高强度聚焦超声联合替吉奥治疗晚期胰腺癌的临床观察

目的 探讨高强度聚焦超声（HIFU）联合替吉奥（S-1）治疗晚期胰腺癌的疗效。方法 选取120例不能切除的晚期胰腺癌患者随机分为A组（n=61）和B组（n=59）,两组均接受口服S-1治疗。根据体表面积（BSA）制定方案：BSA＜1.25m²,80mg／d;1.25～1.5m2,100mg／d;＞1.5m²,120mg／d;d1～d14,3周为1周期。仅A组在S-1基础上联合HIFU。根据实体瘤疗效评价标准（RECIST） 1.0版评价近期疗效并计算有效率（RR）和疾病控制率（DCR）,采用NCI CTCAE 3.0标准评价毒副反应,记录疼痛缓解率并随访患者生存情况。结果 全组均可评价近期疗效。A组获CR 3例、PR 15例、SD 28例和PD 15例,RR和DCR分别为29.5％和75.4％;B组获CR 1例、PR 5例、SD 15例和PD 38例,RR和DCR分别为10.2％和35.6％;A组的RR和DCR均高于B组（P＜0.05）。A组的中位生存期（OS）为11.2个月,6、12个月的生存率分别为80.0％和40.0％,均优于A组的7.9个月、70.0％和10.0％,差异有统计学意义（P＜0.05）。A组的疼痛缓解率为57.4％（35／61）,高于B组的20.3％（12／59）,差异有统计学意义（P＜0,05）。两组均无3～4级毒副反应,1～2级毒副反应为贫血、中性粒细胞减少、血小板减少、恶心、腹泻、手足综合征及神经毒性,组间差异均无统计学意义（P＞0.05）。结论 HIFU联合S 1方案治疗晚期胰腺癌的疗效较好,毒副反应较轻且患者可耐受,是治疗晚期胰腺癌的一种有效手段。     

高强度聚焦超声治疗晚期胰腺癌的临床观察

目的 探讨高强度聚焦超声（HIFU）治疗晚期胰腺癌的疗效和安全性。方法 对41 例晚期胰腺癌患者行HIFU 治疗,观察治疗前后的影像学变化及临床症状,评价HIFU 治疗的近期有效率（RR）、临床受益率（CBR）、生存期及不良反应。结果 全组RR 为29.3%, CBR 85.4%,中位生存期6.7 个月（3.5～10.8 个月）,未发生皮肤烧伤、胰腺炎、胃肠道损伤等并发症。结论 HIFU 是一种治疗胰腺癌的有效方法,具有无创和较高的安全性,应用范围广,适合病情较重、不能耐受其他方法治疗的患者。     

高强度聚焦超声治疗晚期胰腺癌

目的寻求胰腺癌局部治疗新方法,探讨高强度聚焦超声(HIFU)治疗胰腺癌的安全性、有效性及可行性.方法应用高强度聚焦超声治疗胰腺癌25例,其中7例给予术后化疗.结果治疗后临床症状缓解,MRI和彩色超声检查示肿瘤内血供减少,甚至消失,近期生存时间延长.结论高强度聚焦超治疗胰腺癌是安全、有效、可行的.     

替吉奥联合康莱特注射液二线治疗晚期胰腺癌临床观察

目的 探讨替吉奥联合康莱特注射液在晚期胰腺癌二线治疗中的疗效和安全性.方法 44例含吉西他滨一线化疗失败的晚期胰腺癌患者分别给予单药替吉奥(单药组21例)、替吉奥联合康莱特(联合组23例)治疗,评价2组患者的疗效和不良反应.结果 单药组和联合组患者的疾病控制率分别为52.4%和60.9%,差异无统计学意义(P>0.05).单药组和联合组患者的中位疾病无进展生存时间分别为2.3个月和3.1个月,差异有统计学意义(P<0.05).中位生存时间分别为6.0个月和6.7个月,差异无统计学意义(P>0.05).2组患者不良反应均主要为白细胞减少、血小板减少、贫血、恶心、呕吐、腹泻.结论 替吉奥联合康莱特注射液二线治疗晚期胰腺癌比替吉奥单药更能延长患者的疾病无进展生存时间,且安全性好.     

