安罗替尼联合替莫唑胺治疗复发性胶质母细胞瘤1例

患者女性,66岁.2020年8月于外院行右侧额颞顶开颅,右侧额顶叶胶质瘤显微切除术,术前术后头颅CT见图1,术后病理见图2.经复旦大学附属华山医院病理会诊(编号:H20-00962)整合诊断:(右额颞顶)胶质母细胞瘤(WHOⅣ级),IDH野生型.组织学诊断:高级别胶质瘤,胶质母细胞瘤表型;病理级别:WHOⅣ级;分子病理...     

尼莫司汀联合顺铂治疗C6脑胶质瘤的实验研究

目的:观察尼莫司汀(nimustine,ACNU)和顺铂(cisplatin,CDDP)联合应用治疗脑胶质瘤的增效作用,探讨临床联合使用化疗药物治疗脑胶质瘤的理论依据.方法:ACNU和CDDP联合处理C6胶质瘤细胞24 h后,采用FCM法检测细胞周期及细胞凋亡;建立Wistar大鼠颅内C6胶质瘤模型,ACNU和CDDP联合给药3 d后处死部分大鼠,HE染色肿瘤组织,进行形态学观察,免疫组织化学法检测增殖相关蛋白--增殖细胞核抗原(proliferating cell nuclear antigen,PCNA)及凋亡相关蛋白bd-2的表达情况;观察剩余大鼠的生存情况.结果:FCM检测发现,联合用药组与CDDP组和ACNU组比较,细胞周期无明显变化;细胞凋亡率增加,联合用药组细胞凋亡率为(2.10±0.14)%,与CDDP组(1.72±0.21)%、ACNU组(0.57±0.01)%比较差异有统计学意义(P＜0.01).组织学观察发现,瘤灶边缘浸润灶数目减少;免疫组织化学结果显示,联合用药组PCNA、bcl-2蛋白表达下降,与单药应用组比较,差异有统计学意义(P＜0.01).联合用药组与单药应用组相比动物生存期延长,差异有统计学意义(P＜0.01).结论:ACNU与CDDP联合治疗脑胶质瘤比单药应用具有明显的增效作用.     

化疗联合顺铂腹腔热灌注治疗30例中晚期消化道肿瘤

目的探讨中晚期消化道肿瘤腹腔转移的防治方法.方法将58例中晚期消化道肿瘤患者随机分为化疗组28例(对照组),化疗联合顺铂(DDP)腹腔热灌注(CHPP)组30例(热灌组).结果热灌组有效率(63.3%)高于对照组(39.3%)具有显著性差异(P＜0.05).热灌组腹水减少有效率(5/6)较对照组(3/6)高.毒副反应两组无显著性差异(P＞0.05).结论在中晚期消化道肿瘤,尤其伴有腹水的治疗中,化疗联合DDP加CHPP,可明显提高治疗效果.     

顺铂腹腔热灌注联合全身化疗治疗进展期胃肠道癌

目的 :观察顺铂腹腔热灌注 (Intraperitonealperfusionhyperthermicchemotherapy ,CHIP)联合全身化疗治疗进展期胃肠道癌的疗效及其不良反应。方法 :5 1例进展期胃肠道癌患者分成两组 :单纯化疗组 2 6例 ,其中胃癌 11例 ,采用ELF方案 ;大肠癌 15例 ,采用LF方案。CHIP联合化疗组 2 5例 ,其中胃癌 14例 ,大肠癌 11例 ,在ELF或LF方案基础上加用顺铂腹腔热灌注。结果 :单纯化疗组CR 1例 ,PR 6例 ,NC 10例 ,PD 9例 ,有效率 2 6 9% (7/ 2 6 ) ;CHIP联合化疗组CR 1例 ,PR 13例 ,NC 6例 ,PD 5例 ,有效率 5 6 0 % (14 / 2 5 ) ,高于单纯化疗组 (P <0 0 5 )。治疗后主要不良反应为消化系统毒性。结论 :顺铂腹腔热灌注联合全身化疗治疗进展期胃肠道癌较单纯化疗近期疗效显著 ,值得继续研究。     

