力尔凡联合化疗治疗晚期大肠癌的疗效分析

目的 观察与分析力尔凡联合化疗治疗晚期大肠癌的临床疗效.方法 将157例大肠癌患者随机分为二组,治疗组89例,对照组68例.治疗组化疗联用力尔凡,对照组仅用常规化疗方案(即奥杀利铂+5-Fu).共治疗6个疗程,治疗后随访2～5年.近期疗效观察CR、PR、SD和PD,以及肿瘤标志物水平和毒副作用.远期疗效观察无进展生存期、总生存期和平均生存期以及死亡率.结果 CR、PR、SD和PD两组无显著差异(P＞0.05).毒副作用和肿瘤标志物水平差异显著(P＜0.05):远期疗效治疗组各项指标均明显优于对照组(P＜0.05).结论 力尔凡联合化疗可显著抑制肿瘤生长、降低化疗毒副作用和提高晚期大肠癌的远期疗效.     

贝伐珠单抗联合化疗治疗晚期大肠癌的临床疗效

目的:探讨对晚期大肠癌患者采用贝伐珠单抗联合化疗治疗的临床效果.方法:随机选取大连医科大学附属第一医院收治的178例晚期大肠癌患者,按照实际治疗方案分为观察组85例和对照组93例,观察组患者给予贝伐珠单抗联合化疗治疗,对照组患者给予XELOX方案治疗,比较两组患者的近期疗效、不良反应发生情况以及治疗后的生活质量.结果:观察组患者临床疗效显著优于对照组(67.06%vs 47.31%),差异具有统计学意义(P<0.05);两组患者骨髓抑制、神经毒性、肠胃道反应、肝肾毒性及免疫系统障碍发生率比较(25.88%vs 26.88%、17.65%vs 20.43%、20.00%vs 23.66%、15.29%vs 11.83%、11.76%vs 8.60%),差异无统计学意义(P>0.05);观察组患者化疗后各项生活质量评分无明显变化,与化疗前比较(65.62分±3.34分vs 67.83分±4.06分、67.67分±3.46分vs 69.26分±3.98分、66.15分±3.52分vs 68.11分±3.96分、66.58分±3.51分vs 68.02分±4.02分、66.83分±3.55分vs 68.39分±3.81分,差异无统计学意义(P>0.05);对照组患者化疗后各项生活质量评分均显著下降,与化疗前比较(51.57分±3.26分vs 67.89分±4.11分、54.62分±3.31分vs 69.30分±3.89分、53.24分±3.28分vs68.15分±3.92分、52.26分±3.22分vs 67.97分±4.11分、53.16分±3.28分vs 68.41分±3.80分),差异有统计学意义(P<0.05).结论:对晚期大肠癌患者采用贝伐珠单抗联合化疗治疗,能有提高患者的近期疗效,不增加化疗不良反应,对患者生活质量影响较小,值得推广.     

大肠癌病人门诊化疗的护理

大肠癌包括结肠癌和直肠癌，占我国恶性肿瘤发生率的第3位。由于对大肠癌的早期诊断率较低，确诊时多为晚期以及复发转移，手术切除率低，主要靠内科化疗。但临床应用的化疗药物毒副作用较大，对血管有较强的刺激性，对全身组织器官也有不同程度的危害。我科自1999-05／2002-05共收治大肠癌化疗病人48例，经门诊观察、精心护理收到了良好的效果。现将护理体会报告如下。     

联合化疗加草酸铂治疗难治性晚期大肠癌22例疗效观察

20 0 0年 1月以来 ,我们对 2 2例难治性晚期大肠癌患者 ,在原联合化疗方案基础上加用草酸铂 ( L - OHP)治疗 ,并对其疗效和毒性进行系统观察。现报告如下。资料与方法 :本文 2 2例晚期大肠癌患者 ,均经病理证实为腺癌。男 13例 ,女 9例 ;年龄 43～ 68岁 ;病程 1～ 2年。其中肺转移 4例 ,肝转移 6例 ,腹腔淋巴结转移 5例 ,盆腔转移 6例 ,前列腺转移 1例。2 2例患者均为先行 5 -氟脲嘧啶 ( 5 - FU ) /甲酰四氢叶酸钙( CF)化疗两个周期 ,即 CF0 .1～ 0 .2 g/d静滴 0 .5～ 1小时 ,第1～ 5天 ;5 - FU3 5 0 mg/m2静滴 2～ 3小时 ,第 1～ 5天 …     

