较容易发生过敏反应.     

奥沙利铂静滴引起过敏反应1例

患者，男，72岁，2006年12月30日行乙状结肠癌根治术，术后病理报告：乙状结肠中分化腺癌，侵犯肠壁全层；送检两断端未见癌；送检淋巴结10枚，均可见癌转移（10／10）。术后于2007年1月至6月行FOLFOX6方案化疗共9疗程。末次化疗时间为2007年6月20日，患者于2007年7月4日再次收入我科行第10疗程化疗，方案FOLFOX6，奥沙利铂150mg，     

含奥沙利铂与含顺铂方案介入治疗中晚期肝癌的疗效比较

目的评价含奥沙利铂与顺铂经导管化疗栓塞术治疗中晚期原发性肝癌的疗效及不良反应。方法将167例中晚期肝癌患者分为两组:A组79例患者用奥沙利铂100¹50 mg,B组88例患者用顺铂40150 mg,B组88例患者用顺铂40⁶0 mg。之后两组均给予氟尿嘧啶75060 mg。之后两组均给予氟尿嘧啶750¹000 mg静脉缓慢推注,然后将阿霉素40 mg混合超液化碘油7.51000 mg静脉缓慢推注,然后将阿霉素40 mg混合超液化碘油7.5²0 ml行化疗栓塞,化疗药物剂量视患者全身和肝功能情况略有调整。第二周期治疗后进行CT扫描评价近期疗效。结果奥沙利铂介入治疗组患者的近期疗效(总有效率及甲胎蛋白改变)及远期疗效与顺铂介入治疗组之间差异均无统计学意义(P>0.05)。两组患者均未发生严重的不良反应,但奥沙利铂治疗组的患者发生消化道反应及转氨酶升高的比例比顺铂治疗组更低,差异有统计学意义(P<0.05)。结论含奥沙利铂的经导管化疗栓塞术可能为治疗中晚期原发性肝癌的一种有效且不良反应更小的方案。     

丙种球蛋白治疗化疗后血小板减少症的临床观察

目的:探讨丙种球蛋白治疗化疗后血小板减少症的临床观察.方法:将化疗后血小板减少症患者分为3组,丙种球蛋白(IvIg) 粒细胞集落刺激因子组(G-CSF),G-CSF组,IvIg组.结果:IvIg G-CSF组和IvIg组治疗化疗后血小板减少症用药3天和7天后血小板增加值与用药前相比有显著差异P＜0.01和P＜0.05.IvIg G-CSF组对化疗后血小板减少症进行3天和7天治疗后,分别有14例次70.00%和16例次80.00%患者出现血小板升高＞30×109/L,与单用G-CSF组相比较,P＜0.01.单用IvIg进行治疗3天和7天后,18例次患者中有10例次即55.56%患者血小板升高＞30×109/L,与单用G-CSF组相比较,P＜0.01.结论:IvIg具有升高化疗后血小板减少症的作用,G-CSF与IvIg联合应用具有明显增强其升高血小板的作用.     

Bevacizumab protects against sinusoidal obstruction syndrome and does not increase response rate in neoadjuvant XELOX/FOLFOX therapy of colorectal cancer liver metastases

Aim

In patients suffering from colorectal cancer liver metastases, 5-fluorouracil-based chemotherapy plus oxaliplatin ensures superior response rates at the cost of hepatic injury. Knowledge about the consequences of bevacizumab on chemotherapy-induced hepatic injury and tumor response is limited.

Methods

Resected liver specimens from patients of two prospective, non-randomized trials (5-fluorouracil/oxaliplatin ± bevacizumab) were analyzed retrospectively. Hepatotoxicity to the non-tumor bearing liver was evaluated for sinusoidal obstruction syndrome, hepatic steatosis and fibrosis. Tumor response under chemotherapy was assessed according to Response Evaluation Criteria in Solid Tumors (RECIST).

Results

Bevacizumab decreased the severity of the sinusoidal obstruction syndrome. Bevacizumab had no impact on hepatic steatosis and fibrosis. The addition of bevacizumab to chemotherapy had no effect on tumor response compared to combination chemotherapy alone.

Conclusions

This analysis shows that bevacizumab protects against the sinusoidal obstruction syndrome and thus provides the histological explanation of the safe use of bevacizumab prior to liver resection. Furthermore, we show that bevacizumab does not improve tumor response according to RECIST.     