紫杉醇联合顺铂治疗晚期食管癌25例

 【摘要】　目的　观察紫杉醇（TAX）联合顺铂（DDP）治疗晚期食管癌的近期疗效及不良反应。方法　治疗组：TAX 135 mg／m2，第1天，DDP 40 mg，第1天至第3天；对照组：DDP 40 mg，第1天至第3天，亚叶酸钙（CF）200 mg，第1天至第5天，5-氟尿嘧啶（5-Fu）750 mg，第1天至第5天；21 d重复。结果　治疗组完全缓解（CR）3例，部分缓解（PR）13例，有效率64 ％。对照组CR 1例，PR 11例，有效（CR+PR）率44.4 ％，两组间差异有统计学意义（P＜0.05）。不良反应所有患者均可耐受。结论　TAX联合DDP是治疗晚期食管癌较好的化疗方案之一。     

肿瘤电场治疗联合药物治疗老年复发性胶质母细胞瘤1例

患者女性,68岁.间断头痛1个月加重1周起病, 2018年8月外院头颅MRI示:右侧枕叶肿瘤性病变,考虑胶质瘤的可能性大(图1A).并于外院行颅内肿物切除术,术后病理示:胶质母细胞瘤(WHO Ⅳ级).2018年9月于天津市环湖医院行Stupp方案,即替莫唑胺75 mg/(m2·d)同步放化疗.放疗前MRI见图1B.放疗...     

顺铂联合化疗方案治疗晚期肺癌28例临床观察

肺癌是最常见的恶性肿瘤之一,发病率在很多国家都有明显增高的趋势,发现时80％以上已属中晚期,治疗相当困难。由于近年来高效低毒的抗癌新药不断涌现,化疗在肺癌的治疗中已显得日益重要,不只局限于晚期肺癌的保守治疗,手术或放疗后化疗,还可对不能手术的中晚期肺癌作诱导治疗,争取化疗缓解病情获得手术机会。各类抗肿瘤药物中,铂类为重要的药物之一,肺癌的化疗方案大多以铂类为基础,     

紫杉醇联合顺铂治疗复发性小细胞肺癌

背景与目的小细胞肺癌对初次化疗极其敏感,但大多数患者会出现病情进展或复发,需要二线或挽救方案治疗。本研究的目的是观察紫杉醇联合顺铂治疗复发或进展的小细胞肺癌的疗效和安全性。方法紫杉醇联合顺铂治疗41例复发或进展的小细胞肺癌。紫杉醇175mg/m^2静脉滴注,第1天,顺铂30mg/m^2静脉滴注,第1-3天,每21天为一周期。结果39例可评价疗效,完全缓解率为12.8%（5/39）,部分缓解率为46.2%（18/39）,稳定率为33.3%（13/39）,进展率为7.7%（3/39）,有效率为59.0%。中位疾病进展时间为20周,中位生存期为27周,1年生存率为10.3%（4/39）。主要不良反应为血液学毒性,Ⅲ＋Ⅳ度白细胞下降率为24.4%（10/41）,无粒细胞减少性发热,Ⅲ度血小板下降率为4.9%（2/41）,无Ⅳ度下降。恶心呕吐发生率为82.9%（34/41）,仅3例为Ⅲ度毒性,无肾毒性及严重神经毒性。全组无毒性相关死亡病例。结论紫杉醇联合顺铂作为二线方案治疗复发的小细胞肺癌有较好的疗效,不良反应可以耐受。     

国产吉西他滨联合顺铂治疗葸环类药物化疗后复发乳腺癌

乳腺癌的发病率正逐年升高，蒽环类药物是治疗乳腺癌的主要药物，出现葸环类药物耐药后，需要选择合适的二线化疗方案。现将我科自2004年5月～2005年3月应用国产吉西他滨（泽菲）联合顺铂组成的GP方案治疗葸环类药物化疗后复发的乳腺癌近期疗效报道如下。     