21例大肠癌早期化疗疗效观察

2004年12月~2006年12月，我院收治大肠癌Duke，sA期微转移指标角蛋白（CK20）mRNA阳性患者21例，经化疗12例转阴。现报告如下。     

内镜下射频加局部化疗治疗晚期大肠癌临床研究

射频加局部化疗或单纯射频治疗消化道恶性肿瘤国内已有许多报道，作为姑息疗法的一种手段，尚缺乏系统、深入的临床研究和远期疗效观察。自2004年1月，我们通过对部分晚期大肠癌失去手术切除时机患者进行射频加局部化疗的系统临床研究，并与单纯射频治疗进行对比研究，在肠梗阻缓解率、再转移率、生存率方面，初步取得了良好的效果，现报道如下。     

内镜下射频热疗联合局部化疗治疗晚期大肠癌的随机对照研究

目的：探讨射频加局部化疗治疗晚期大肠癌的疗效,并与单纯射频治疗比较。方法选择晚期大肠癌失去手术切除时机患者55例行射频加局部化疗或单纯射频治疗,随机分为射频加局部化疗组（A组）27例、射频组（B组）28例,观察两组患者5年内肠梗阻缓解率、再转移率、生存率。结果 A组与B两组1～5年肠梗阻缓解率分别为88.9%vs 70.8%、95.8 vs 70%、89.5%vs 52.9%、100%vs 33.3%、100%vs 0,具有统计学差异（P＜0.05）;5年内再转移情况,A组27例无一例出现再转移,再转移率为0（0/27）,B组11例出现了新的转移病灶,再转移率为39.3%（11/28）,有统计学差异（P＜0.05）;A组5年生存率为44.4%（19/27）,B组为无一例生存,有统计学差异（P＜0.05）。结论内镜下射频热疗联合局部化疗能显著提高晚期大肠癌患者5年内肠梗阻缓解率和5年生存率,显著降低再转移率。     

奥沙利铂为主方案治疗老年晚期大肠癌的临床疗效观察

大肠癌是直肠癌和结肠癌的总称,是我国较为常见的恶性肿瘤之一.临床上,大肠癌确诊时往往有25％～35％属于晚期[1],50％患者在术后5年内复发或转移.化疗在治疗晚期大肠癌中占有重要地位.晚期大肠预后差,复发转移和化疗不理想,5-氟尿嘧啶(5-Fu)是治疗大肠癌首选药,联合亚叶酸钙(CF)被认为是治疗大肠癌标准方案.奥沙利铂是继顺铂和卡铂之后第三代铂类抗癌药,它对大肠癌细胞及顺铂耐药细胞株等多种肿瘤均有显著抑制作用,且与顺铂之间无交叉耐药性[2].     

大肠癌和胃癌个体化疗的现状与未来

大肠癌和胃癌是我国常见的肿瘤,由于我国大多数大肠癌和胃癌患者确诊时已属中晚期,因此,化疗作为全身性内科治疗手段成为患者的主要选择.目前肿瘤的"标准化疗"仍然是以大样本统计学结果为基础选择化疗药物的治疗.由于肿瘤本身以及个体之间异质性的存在,同一部位的肿瘤对"标准化疗"的敏感性和毒副作用差异很大.以药物基因组学及药物遗传学为基础的"个体化疗"受到广泛关注,并显示出其潜在的应用前景.本文着重论述大肠癌和胃癌领域"个体化疗"的研究进展,初步探索各种有药物相关基因的应用价值.     