Hepatic complications following preoperative chemotherapy with oxaliplatin or irinotecan for hepatic colorectal metastases

Aims

The aim of this article is to review the current state of knowledge in relation to the development of chemotherapy associated steatohepatitis (CASH) and sinusoidal obstruction syndrome (SOS) occurring following the administration of irinotecan and oxaliplatin respectively to patients with colorectal liver metastases and also to highlight potential concerns relating to other new agents.

Methods

An electronic search was performed of the medical literature using the MEDLINE database to identify relevant articles related to the incidence, aetiology, pathology and effects of CASH and SOS outcome in patients undergoing hepatic resection.

Results

CASH and SOS are relatively common findings in liver resection specimens following the administration of irinotecan and oxaliplatin-based regimes being reported in up to 50% and 20% of cases respectively. Whilst the aetiology and pathological changes are well-described, the relationship between the presence of these pathologies and outcomes is less well defined. The data in relation to SOS following oxaliplatin is limited but there may be an increased morbidity associated with the presence of SOS. There is significantly more evidence that the presence of CASH is associated with an increased morbidity and possibly mortality following hepatic resection as a result of the development of liver failure. Further studies are required to clarify these early observations.

Conclusions

The frequent identification of distinct pathological entities in association with oxaliplatin and irinotecan chemotherapy means that patients undergoing liver resection following treatment with these agents should be carefully monitored to accurately determine the morbidity and mortality attributable to the use of these agents. Furthermore, additional studies are required to clarify risk factors for the development of CASH and SOS so that certain regimens can be avoided in at risk populations thus reducing hepatic damage and increasing the chances of cure and survival following liver resection.     

鹿血晶联合白细胞介素-11治疗化疗后血小板减少症的临床观察

目的 观察中药鹿血晶联合白细胞介素-11治疗化疗后血小板减少症的疗效.方法 将60例晚期非小细胞肺癌化疗后血小板减少症患者,按数字表法随机分为两组,联合组30例给予中药鹿血晶联合白细胞介素-11,对照组30例给予白细胞介素-11,检测两组治疗后第3天、第7天及第14天血常规,观察两组血小板计数变化情况,同时评价治疗疗效.结果 治疗前及治疗后第3天两组血小板计数无显著差异(P>0.05).治疗后第7天及第14天两组血小板计数相比较,联合组显著高于对照组,差异具有统计学意义(P<0.05).另外,两组疗效相比,联合组有效率高于对照组(P<0.05).结论 中药鹿血晶联合白细胞介素-11治疗化疗后血小板减少症,能更加迅速安全地提高血小板,缩短治疗时间,最终使患者获益.     

Nodular regenerative hyperplasia (NRH) complicating oxaliplatin chemotherapy in patients undergoing resection of colorectal liver metastases

Introduction

Sinusoidal obstructive syndrome (SOS) is well associated with the use oxaliplatin-based chemotherapy, and represents a spectrum of hepatotoxicity, with nodular regenerative hyperplasia (NRH) representing the most significant degree of injury. The aim of this study was to determine the prevalence of NRH in patients undergoing resection of colorectal liver metastases (CRLM) and to determine its impact on outcome.

Methods

From January 2000 to December 2010, some 978 first primary liver resections were performed for CRLM. A prospectively maintained database was analysed to identify all patients with evidence of NRH in the non-tumour portion of their histopathology specimens. Clinical data of these patients was reviewed and outcomes assessed.

Results

Five patients exhibited NRH (four males, one female) with a median age of 69 years (range: 35–74). Three patients presented with synchronous hepatic metastases, and two with metachronous lesions. All received at least 6 cycles of oxaliplatin as either adjuvant or neo-adjuvant chemotherapy. Only one patient developed a post-operative complication namely transient hepatic failure that required a 4-day stay in the intensive care unit. The median hospital stay was 6 days (range: 6–14 days). There were no 90-day mortalities. One patient is alive and disease free at 55 months, the remaining 4 died of recurrent disease between 37 and 70 months following diagnosis of their primary tumours.

Conclusions

NRH is not an uncommon finding amongst patients with SOS with all patients having received oxaliplatin-based chemotherapy. Data on outcome would suggest no increased morbidity and mortality associated with the presence of NRH.     