高强度体外聚焦超声热疗治疗晚期胰腺癌近期疗效观察

目的 :初步探讨高强度体外聚焦超声 (highintensityfocusedultrasound ,HIFU)热疗治疗晚期胰腺癌的疗效及安全性。方法 :13例晚期胰腺癌共接受 91次 (平均 7次 )HIFU治疗、其中 4例同时应用小剂量5 FU单药化疗。结果 :CR 2例、PR 4例 ,有效率 4 6 2 % ;临床受益反应率 (clinicalbenefitresponse ,CBR)高达 92 3% ;中位生存期 7 0个月 ;除 1例HIFU治疗后 5个月出现阻塞性黄疸外 ,未见其他副作用。结论 :HIFU治疗晚期胰腺癌能取得一定的疗效 ,治疗安全性高 ,值得临床进一步观察研究。     

高强度聚焦超声与伽玛刀治疗晚期胰腺癌的对比观察*

目的：本研究主要对比观察高强度聚焦超声（HIFU）与伽玛刀治疗伴有癌痛的晚期胰腺癌疗效和不良反应。方法：回顾性分析武警上海总队医院2006年3 月至2008年10月收治晚期胰腺癌患者80例,其中26例（A 组）为HIFU治疗,54例（B 组）为伽玛刀治疗。对比评价两组的近期有效率（CR+PR）、平均生存期、临床受益率（CBR ）及不良反应。CBR 评价标准：疼痛程度减轻≥50% ,持续4 周以上;止痛药用量减少≥50% ,持续4 周以上;Karnofsky 评分增加≥20% ,持续4 周以上,体重增加7% 。结果：两组的平均生存期分别为（5.6 ± 4.1）个月及（5.4 ± 3.6）个月。A 组近期有效率26.9% ,B 组24.1% ,两组无显著性差异。A 组CBR 为84.6% ,B 组为57.4% 。两组比较差异有统计学意义（P=0.022）。 主要不良反应为：骨髓抑制,恶心,呕吐。A 组的不良反应明显小于B 组（P=0.040）。 结论：高强度聚焦超声与伽玛刀均是治疗晚期胰腺癌的安全、有效的治疗方法。HIFU与伽玛刀治疗的近期疗效与远期疗效相似,但在改善患者疼痛、体力状态等方面优于伽玛刀。在两者的不良反应上,HIFU治疗的骨髓抑制、消化道反应等方面均明显低于伽玛刀。提示HIFU可以应用于一般状况更差的患者。     

高强度聚焦超声联合腹腔化疗治疗晚期胰腺癌的疗效观察

目的观察高强度聚焦超声(以下简称HIFU)联合腹腔化疗治疗晚期胰腺癌的疗效。方法 36例晚期胰腺癌患者随机分成两组:A组为HIFU+腹腔化疗组,B组为单纯腹腔化疗组。结果 A组有效率为68.4%,B组有效率为35.2%,两组比较有显著性差异(P＜0.05)。结论 HIFU联合腹腔化疗治疗晚期胰腺癌有更好的临床疗效。     

高强度聚焦超声治疗晚期胰腺癌的疗效分析

目的探讨高强度聚焦超声(HIFU)治疗晚期胰腺癌的疗效及安全性。方法对64例晚期胰腺癌进行HIFU治疗。结果 5例(7.8%)完全缓解(CR),20例(31.2%)部分缓解(PR),15例(23.4%)稳定(SD),有效率达62.4%;患者均未见明显不良反应。结论 HIFU治疗晚期胰腺癌有一定疗效,安全性高,患者无痛苦、并发症,值得临床进一步观察研究。     

GEMOX方案联合高强度超声聚焦治疗晚期胰腺癌23例临床观察

目的:探讨高强度超声聚焦（HIFU）联合GEMOX方案治疗晚期胰腺癌的疗效和安全性。方法:23例经病理证实的转移性胰腺癌患者,予GEMOX方案（奥沙利铂135mg/m2,静脉滴注,d1,吉西他滨1.0g/m2,静脉滴注,d1,8）化疗,21天为1个周期。同时应用FEP-BY02型高能聚焦超声肿瘤治疗机治疗,根据肿瘤大小、转移数目、部位决定治疗次数,每次治疗时间约30-50分钟,每次间隔1-2天。治疗后定期随访观察0.6-2年。通过治疗有效率、疾病控制率、CA199水平的变化及不良反应进行评价,并分析生存状况。结果:23例患者接受治疗,全部可评价疗效,治疗有效率（RR）17.39%,疾病控制率（DCR）56.52%,中位无疾病进展生存时间（mTTP）3.3个月,中位总生存时间（mOS）7.9个月,1年生存率8.69%。12例患者CA199出现下降。总获益率(CBR)43.48%。Ⅲ级以上不良反应共5例（21.74%）。最常见的不良反应为疲乏,共15例。结论:对于晚期胰腺癌患者,GEMOX方案联合高强度超声聚焦是一种有效的治疗手段,不良反应可以耐受,值得扩大样本量进一步研究。     