不能手术切除晚期胃癌病人介入化疗的疗效观察

目的探讨动脉内介入化疗治疗不能手术切除的晚期胃癌病人的临床疗效和毒副反应.方法对不能手术切除的晚期胃癌60例行动脉内介入化疗者作为对照组.32例行常规静脉滴注化疗者作为对照组.从肿瘤大小变化方面和生存时间方面进行对比观察.结果动脉内介入化疗有效率58.3%,静脉化疗有效率28.1%,平均生存时间、动脉内介入治疗为306d,静脉化疗为72d.两组比较差异有显著性.毒副反应静脉滴注组发生率高,主要为白细胞下降、恶心、呕吐等.结论动脉内介入化疗方法治疗不能切除的晚期胃癌临床疗效优于静脉化疗方法.     

The value of routine preoperative urologic evaluation in patients with colorectal carcinoma

Routine preoperative intravenous pyelography was performed in a series of 105 consecutive male patients with rectal or rectosigmoid carcinomas who were totally free of urinary symptoms. Abnormal findings were present in 26 percent of those patients. Postoperative intravenous pyelograms were performed in 61 patients. Twenty-one percent of patients with negative preoperative intravenous pyelograms and 42 percent of patients with positive preoperative intravenous pyelograms had abnormal findings in the postoperative intravenous pyelograms. Preoperative cystoscopy was performed in 52 patients. Thirtyone percent of patients with negative preoperative intravenous pyelograms and 76 percent of patients with positive preoperative intravenous pyelograms had abnormal cystoscopic findings. The overwhelming majority of cystoscopic findings in patients with negative preoperative intravenous pyelograms were not related to the primary tumor. The findings of this prospective study suggest that routine preoperative intravenous pyelography is indicated in patients with rectosigmoid or rectal tumors without symptoms related to the urinary tract. Postoperative intravenous pyelography is indicated only in patients with positive preoperative intravenous pyelograms. Preoperative cystoscopy is indicated when the preoperative intravenous pyelogram is positive and especially if intravenous pyelography findings are suggestive of bladder-wall defect or extrinsic pressure.     

内镜电化学(5-FU)治疗中晚期食管癌

目的 探讨内镜电化学加局部化疗对中晚期食管癌的治疗作用。 方法 采用内镜电化学加食管癌肿局部注射5-FU治疗16例中病例确诊的晚期食管癌。 结果 治疗后达CR 6例,PR 8例,NC 2例。总有效率(CR PR)87.5％(14/16)。无明显毒副作用。 结论 内镜电化学治疗加局部化疗对严重吞咽困难失去手术时机的中晚期食管癌有较好的治疗作用。     

The relationship between different staging methods and survival in colorectal carcinoma

A routine clinicopathologic (CP) staging system for patients who have had surgical resection for colorectal carcinoma was established at Concord Hospital in 1971. Research on this prospective series of resections has evaluated the CP staging system as a guide to prognosis. The aim of this study was to compare the CP system with the classic Dukes' staging system and its modified form introduced by Astler and Coller to determine which method provided the most accurate basis for prognosis. Life table survival analysis was used to examine the survival of 709 patients according to each staging system. Relative mortality rates for groups of patients cross-classified by each possible pair of staging systems were examined and the Cox regression model was used to determine the independent effects of staging by each system on survival. The CP system was found to have a stronger association with survival than either the classic Dukes' system or the Astler-Coller modification of the Dukes' system. The importance of supplementing data on the operative specimen with data about the spread of tumor beyond the limits of surgical resection, is emphasized Supported by the Royal Australasian College of Surgeons, the Department of Veterans Affairs, the New South Wales State Cancer Council and Telmark Pty Ltd. This work was done at Concord Hospital, Sydney, Australia     

以羟基喜树碱为主联合治疗晚期大肠癌

目的 评价以羟基喜树碱（HCPT）为主联合5-FU、CF治疗晚期大肠癌疗效及毒副反应。方法 将56例病人随机分为Ⅰ组20例,采用HCPT 5-FU CF方案;Ⅱ组18例,应用CDDP 5-FU CF方案;Ⅲ组18例,采用5-FU CF方案,4周为1周期,共完成6个周期,比较各组疗效及毒副作用。结果 Ⅰ组有效率（CR PR）50%,Ⅱ组33.3%,Ⅲ组11.1%,各组之间比较有显著性差异。结论 在无条件行体外肿瘤细胞药敏试验的情况下,以HCP为主联合方案治疗晚期大肠癌疗效肯定。病人耐受性好,值得推广应用。     