紫杉醇与顺铂联合化疗致听力下降二例

例 1　男性 ,6 5岁 ,因消瘦半年入院。经胸部ＣＴ、骨穿刺检查确诊为肺腺癌伴全身多发骨转移。给予紫杉醇 180ｍｇ 3小时静脉点滴第 1天 ,顺铂 40ｍｇ静脉点滴第2、3天。 2个月后再次以同方案同剂量化疗。化疗结束后患者自诉耳鸣、听力明显下降 ,需戴助听器 ,听觉诱发电位检查示感音神经性耳聋 ,未予特殊处理。以后改用其它化疗方案 ,间隔 10个月后患者听力基本恢复正常。例 2　男性 ,6 0岁 ,因咳嗽、咳血痰 3月 ,左颈部肿块 1月入院。经纤维支气管镜检查及左锁骨上淋巴结活检确诊为肺腺癌伴左锁骨上淋巴结转移。给予紫杉醇 180ｍｇ 3小时静…     

MGMT和Ki-67在胶质母细胞瘤中的表达对ACNU化疗预后的影响

背景与目的:胶质母细胞瘤是预后极差的常见颅内恶性肿瘤,手术切除、放疗和化疗联合应用是常规治疗方法;Ki-67是肿瘤细胞生长活跃程度的标志,与胶质瘤的分级显著相关;O6-甲基鸟嘌呤DNA甲基转移酶(MGMT)是一种DNA修复蛋白,其表达影响肿瘤对化疗药的敏感性。本研究通过免疫组织化学方法对胶质母细胞瘤的Ki-67和MGMT进行检测,探讨其对胶质母细胞瘤化疗预后的影响。方法:总结39例脑胶质母细胞瘤患者的性别、年龄、术前Karnofsky评分、生存时间等;将患者手术切除标本石蜡切片进行Ki-67和MGMT的免疫组织化学染色,计算细胞核染色阳性率;多元逐步回归分析法判断Ki-67和MGMT的表达与患者生存时间的关系。结果:本组病例男22例,女17例;年龄21～75岁,平均54.0岁;生存时间6～38个月,平均19.3个月,中位生存期17.0个月。Ki-67在所有标本有不同程度的表达,表现为胞核明显染色,Ki-67阳性率4.0%～26.6%,平均10.5%。MGMT除2例外均有不同程度表达,胞浆染色较淡,胞核可见浓染,MGMT胞核阳性率0%～51.4%,平均21.2%。Ki-67阳性率与生存时间无相关性。MGMT胞核阳性率与生存时间呈负相关(P=0.002)。结论:Ki-67在胶质母细胞瘤表达与肿瘤的预后无关。MGMT在胶质母细胞瘤表达与肿瘤化疗后的预后有关,MGMT的检测对胶质母细胞瘤术后化疗可能有指导意义。     

Randomized Comparison of Intra-arterial Versus Intravenous Infusion of ACNU for Newly Diagnosed Patients with Glioblastoma

The purpose of the present study was to assess the ability of technetium-99m-tetrofosmin (^99mTc-TF) to predict tumor malignancy and to compare its uptake with that of thallium-201 (²⁰¹Tl), technetium-99m-hexakis-2-methoxyisobutyl isonitrile (^99mTc-MIBI) and fluorine-18-fluorodeoxyglucose (¹⁸F-FDG) in brain tumors. ^99mTc-TF single-photon emission computed tomography (SPECT) imaging was performed in 22 patients with brain tumors and 3 healthy controls. Some of the patients underwent ²⁰¹Tl (n = 12) and ^99mTc-MIBI SPECT (n = 14) and ¹⁸F-FDG positron emission tomography (PET) (n = 12). The radioactivity ratio of tumor to contralateral normal tissue (T/N) and the ratio of tumor to contralateral white matter (T/WM) were calculated in SPECT and PET images, respectively. In healthy controls, ^99mTc-TF uptake was seen only in scalp, in the choroid plexus and pituitary gland, but not in normal cerebral parenchyma. TF T/N in low grade gliomas (2.8 ± 0.4) was significantly lower than that in high grade gliomas (22.5 ± 29.8) and malignant non-gliomas (8.3 ± 2.8) without overlap of values (p = 0.003 and p = 0.014, respectively). TF T/N was significantly correlated with MIBI T/N ( = 0.92, p = 0.001), Tl T/N ( = 0.72, p = 0.017), and FDG T/WM ( = 0.65, p = 0.031). There was an excellent agreement between TF T/N and MIBI T/N values on linear regression analysis (MIBI T/N = –0.63 + 0.97 × TF T/N). These preliminary results indicate that SPECT imaging with ^99mTc-TF may be useful for the non-invasive grading of brain tumors. They also suggest that ^99mTc-TF and ^99mTc-MIBI may accumulate in brain tumors by a similar mechanism or in relation to a similar process of tumor cell proliferation.     