替吉奥联合体部伽玛刀治疗局部晚期胰腺癌的临床观察

目的 观察替吉奥联合体部伽玛刀对局部晚期胰腺癌患者的治疗效果及安全性.方法 45例局部晚期胰腺癌患者被随机分为两组,联合组23例患者采用体部伽玛刀治疗,计划靶体积（PTV）覆盖95％以上临床靶体积（CTV）,等剂量曲线为50％～60％.肿瘤直径≤5 cm的单次周边剂量3.6～4.5 Gy,肿瘤直径＞5 cm的单次周边剂量3.0～4.0 Gy,治疗9～ 12次,同时口服替吉奥40 mg/m2,2次/d,连续口服21 d,28 d为1个周期,口服4个周期.对照组22例患者单纯接受体部伽玛刀治疗.评价治疗效果及不良反应.结果 两组完全缓解率分别30.4％（7/23）和13.6％（3/22）,有效率分别为91.3％（21/23）和63.6％（14/22）,差异具有统计学意义（x2=4.980,P=0.026）.两组胃肠道反应发生率分别为82.6％和68.2％（x2=1.267,P=0.260）;骨髓抑制发生率分别为78.3％和63.6％（x2=1.171,P=0.279）,联合组Ⅲ～Ⅳ级骨髓抑制的发生率高于对照组（x2=4.874,P=0.027）.两组中位无进展生存期分别为8个月和6个月（x2=1.357,P＞0.05）;中位总生存期分别为17个月和14个月（x2=1.017,P＞ 0.05）;1年生存率分别为60.9％和54.5％（x2=0.184,P＞ 0.05）.结论 口服替吉奥配合体部伽玛刀治疗胰腺癌可提高患者局部控制率和有效率,且不良反应的耐受性良好,可作为局部晚期胰腺癌同步放化疗安全、有效的选择.     

The Efficacy of High-Intensity Focused Ultrasound （HIFU） in Advanced Pancreatic Cancer

OBJECTIVE To observe the efficacy of high-intensity focused ultrasound (HIFU) in the treatment of late-stage pancreatic cancer. METHODS Sixteen patients with advanced pancreatic cancer received HIFU therapy.Evaluation of efficacy was made on the basis of changes in clinical symptoms and variations in the tumor echo and size. RESULTS Clinical symptoms such as pain were significantly alleviated,echo of the tumor was enhanced with B-US and the quality of life such as eating,sleeping and mental status was markedly improved;no serious complications were observed. CONCLUSION The use of HIFU in the treatment of advanced pancreatic cancer is feasible and safe.It is effective in killing the carcinoma cells and alleviating pain.This technique may offer non-invasive therapy for the treatment of patients with late-stage pancreatic cancer.     

高强度超声聚焦刀联合FOLFOX4方案治疗晚期胰腺癌的临床观察

目的：探讨高强度超声聚焦刀联合FOLFOX4方案治疗晚期胰腺癌的疗效及安全性。方法60例晚期胰腺癌患者根据所采取的治疗方式分为治疗组32例和对照组28例,两组均行FOLFOX4方案化疗,治疗组联合高强度超声聚焦刀治疗。比较两组疗效、不良反应、疼痛缓解情况及无病生存时间（PFS）。结果6治疗组和对照组的有效率（RR）分别为28.1%和7.1%,疾病控制率（DCR）分别为71.9%和35.7%,治疗组高于对照组,差异有统计学意义（P﹤0.05）。治疗组的疼痛缓解率为53.1%（17/32）,高于对照组的21.4%（6/28）,差异有统计学意义（P﹤0.05）。治疗组的中位PFS为6.1个月,长于对照组的2.8个月,差异有统计学意义（P﹤0.05）。两组治疗最常见的不良反应为血液学毒性、恶心呕吐、神经毒性,但两组比较差异均无统计学意义（P﹥0.05）。结论高强度超声聚焦刀联合FOLFOX4方案治疗晚期胰腺癌的疗效较好,不良反应可耐受,值得临床应用。     

Retrospective analysis of high intensity focused ultrasound combined with S-1 in the treatment of metastatic pancreatic cancer after failure of gemcitabine

The purpose of this study was to verify the efficacy and safety of high intensity focused ultrasound therapy (HIFU) combined with S-1 in the treatment of metastatic pancreatic cancer after failure of gemcitabine (GEM). In total, 120 patients with GEM-refractory PC who received HIFU and S-1 between Aug 2012 and December 2014 were randomly assigned to 2 groups. The patients in group A (n = 61) received HIFU in combination with S-1 and those in group B (n = 59) were given S-1 alone. S-1 was administered orally twice a day on days 1-14. Cycles were repeated every 21 days. The follow up time was 3~19 months in both groups. The median overall survival (OS) time and progression free survival (PFS) were analysed by Kaplan-Meier method and Logrank test. The pain remission rate of the two groups was compared by χ² test. Patient characteristics and prognostic factors were compared. Patient characteristics did not significantly differ between the 2 groups. Median OS was significantly longer in group A (10.3 months) than in group B (6.6 months, P = 0.000). Median PFS was also significantly longer in group A than in group B (5.1 months vs 2.3 months, P = 0.000). Meanwhile, the pain remission rate was markedly higher in group A than in group B (57% vs. 20%, P = 0.000). There were mild side effects and no significant difference was observed between the two groups. The treatment effect was independently associated with a good outcome. HIFU in combination with S-1 might be effective and well tolerated as salvage chemotherapy in the treatment for metastatic pancreatic cancer.     

