GP方案胰腺区域性动脉灌注治疗晚期胰腺癌的临床观察

目的 比较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疗效与毒副反应.方法 将53例晚期胰腺癌采用信封抽签法随机分为胰腺区域性动脉灌注组26例和静脉化疗组27例,平均化疗2.6个周期.结果 胰腺区域性动脉灌注组有效率为53.85%(14/26),中位缓解期为10个月,中位生存期为21个月;静脉化疗组有效率为33.33%(9/27),中位缓解期为6.5个月,中位生存期为14个月.胰腺区域性动脉灌注组有效率、中位缓解期及中位生存期均高于静脉化疗组,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61.54%(16/26)、42.31%(11/26),静脉化疗组分别为77.78% (21/27)、59.26% (16/27),两组比较差异均有统计学意义(P<0.05).结论 GP方案胰腺区域性动脉灌注是治疗晚期胰腺癌的有效方案,且毒副反应可耐受.     

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。     

动脉化疗联合三维适形放疗治疗局部晚期胰腺癌的临床疗效

目的探讨动脉化疗联合三维适形放疗治疗局部晚期胰腺癌的疗效和安全性。方法 20例局部晚期胰腺癌采用吉西他滨（1 000 mg/m^2）区域性动脉灌注结合静脉化疗联合三维适形放疗治疗。放疗采用常规分割,1.8～2.0Gy/次,1次/天,5次/周,放疗剂量95%PTV45～50 Gy/25次。结果 20例患者全部完成治疗计划,原发灶完全缓解率为5.0%,部分缓解率为65.0%,总有效率为70.0%。临床获益率为80.0%。中位生存期为13个月,1、2年总生存率分别为56.2%、19.6%。1～2级白细胞下降发生率为80.0%,3级为20.0%;1～2级急性胃肠道反应发生率为90.0%,3级为5.0%。结论区域性动脉灌注化疗联合三维适形放疗是治疗局部晚期胰腺癌的1种有效方法。     

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。     

腹腔循环热灌注联合化疗治疗晚期胃癌的临床研究

目的:观察腹腔循环热灌注联合化疗治疗晚期胃癌的有效性和安全性.方法: 单纯接受化疗者采用DCF方案[多西他赛(DXT)、顺铂(CDDP)、5-氟尿嘧啶(5-FU)]56例,采用ECF方案[表阿霉素(EPI)、CDDP、5-FU]65例.腹腔循环热灌注联合化疗者,分别将DCF和ECF方案中CDDP经腹腔给药,其余药物经静脉给予,同时进行腹腔循环热灌注治疗,DCF方案56例,ECF方案64例.结果: 腹腔循环热灌注联合化疗者(120例)与单纯化疗者(121) 治疗有效率分别为68.3%和48.8%(P<0.01),临床获益率分别为 92.5%和72.7%(P<0.01); 其中腹水控制有效率,联合治疗者(76例) 与单纯化疗者(74例)分别为65.8%和48.6%(P<0.05).治疗后两组KPS评分提高率分别为58.3%和45.5%(P<0.05).中位无进展生存期分别为9.8个月和7.7个月,中位总生存期分别为15.7个月和11.8个月,1年生存率分别为61.7%和48.8%(P<0.05).Ⅱ-Ⅳ度血液学毒性及消化道不良反应二者相当(P>0.05),化学性腹膜炎联合化疗组略高(2例)(P>0.05).结论: 腹腔循环热灌注联合静脉化疗和单纯静脉化疗均是治疗晚期胃癌的有效方法,但腹腔循环热灌注联合静脉化疗显示出优越性并且安全.     

氟脲苷肝动脉持续灌注联合草酸铂静脉化疗治疗肝转移癌

目的观察经肝动脉灌注氟脲苷(FUDR)同时联合草酸铂(OXA)静脉化疗治疗肝转移癌的疗效及毒副反应.方法 28例结直肠癌或胃癌肝转移患者,经肝动脉灌注FUDR,静脉输入OXA治疗2～6个周期.所有病例均行术前术后CT扫描评价治疗效果.随访44个月,评价疗效、生存期及毒副反应.结果总有效率为42.8%,中位生存时间(MST)为25个月,出现肝转移后的MST为15.5个月,1,2,3年生存率分别为89.3%、67.8%和25.0%.结论采用新的化疗方案FUDR加OXA局部联合全身同时化疗安全有效,患者生存期得以延长.     