静脉持续滴注氟尿嘧啶联合顺铂治疗晚期头颈部鳞癌30例的临床分析

目的探讨持续静脉滴注氟尿嘧啶联合顺铂,治疗复发和远处转移头颈部鳞癌的疗效和安全性。方法30例复发和转移头颈部癌予5-Fu750mg/（m^2.d）持续静脉滴注120h,每天DDP25mg/m^2,第1～3天,3W为1个周期,2个周期后评价疗效。结果CR1例,PR12例,近期客观有效率为44.8%（13/29）。中位TTP7.8个月。初治与复治有效率分别为76.9%（10/13）、18.7%（3/16）,差异有统计学意义（χ^2=9.814,P=0.02〈0.05）。主要不良反应为骨髓抑制,胃肠道反应和黏膜炎。结论持续静脉滴注氟尿嘧啶联合顺铂治疗晚期头颈部癌安全有效。     

吉西他滨联合顺铂治疗复发性晚期头颈部癌的临床研究

 目的 评价吉西他滨联合顺铂治疗复发性晚期头颈部肿瘤的疗效及毒副作用。方法 对复治的晚期头颈部肿瘤患者，给予GEM 1000mg／m²静滴，第1、8d，每周期CDDP 60mg／m²，静滴（分5次第1-5d），21d为1周期，2周期后评定疗效，平均3．52个周期。结果 27例可评价疗效，完全缓解1例，部分缓解7例，总有效率29．63％，中位缓解期4．4个月，中位生存期9个月。毒副作用主要为剂量限制性毒性，表现为骨髓抑制。结论 吉西他滨加顺铂可作为复发性晚期头颈部肿瘤的挽救性化疗方案。     

吉西他滨联合顺铂治疗复发或转移性鼻咽癌的临床研究

目的 观察吉西他滨联合顺铂治疗复发或转移性鼻咽癌的临床疗效和不良反应。方法 吉西他滨1000mg／m^2，分别于第1天和第8天静脉点滴；顺铂80mg／m^2,第1天，或顺铂每天20mg／m^2,第1-4天，21天为1个周期，所有病例接受至少2个周期的化疗。结果 28例患者入组，完全缓解6例，部分缓解18例，总有效率为85．7％（24／28）。中位随访时间15个月（6～23个月），1年生存率为86％，中位疾病进展时间为8．6个月（2．5～18个月）。主要不良反应为骨髓抑制及恶心、呕吐，有4例（14％，4／28）发生了Ⅲ～Ⅳ度骨髓毒性。结论 吉西他滨联合顺铂方案治疗复发或转移性鼻咽癌有较好的疗效，患者耐受性好，值得临床进一步研究。     

A Randomized Cross-over Study of High-dose Metoclopramide plus Dexamethasone versus Granisetron plus Dexamethasone in Patients Receiving Chemotherapy with High-dose Cisplatin