高强度聚焦超声对体外胰腺癌细胞凋亡和STAT3/pSTAT3蛋白表达的影响

目的：探讨高强度聚焦超声（ high-intensity focused ultrasound,HIFU）体外处理胰腺癌细胞株PANC-1后仍存活细胞的STAT3/pSTAT3蛋白表达和细胞凋亡的变化及关系。方法：建立琼脂凝胶包埋的人胰腺癌组织体外实验模型,随机分为对照组和实验组并标记,实验组行JC200型HIFU治疗仪治疗,对照组不做任何处理,HE染色观察标本病理变化;免疫组化观察STAT3/pSTAT3蛋白表达变化。再将体外胰腺癌细胞实验模型分别行不同剂量的HIFU照射（0J,100J,200J,400J,800J）,通过MTT观察胰腺癌细胞的增殖抑制情况,通过Western blot检测STAT3/pSTAT3表达情况。结果：经HIFU治疗后,离体的胰腺癌靶区组织病理可以看到明显的凝固型坏死灶,细胞结构消失,免疫组化染色可见HIFU治疗的靶区组织棕色颗粒明显减少,提示治疗后STAT3/pSTAT3蛋白表达减低;MTT细胞增殖率检测提示与对照组（0J）相比,低功率组（100J,200J,400J）细胞增殖抑制无明显差异,高功率组（800J）的细胞增殖率明显减低,组间比较差异无统计学意义（ P﹥0.05）。Western blot检测STAT3/pSTAT3表达提示低功率组（100J,200J,400J）与对照组无明显差异。结论：HIFU能有效的治疗胰腺癌,其机制可能与破坏肿瘤细胞自身结构及影响STAT3/pSTAT3蛋白表达有密切关系。     

Advances of high intensity focused ultrasound (HIFU) for pancreatic cancer

Abstract

High intensity focused ultrasound (HIFU) is a novel therapeutic modality. Several preclinical and clinical studies have investigated the safety and efficacy of HIFU for treating solid tumours, including pancreatic cancer. Preliminary studies suggest that HIFU may be useful for the palliative therapy of cancer-related pain in patients with unresectable pancreatic cancer. This review provides a brief overview of HIFU, describes current clinical applications of HIFU for pancreatic cancer, and discusses future applications and challenges.     

高强度聚焦超声治疗门静脉癌栓的初步临床观察

目的:探讨高强度聚焦超声(high intensity focused ultrasound,HIFU)治疗门静脉癌栓(portal vein tumor thrombosis, PVTT)的安全性和有效性。方法:应用FEP-BY01型肿瘤超声治疗机对42例原发性肝癌合并的门静脉癌栓进行HIFU治疗。结果:HIFU治疗后31％(13／42)癌栓消失;33．3％(14／42)癌栓部分消失; 35．7％癌栓不消失。未发生皮肤烧伤、出血和胃肠道穿孔等并发症。结论:HIFU治疗PVTT是一种新的和安全有效的局部治疗方法。     

Extracorporeal High-Intensity Focused Ultrasound Treatment for Breast Cancer

OBJECTIVE To evaluate the clinical safety and efficacy of using highintensity focused ultrasound (HIFU) therapy, for breast cancer, and to select the appropriate methods in evaluating the therapeutic effects.METHODS A total of 24 patients with breast cancer underwent HIFU treatment 1-2 weeks before receiving modified radical mastectomy. During and after HIFU therapy, changes in blood pressure, breath, pulse and peripheral blood oxygen saturation were monitored. At the same time, the damage of the skin and tissue produced by HIFU at the target region was evaluated as well. Surgically excised samples were used for pathological examinations to evaluate the HIFU-induced destruction of the targeted tissue. Three patients received Tc-ECT and 1 MRI examinations before and after HIFU.RESULTS HIFU treatment had no apparent influence on either the tissue nearby the target or on vital signs of the patients. Pathological, tc-ECT and MRI examinations demonstrated that targeted tissue showed complete coagulative necrosis.CONCLUSION Under the guidance of real-time ultrasonic imaging, HIFU can effectively and safely destroy the breast cancer mass and ^99MTc-ECT and MRI examination can be utilized to evaluate the therapeutic effects.HIFU may become one of the options for breast cancer therapy in the future.