Combination of ZD55-MnSOD therapy with 5-FU enhances antitumor efficacy in colorectal cancer

Purpose ZD55-MnSOD is an E1B 55 kDa-deleted replication-competent adenovirus and armed with the therapeutic gene MnSOD. The expression of the therapeutic gene MnSOD increases with the selective replication of the oncolytic adenovirus (ZD55) so that ZD55-MnSOD has more significant activity than the replicate defective adenovirus Ad-MnSOD in vitro and in vivo. The tumor cannot be completely eradicated only with ZD55-MnSOD, although ZD55-MnSOD has obvious antitumor activity. 5-fluorouracil (5-FU) is still the most effective adjuvant therapy for patients with colorectal cancer. Methods We reasoned that combined treatment of cancer cells with ZD55-MnSOD and 5-FU might have a synergistic effect. In vitro experiments with SW620 colorectal carcinoma cell line demonstrated that it was sensitive to ZD55-MnSOD, especially most sensitive to ZD55-MnSOD plus 5-FU treatment. Treatment with both ZD55-MnSOD and 5-FU could induce more significant apoptosis in cancer cells compared with ZD55-MnSOD or 5-FU alone, respectively. A better antitumor activity was observed by ZD55-MnSOD plus 5-fluorouracil (5-FU) treatment. Tumor growth was greatly inhibited by this combined treatment, and animal survival time increased. Conclusion These results show that, by using the combination therapies, a significant decrease in tumor mass can be achieved, which suggest that ZD55-MnSOD in combination with 5-FU may have potential clinical implications.     

结肠癌中骨形成蛋白-6启动子异常甲基化

目的研究骨形成蛋白-6（BMP-6）启动子在结肠癌细胞中的甲基化状态。方法运用甲基化特异PCR（MSP）法检测30例原发结肠癌和癌旁组织中BMP-6的甲基化水平。甲基化修饰后亚硫酸盐测序PCR（BSP）分析结肠癌细胞COLO-205细胞BMP一6启动子CpG岛甲基化状态。提取细胞RNA,通过实时定量PCR（real time-PCR）检测BMP-6mRNA在不同浓度的DNA甲基化酶抑制剂5＇-杂氮-2’-脱氧胞嘧啶（5-aza-dC）处理COLO-205细胞后BMP-6mRNA的改变情况。结果原发性结肠癌的甲基化异常检出率是33．3％（10／30）。BMP-6在COLO-205细胞中存在高甲基化状念,COLO-205细胞经5-aza-dC处理后BMP-6mRNA表达明显上调。结论BMP-6在原发性结肠癌中存在甲基化异常,说明BMP-6鹾闪甲基化异常可能参与结肠癌的发生。     

小肠三叶肽在大肠癌中的表达及其意义

目的　探讨小肠三叶肽 (ITF)与大肠癌的发生、进展及预后的关系。方法　收集手术切除的大肠癌标本 ,同时取距癌灶 5cm以外的癌旁组织及 10cm以外的正常组织。用原位杂交法检测癌组织、癌旁组织及正常组织中ITFmRNA ,同时结合临床病理资料进行分析。结果　癌组织、癌旁组织及正常组织均有不同程度的ITFmRNA表达 ,三组间ITFmRNA表达比较 ,差异无显著性 (P >0 .0 5 )。在结肠癌组织中 ,Dukes分期较高 (B、C、D期 )组的ITFmRNA表达 (0 .3 14±0 .119)明显低于Dukes分期较低 (A期 )组的表达 (0 .45 3± 0 .10 2 ) ,两者比较差异有显著性 (P <0 .0 5 )。但在癌旁和正常组织中 ,ITFmRNA的表达在不同Dukes分期组中的表达差异无显著性 (P>0 .0 5 )。不同分化程度组间ITFmRNA的表达差异亦无显著性 (P >0 .0 5 )。ITFmRNA的表达与是否有淋巴结转移及远处转移无密切相关 (P >0 .0 5 )。结论　ITFmRNA不仅表达于正常结肠粘膜 ,亦表达于癌旁和癌组织。ITF的表达在Dukes分期较高组低于分期较低组 ,且与分化程度有潜在的正相关 ,提示ITF可能与肿瘤的进展呈负相关     