We carried out a randomized, single-blind, cross-over trial to compare the antiemetic effect, for both acute and delayed emesis, of granisetron plus dexamethasone (GRN+Dx) with that of high-dose metoclopramide plus dexamethasone (HDMP + Dx). Fifty-four patients with primary or metastatic lung cancer, given single-dose cisplatin (> 80 mg/m²) chemotherapy more than twice, were enrolled in this study. They were treated with both HDMP+Dx and GRN+Dx in two consecutive chemotherapy courses. On day 1, patients experienced a mean of 2.5 (SD=4.3) and 0,1 (SD = 0.4) episodes of vomiting in the HDMP+Dx and the GRN + Dx groups, respectively ( P =0.0008). Complete response rate on day 1 was 45 and 90% in the HDMP+Dx and the GRN+Dx groups, respectively ( P = 0.0001). Patients treated with GRN+Dx had a tendency to suffer more episodes of vomiting than the HDMP+Dx group on days 2–5, but it was not statistically significant. Twenty-four patients (57%) preferred the GRN+Dx treatment and 14 patients (33%), HDMP + Dx. In the HDMP + Dx group, nine patients (21%) had an extrapyramidal reaction, and 5 patients (12%) had constipation that lasted for at least two days. In contrast, no patients had extrapyramidal reactions, and IS patients (43%) had constipation in the GRN+Dx group ( P < 0.01). GRN+Dx was more effective than HDMP+Dx only in preventing the acute emesis induced by cisplatin. An effective treatment for delayed emesis is still needed.     

Phase II Study of Chemotherapy with ACNU Plus Cisplatin Followed by Cranial Irradiation in Patients with Newly Diagnosed Glioblastoma Multiforme

Purpose: To evaluate the efficacy and toxicity of chemotherapy with ACNU (1-(4-amino-2-methyl-5-pyrimidinyl)-methyl-(2-chloroethyl)-3-nitrosourea) plus cisplatin followed by cranial irradiation in patients with newly diagnosed glioblastoma multiforme. Patients and methods: Between August 1999 and July 2001, previously untreated 30 patients with histologically confirmed glioblastoma multiforme were treated. Chemotherapy consisting of up to 2 cycles of 72 h of continuous intravenous infusion of ACNU (40 mg/m²/day) and cisplatin (40 mg/m²/d) was given over a 6-week period. Radiation was begun 6 weeks after the second cycle of chemotherapy. Results: Median age was 48 years (range 18–66 years) and 22 patients with residual measurable disease after surgery were eligible for response analysis. One (5%) had a complete response (CR), 36% partial response (PR), 14% stable disease (SD), and 45% progressive disease (PD) after chemotherapy. After additional radiation, 22% had CR, 22% PR, 16% SD, and 42% PD. Grades III and IV leukopenia and thrombocytopenia occurred in 18 cycles (36%) and 15 cycles (30%), respectively. No fatal complications occurred. Median time to progression was 5.9 months (95% CI 5.1–6.8 months) and median overall survival was 14.9 months (95% CI 9.1–20.7 months). Conclusions: Preradiation chemotherapy with ACNU plus cisplatin is effective and feasible in patients with glioblastoma multiforme.     

腹腔内灌注结合静脉给药双路化疗法治疗晚期大肠癌的疗效观察

目的：比较双路化疗法与静脉单路化疗法治疗晚期大肠癌的疗效及毒副反应。方法：1996年3月至2002年8月间，我科采用随机对照方法，将89例志愿晚期结肠直肠癌患者，分为双路化疗组(44例)及单路静脉化疗组(45例)。双路化疗组给予吡喃阿霉素静推、羟基喜树碱静滴，5-Fu同顺铂腹腔灌注；静脉化疗组给予吡喃阿霉素静推、羟基喜树碱静滴、5-Fu静滴及顺铂静滴。两组以21天为一疗程，治疗二疗程结束后评价疗效，随访三年以上。结果：双路化疗组近期完全缓解(CR)率 部分缓解(PR)率为48．7％(19／39)，二年生存率为53．8％(2l／39)，毒副反应轻；静脉化疗组近期CR ：PR率为43．9％(18／41)，二年生存率为31．7％(13／41)，毒副反应重。结论：作者初步认为双路化疗法优于静脉化疗法。由于病例太少，最后结论有待于今后大宗病例的研究。     