不同化疗途径对中晚期胰腺癌治疗价值的分析

目的评价不同化疗途径对中晚期胰腺癌的治疗价值。方法对15例中晚期胰腺癌患者行单纯静脉化疗,15例行介入动脉化疗,15例行胃十二指肠动脉插管化疗;对患者的临床受益反应、客观疗效、不良反应以及生存期进行分析。结果三组病例的临床受益率分别为25.0%、61.5%和76.5%（P〈0.05）;有效率分别为33.3%、46.2%和64.7%（P〉0.05）;出现严重不良反应的病例分别为4例、2例和1例（P〉0.05）;中位生存时间分别为8.0、9.0和11.5个月（P〈0.05）。结论行胃十二指肠动脉插管化疗可提高中晚期胰腺癌患者的临床受益率,疗效较好,并可延长患者生存期。     

三维适形放疗联合动脉灌注化疗治疗局部晚期胰腺癌的临床疗效观察

目的 评价三维适形放射治疗结合动脉灌注化疗局部晚期胰腺癌的疗效.方法 59例局部晚期胰腺癌患者,其中33例采用三维适形放射治疗结合动脉灌注化疗(综合治疗组),26例单纯放疗组(对照组).结果 综合治疗组和对照组临庆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78.8%,对照组总有效(CR+PR)为42.3%,两组差异有统计学意义(P<0.01);综合治疗组和对照组的1、2和3年生存率分别为72.2%、48.5%、9.1%和50.0%、15.4%、3.9%,2年生存率综合组优于对照组(P<0.01).结论 三维适形放射治疗结合动脉灌注化疗治疗局部晚期胰腺癌,在提高生存率、长生存期方面优于单纯放射治疗.     

药盒埋置持续性动脉灌注化疗治疗中晚期胰腺癌的临床研究

 目的　评价药盒埋置持续性动脉灌注化疗治疗中晚期胰腺癌的临床效果。方法　采用左锁骨下动脉药盒埋置持续性动脉灌注化疗治疗的 2 5例胰腺癌患者为介入治疗组 ,同期接受全身化疗的 2 8例胰腺癌患者为全身化疗组 ,两组均给予健择 +5 氟尿嘧啶方案 ,比较两组临床受益反应、肿瘤大小变化、患者生存情况以及毒副反应。结果　介入治疗组和全身化疗组临床受益率分别为 5 2 .0 %和 2 1.4 %(P <0 .0 5 ) ;总有效率 (CR +PR)分别为 16 .0 %和 10 .7% (P >0 .0 5 ) ;中位生存时间分别为 8.1个月和 6 .8个月 (P >0 .0 5 ) ,半年累积生存率分别为 79.4 %和 5 2 .3% (P <0 .0 5 ) ;1年累积生存率分别为 35 .7%和31.5 % (P >0 .0 5 )。毒副反应以胃肠道反应为主 ,无Ⅲ度以上的血液学、胃肠道及肝肾功能的毒副反应。结论　药盒埋置持续性动脉灌注化疗可以提高中晚期胰腺癌的临床受益率和短期生存率     

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.     

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.     

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 continuous 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 continuous transarterial infusion chemotherapy, 26 were treated with systemic venous chemotherapy, and curative effectiveness 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.     

A novel arterial infusion chemotherapy for the treatment of patients with advanced pancreatic carcinoma after vascular supply distribution via superselective embolization

BACKGROUND: Patients with American Joint Committee on Cancer Stage IV advanced pancreatic carcinoma have been treated by systemic chemotherapy, intraarterial chemotherapy, radiation therapy, and multidisciplinary treatment using a combination of these. However, the outcome has not always been satisfactory. In the current study the authors describe the method and results of a new chemotherapy for advanced pancreatic carcinoma. METHODS: To restrict the blood flow into the pancreas (mainly to the great pancreatic artery and the caudal pancreatic artery), the peripancreatic blood vessels were embolized superselectively with microcoils. In 31 patients with advanced pancreatic carcinoma, the catheter tip for the arterial infusion chemotherapy was placed in the splenic artery just proximal to the branching of the great pancreatic artery when the treatment was given for primary tumors, and in the common hepatic artery when the treatment was given for a metastatic liver lesion. The other end of the catheter was connected to an implanted injection port embedded in the femoral region, and 5-fluorouracil and cisplatin were administered by continuous arterial infusion. RESULTS: Of the 31 patients with advanced pancreatic carcinoma, 23 (74%) underwent hemodynamic change and arterial infusion chemotherapy, with a response rate of 73.9% (complete response rate of 8.7% and a partial response rate of 65.2%) and a mean survival period of 18.26 +/- 10.06 months. The 1-year, 2-year, and 3-year survival rates were 90.9%, 42. 8%, and 18.3%, respectively, with a mean survival period of 19.0 months. Of these 23 patients, the 16 patients with liver metastases had a response rate of 68.8% and a mean survival period of 16.25 +/- 8.35 months, whereas the 7 patients without liver metastases had a response rate of 87.5% and a mean survival period of 22.86 +/- 12.69 months. CONCLUSIONS: In patients with Stage IV advanced pancreatic carcinoma, arterial infusion chemotherapy after hemodynamic change was found to be effective against both primary tumors and metastatic liver lesions. The authors believe that the treatment presented in the current study should be attempted, even in patients with advanced pancreatic carcinoma, as long as the blood vessels for vascular supply distribution exist.     