基因重组人白细胞介素-11预防化疗所致血小板减少的临床效果

观察迈格尔(基因重组人白细胞介素-11,rhIL-11)预防化疗所致血小板减少的疗效和不良反应。方法:对21例接受以卡铂或健择为主的方案化疗患者,采用随机双盲安慰剂对照,自身交叉研究方法,比较rhIL-11和安慰剂对化疗后血小板最低值的影响及毒性。rhIL-11在化疗药给药结束后24小时开始用药,25μg/kg皮下注射,连续用药7～14天,血小板高于300×109/L时停药。结果:rhIL-11可以明显升高化疗中血小板最低值,减少输血的次数,rhIL-11的不良反应主要是轻度水肿,乏力及感冒样症状等。结论:rhIL-11对化疗所致血小板降低有明显的防治作用,可以作为升血小板的有效、安全药物在化疗中推广应用。     

重组人白细胞介素-11治疗实体瘤化疗所致的血小板减少症的随机对照研究

目的:观察重组人白细胞介素-11(rhIL-11)治疗实体瘤化疗所致的血小板减少症的客观疗效;观察rhIL-11在人体的不良反应及其安全性.方法:本研究采用随机对照试验,55例化疗后血小板低于50×109/L的患者,随机分为A组和B组,A组接受rhIL-11,B组不接受rhIL-11治疗.主要观察IL-11能否治疗化疗引起的血小板减少症.结果:A组血小板值在第2～21d均高于B组,第4～21天差别具有显著的统计学意义;A组Ⅱ°、Ⅲ°及Ⅳ°血小板减少的持续天数分别为3.0d、3.2d及0.4d,B组分别为5.1d、5.8d及2.2d,A组血小板减少持续天数短于B组,但无统计学差异.IL-11的不良反应主要包括:心悸、心律失常、水肿、发热、关节肌肉疼痛、注射局部疼痛、皮疹、头痛头晕、乏力等.大多较轻,可以耐受.结论:rhIL-11能刺激血小板增生,治疗化疗引起的血小板降低,是一种有效、安全的治疗血小板减少的药物,值得进一步研究.     

国产奥沙利铂联合亚叶酸钙和氟尿嘧啶治疗晚期胃癌的临床研究

目的：评价奥沙利铂（OXA）联合亚叶酸钙（LV）和氟尿嘧啶（5-Fu）方案治疗国人晚期胃癌的近期疗效和毒性反应。方法：28例晚期胃癌，给予FOLFOX改良方案，即OXA120mg／衍、静脉滴注4小时，LV200mg、静脉滴注2小时，5-Fu 500mg于LV滴完后静脉推注，5-Fu 3．0g持续静脉滴注46小时，每3周重复。按WHO标准评价近期疗效和毒性反应；同时观察TTP和MST。结果：可评价疗效者26例，获得PR11例（42．31％），SD11例（42．31％），PD4例（15．38％），总有效率（CR＋PR）为42．31％。中位TTP 5．6个月，MST9个月。主要毒性反应为恶心、呕吐、骨髓抑制及一过性感觉异常，全组无治疗相关性死亡。结论：OXA联合LV／5-Fu组成的FOLFOX改良方案治疗晚期胃癌患者有效，临床缓解率较高，不良反应轻，可以耐受。     

奥沙利铂联合羟基喜树碱期胃癌临床分析

背景与目的:体外及体内的临床研究显示,奥沙利铂(L-OHP)对多种肿瘤有显著抑制作用并与绝大多数抗癌药物具有相加或协同细胞毒作用。本文旨在观察L-OHP联合羟基喜树碱(HCPT)治疗晚期胃癌的近期疗效和患者耐受性,并与传统的化疗方案进行对比。方法:采用非随机的分组方法将43例晚期胃癌患者分为L-OHP+HCPT方案组(治疗组)与Vp-16+CF+5-FU(ELF)方案组(对照组),其中男性28例,女性15例,中位年龄59岁,KPS评分≥60,观察两组的近期疗效和患者耐受性。结果:治疗组24例有效率58.3%(14/24),对照组19例有效率42.1%(8/19)。治疗组有效率高于对照组,两组差异有显著性(P<0.05)。两组不良反应主要是骨髓抑制、恶心、呕吐、口腔炎、周围神经炎、静脉炎、脱发等,均在Ⅰ、Ⅱ度范围内。结论:L-OHP联合HCPT方案治疗晚期胃癌疗效较好,不良反应可以耐受。