去甲长春花碱、异环磷酰胺和顺铂动静脉给药治疗46例非小细胞肺癌的疗效观察

目的　观察去甲长春花碱 (NVB)、异环磷酰胺 (IFO )和大剂量顺铂 (DDP )联合动、静脉给药治疗晚期非小细胞肺癌(NSCLC)的疗效及不良反应。方法　 46例NSCLC随机分为供瘤动脉给药组 (A组 )和静脉给药组 (B组 )。A组 :2 6例 ,NVB 30mg/m2 ,DDP 80mg/m2 ,供瘤支气管动脉灌注 ,第 1天 ;B组 :2 0例 ,NVB 30mg/m2 ,DDP 80mg/m2 ,静脉点滴 ,第 1天。 2组均用IFO 2 .0 g ,静脉点滴 ,连用 3天。 2 8天为 1个周期 ,至少治疗 2个周期。 结果　CR 0例 ,PR 32例 ,总有效率 6 9.6 %。A组有效率为 73 .1% (19/2 6 ) ,B组有效率为 6 5 .0 % (13/2 0 )。毒副作用主要为骨髓抑制 ,白细胞减少发生率达 10 0 .0 % ,其中Ⅲ度、Ⅳ度发生率为 6 3 .0 % ,A组为 5 7.7% (15 /2 6 ) ,B组为 70 .0 % (14 /2 0 )。静脉注射局部毒性发生率为 35 .0 % (7/2 0 )。结论　NVB、IFO和DDP联合治疗晚期NSCLC的有效率高 ,供瘤支气管动脉给药优于静脉给药 ,毒性可耐受。     

Antiemetic Efficacy of High-Dose Intravenous Metoclopramide and Dexamethasone in Patients Receiving Cisplatin-Based Chemotherapy: A Randomized Controlled Trial

High-dose intravenous (IV) metoclopramide has shown efficacywith few side effects for the treatment of nausea and vomitingon the day of cisplatin administration. From November 1984 toJanuary 1986, two randomized trials in an antiemetic study wereconducted. In trial I, the antiemetic effect of a short courseof high-dose dexamethasone was compared with that of high-dosemetoclopramide in 29 patients with lung cancer receiving chemotherapycon taining cisplatin (80 mg/m² IV) in a randomized controlledtrial. Dexamethasone was given IV at a dose of 16 mg 1/2 hrbefore and 8 mg, 1 1/2, 3 1/2 and 5 1/2 hr after cisplatin.Metoclopramide was given IV at a dose of 2 mg/kg, 1/2 hr beforeand 1 1/2, 3 1/2 and 5 1/2 hr after cisplatin. Major emeticcontrol (0–2 episodes of vomiting) during the 24 hr aftercisplatin administration was achieved in 55% (6/11) and 67%(12/18) of the patients receiving dexa methasone and metoclopramide,respectively, without serious toxicity. The dura tion of nauseaor anorexia was similar for the two treatment groups. In trial11, the combination of metoclopramide and dexamethasone wascompared with metoclopramide alone to assess the additive antiemeticeffect of the two drugs in 23 patients with lung cancer receivingcisplatin at a dose of 120 mg/m IV in a randomized cross-overstudy. A major antiemetic response was observed in 27% (3/11)and 92% (11/12) of the patients receiving metoclopramide aloneand metoclopramide plus dexamethasone, respectively (p <0.005). The duration of nausea and anorexia was similar forthe two treatment groups. Pa tients tended to prefer the combinationof metoclopramide and dexamethasone; however, the differencewas not statistically significant (p = 0.14) in the small numberof patients entered in this study. Despite excellent controlof acute chemotherapy-induced emesis, 45% of 52 patients experienceddelayed nausea and vomiting more than 24 hr after cisplatinadministration even among those who had had an excellent short-termresponse to the antiemetic agents.