Hepatic chemoembolization combined with systemic infusion of 5-fluorouracil and bolus leucovorin for patients with metastatic colorectal carcinoma: A Southwest Oncology Group pilot trial.

BACKGROUND: Rates of response to systemic chemotherapy among patients with advanced colorectal carcinoma rarely exceed 25- 30%, and complete responses are rare. The liver is the most common site of metastasis; however, regional therapies have not improved survival rates. The Southwest Oncology Group designed a clinical trial combining hepatic arterial chemoembolization with systemic infusion of 5-fluorouracil chemotherapy in an attempt to increase the complete response rate and prolong the time to disease progression. METHODS: Patients with documented liver metastasis from colorectal carcinoma were treated with two or three cycles of chemoembolization using a collagen suspension with doxorubicin, mitomycin C, and cisplatin. Subsequently, systemic chemotherapy with continuous infusion of 5-fluorouracil and weekly leucovorin was initiated. Patients were assessed for response at 12-week intervals, with treatment continuing until disease progression. RESULTS: Thirty-one eligible, evaluable patients were treated. One complete and 8 partial responses were observed, for an overall response rate of 29%. Fifty-eight percent of patients survived 1 year, and the median survival for the whole cohort was 14 months. The median time to progression was 8 months. Seven patients (23%) experienced Grade 4 toxicity and 21 patients (67%) had Grade 3 toxicity. CONCLUSIONS: The response rate in this trial was comparable to that achieved with systemic chemotherapy consisting of a fluorinated pyrimidine-based regimen for patients with this disease. No improvement in complete response rate or time to progression was observed compared with the Southwest Oncology Group's experience with systemic therapy. The authors are not planning to study this regimen further as a treatment for patients with metastatic colorectal carcinoma.     

A phase II study of mitomycin C, cisplatin and protracted infusional 5-fluorouracil in advanced pancreatic carcinoma: efficacy and low toxicity.

BACKGROUND: The effective treatment of unresectable pancreatic carcinoma represents a formidable challenge. There is a need to develop systemic therapies which combine efficacy with acceptable toxicity. The current 'gold standard' gemcitabine gives an objective response rate of the order of 20% and median survival up to 6 months. Here we have evaluated the efficacy and toxicity of mitomycin C, cisplatin and protracted infusional 5-fluorouracil (MCF). PATIENTS AND METHODS: Forty-five patients with locally advanced (13 patients) or metastatic (32 patients) pancreatic carcinoma were treated with mitomycin C 7 mg/m(2) 6 weekly, cisplatin 60 mg/m(2) 3 weekly and protracted venous infusion 5-FU 300 mg/m(2)/day. Patients were evaluated for response after three cycles and received six cycles in total in the absence of progressive disease or poor tolerance. Median age was 62 (45-75) years; 41 patients were World Health Organization performance status 0-1. RESULTS: Treatment was well tolerated with 36 (84%) patients completing three or more cycles. Grade 3 or 4 toxicities were uncommon: anaemia in three patients (7%), mucositis in two (5%), nausea and vomiting in three (7%) and diarrhoea in one (1%). An objective response was seen in 21 (46%) patients. There was one complete response. The median survival overall was 7.1 months and 10.5 months in responders. The median duration of response was 4.3 months. One-year survival was 29%, 2-year survival was 18%. CONCLUSIONS: MCF combines efficacy with low toxicity in the treatment of advanced pancreatic carcinoma. The efficacy is at least comparable and may be superior to single-agent gemcitabine and MCF may therefore provide a cost-effective alternative.     

吉西他滨联合奥沙利铂治疗晚期胰腺癌30例

Objective: To evaluate the activity and safety of combination chemotherapy with gemcitabine plus oxaliplatin (GEMOX regimen) in patients of advanced pancreatic carcinoma. Methods: 30 patients with advanced pancreatic cancer were enrolled into this study. All patients received gemcitabine 1000 mg/m2, given by 30-minute intravenous infusion, on days 1 and 8 of each 21-day cycle. Oxaliplatin 100 mg/m2 was administered as a 2 h infusion on day 1 of each 21 day. Clinical outcomes for patients treated with two cycles of chemotherapy were evaluated according to WHO criteria. Results: All 30 patients were eligible for effectiveness and safety analysis. Objective response rate was approximately 20.0%. Clinical benefit response (CBR) was a composite of assessment of pain, performance status and body weight. The pain relief rate, improve-ment rate of performance status and body weight were 53.3%, 46.7% and 36.7%, respectively. The main adverse effects were bone marrow depression, peripheral nerve toxicity and gastrointestinal reaction. There was no treatment-related death during the chemotherapy. Conclusion: The high response rate with low toxicity observed in this study suggests that GEMOX regimen may be an effective alternative curative treatment for patients with advanced pancreatic carcinoma and can be used more extensively in clinical practice.