奥沙利铂联合氟尿嘧啶和亚叶酸钙方案治疗70岁及以上转移性结直肠癌的疗效和安全性

目的 对比观察奥沙利铂联合氟尿嘧啶和亚叶酸钙方案(FOLFOX4)治疗70岁及以上转移性结直肠癌患者与70岁以下患者的不良反应和疗效.方法 61例转移性结直肠癌患者,其中≥70岁组28例,＜70岁组33例,两组患者均接受FOLFOX4方案化疗,14 d为1个周期,治疗期间观察不良反应,3个周期后评价疗效.结果 61例患者均可评价不良反应及疗效.主要不良反应为骨髓抑制、胃肠道反应及神经毒性,≥70岁组腹泻的发生率高于＜70岁组,但主要为1～2度不良反应.≥70岁组白细胞和中性粒细胞下降的发生率高于＜70岁组(92.8%比78.8%和39.3%比36.3%),但差异无统计学意义.≥70岁组神经系统毒性发生率为46.5%,＜70岁组为36.4%,均为1～2度,两组间差异无统计学意义.≥70岁组患者近期有效率为25%,疾病控制率为71.4%,中位疾病进展时间(TTP)为6个月,＜70岁组患者近期有效率24.2%,疾病控制率84.8%,中位TTP 7个月,两组有效率和疾病控制率差异无统计学意义,而＜70岁组患者的中位TTP比≥70岁组略长.结论FOLFOX4方案同样适用于≥70岁转移性结直肠癌患者,其耐受性较好且疗效肯定.

Abstract：

Objective To observe the safety and efficacy of FOLFOX4 regiment in elderly versus young patients with advanced colorectal cancer. Methods There were 61 patients enrolled in this study, with 28 elderly patients aged 70 years and over, 33 young patients aged less than 70 years.They suffered from advanced/recurrent colorectal cancer and received FOLFOX4 regiment (Oxaliplatin +CF+5-FU). Every 14 days were as a cycle, and the therapeutic safety and efficacy were evaluated after three cycles. Adverse events and response to treatment were compared between the elderly and young patients. Results The main adverse effects were myelosuppression, gastrointestinal disturbance and neurotoxicity. The incidence rate of diarrhea was significantly higher in elderly patients than in young patients, but the most of diarrhea were at grade Ⅰ - Ⅱ. The incidence rates of leucocyte decrease and neutrophil decrease were higher in elderly patients than in young patients (92. 8% vs. 78. 8%, 39.3% vs. 36.3%), but there were no statistically significant differences between them. The incidence rate of neurotoxicity was 46.5% in elderly patients and 36.4% in young patients (P＞0. 05). The recent efficacy rate was 25%, disease control rate was 71.4% and median time-to-progression (TTP) was 6 months in elderly patients and 24.2%, 84.8% and 7 months in young patients (all P＞0.05). Conclusions FOLFOX4 regiment is well-tolerated and effective in both young and elderly patients.     

重组人促红细胞生成素治疗结肠和直肠癌化疗相关贫血

目的 :观察重组人促红细胞生成素 (rhEPO)治疗结、直肠癌化疗相关贫血的疗效。方法 :选择 6 2例结、直肠癌采用以奥沙利铂为主联合方案化疗所致贫血患者 ,随机分为两组 :rhEPO治疗组 34例 ,给予皮下注射rhEPO 4 0 0 0 0U/周。对照组 2 8例 ,不给予rhEPO治疗 ,仅给予五参芪口服液。结果 :治疗后 4周起治疗组患者血红蛋白 (Hb) ,红细胞压积 (HCT)、红细胞总数 (RBC)均明显上升 ,与对照组相比差异有统计学意义 (P <0 .0 1)。rhEPO治疗组总有效率为 79.4 % ,对照组为 2 1.7% ,差异有统计学意义 (P <0 .0 1)。结论 :rhEPO 4 0 0 0 0U/周对晚期结、直肠癌联合方案化疗相关贫血有肯定的疗效