顺铂联合表阿霉素对子宫颈癌介入化疗价值的评估

目的：探讨顺铂（DDP）联合表阿霉素（E-ADM）对子宫颈癌术前介入化疗的临床价值。方法：对54例中位年龄为41．6岁（30～70岁）ⅠB2期-Ⅲ期巨块型子宫颈癌病例，行DDP＋E-ADM髂内动脉介入化疗，再行手术或放疗，介入化疗的近期疗效、对手术的影响、毒副反应，并作进一步随访以观察远期疗效。结果：经1～3个疗程介入化疗，总有效率为94．4％。病理切片检查示肿瘤细胞大量坏死及退变，7．4％的病例可见肿瘤细胞消失；未见严重毒副反应。51例赢得手术切除机会，术中见宫颈癌灶缩小、肿瘤组织疏松易分离，手术难度降低，肿瘤组织更易清除。5年以上存活率达93．3％，复发率和死亡率均为4％。结论：顺铂联合表阿霉素用于子宫颈癌术前介入化疗，可明显缩小病灶、提高手术的顺应性，使晚期或巨块型肿瘤年轻患者获得手术清除病灶的机会；其近期疗效好，毒副作用小，复发率低，术后存活率高，值得临床进一步研究应用。     

宫颈癌辅助性化疗的探讨

自1989年5月至1996年1月采用改良VBP方案作为宫颈局部肿瘤是巨块型（＞4cm）宫颈癌病例的第一线治疗共48人，142个疗程，无致命性毒性反应，获得了85％以上的有效率，完全缓解达45％，使48例原本只能放疗的患者有41例得以手术根治，而且手术切缘无残瘤。手术标本的病理学评价Ⅲ,Ⅳ级者占鳞癌病例的54％，占临床反应者的63％。淋巴结阳性率为12．1％。辅助化疗组5年生存率79.1％，对照组仅50.8％（P＜0.005）。     

中晚期宫颈癌术前介入治疗的临床研究

目的探讨术前应用髂内动脉灌注化疗及血管栓塞疗法的介入治疗,提高中晚期宫颈癌手术切除率的可行性。方法治疗组22例,给予顺铂和氟尿嘧啶髂内动脉介入并血管栓塞治疗,并于介入后第2天静脉给予紫杉醇240mg。对照组23例,静脉给予紫杉醇＋顺铂＋氟尿嘧啶化疗。结果治疗组总有效率为81．8％,其中50％经双路化疗后手术切除病灶。对照组总有效率34．8％,其中有17．3％的患者手术切除。治疗组疗效优于对照组（P〈0．01）。结论中晚期宫颈癌术前的双路化疗,提高了手术切除率,使患者的生存率及生存质量均有明显提高。     

SHORT－TIME ANALYSIS FOR ADJUVANT CHEMOTHERAPY IN PATIENTS WITH EARLY－STAGE BULKY CERVICAL CARCINOMA

Bulky early-stage cervical cancer is defined as stage I~IIa cervical carcinoma with the diameter of enlarged cervix reaching 4 centimeters or more. These patients have higher recurrence rate and poor prognosis compared to those with smaller tumors at the same stage[1-3]. In or study, 21 patients with early-stage bulky cervical cancer were assigned to receive the addition of cisplatin-based chemotherapy for 1~2 courses followed by radical hysterectomy and the effect was analyzed. MATERIS…     

支气管动脉灌注化疗联合全身静脉化疗治疗中晚期肺癌的疗效观察

目的 研究支气管动脉灌注化疗联合全身化疗治疗中晚期非小细胞肺癌的临床价值。方法 138例中晚期肺癌患者分为两组:A组:介入化疗的同时联合全身静脉化疗;B组:单纯全身静脉化疗。两组全身化疗方案相同。对其临床资料进行回顾性分析。结果 A组近期有效率、半年生存率、年生存率和疾病进展时间分别为61.42%、94.29%、72.86%和85.94天,B组分别为46.27%、82.35%、42.65%和125.23天。两组均有显著性差异。结论 中晚期非小细胞肺癌行介入治疗联合全身化疗可明显提高疗效,延长生存期并改善生存质量。     

Radiation therapy with chemotherapy for patients with cervical cancer and supraclavicular lymph node involvement

Objective

We wanted to evaluate the outcomes of cervical cancer patients with supraclavicular lymph node (SCLN) involvement and who received radiation therapy (RT) combined with chemotherapy.

Methods

From August 2001 to April 2009, nine cervical cancer patients with SCLN involvement were treated by RT and cisplatin-based chemotherapy. Most of the patients (8/9, 88.9%) also had a positive para-aortic lymph node (PALN). The RT field was designed to include the whole pelvis, the involved PALNs and the SCLN area. The median SCLN RT dose was 66.6 Gy (range, 60 to 70 Gy).

Results

The median follow-up period was 61 months (range, 13 to 98 months). The 3- and 5-year overall survival rates were 66.7% and 55.6%, respectively and the 3- and 5-year progression-free survival rates were 66.7% and 44.4%, respectively. The acute hematologic toxicities according to the criteria of Radiation Therapy of Oncology Group (RTOG) were G1/2 leucopenia in 3 (33.3%), G3/4 leukopenia in 6 (66.7%), G1/2 anemia in 7 (77.8%), G3 anemia in 1 (11.1%), G2 thrombocytopenia in 2 (22.2%), and G3/4 thrombocytopenia in 2 (22.2%). Within 6 months after RT, most of the patients (5/6, 83.3%) recovered from the G3/4 leukopenia, except for 1 patient who received chemotherapy after completing RT due to subsequent bone metastasis.

Conclusion

For patients with advanced cervix cancer and SCLN involvement, RT with chemotherapy as active therapy can be expected to provide favorable results, although there is an increased risk of G3/4 hematologic toxicity.     

宫颈癌术后盆腔淋巴结转移化放疗的价值

目的：对宫颈癌根治术后有盆腔淋巴结转移的患采用化疗加盆腔放疗,评价其治疗效果。方法：１０３例Ⅰｂ、Ⅱａ期宫颈鳞癌行广泛性子宫切除加双 盆腔淋巴结清扫术,术后病理检查有盆腔淋巴结转移分两组,Ａ组５２例,ＢＶＰ方案化疗加盆腔放疗;Ｂ组５１例,单纯盆腔放疗。结果：五年生存率Ａ、Ｂ两组分别为５７．７％和４９％,盆腔复发和远处转移分别是４６．３％和５２．９％,经统计学处理均无显差异（Ｐ〉０．０５）。临     

Efficacy of neoadjuvant chemotherapy in patients with FIGO stage IB1 to IIA cervical cancer: An international collaborative meta-analysis

Background

The efficacy of neoadjuvant chemotherapy before surgery (NCS) has not been well-established in FIGO stage IB1 to IIA cervical cancer when compared with primary surgical treatment (PST). Thus, we performed a meta-analysis to determine the efficacy of NCS in patients with FIGO stage IB1 to IIA cervical cancer when compared with PST.

Methods

We searched Pubmed, Embase and the Cochrane Library between January 1987 and September 2010. Since there was a relative lack of relevant randomized controlled trials (RCTs), we included 5 RCTs and 4 observational studies involving 1784 patients among 523 potentially relevant studies.

Results

NCS was related with lower rates of large tumor size (≥4 cm) (ORs, 0.22 and 0.10; 95% CI, 0.13–0.39 and 0.02–0.37) and lymph node metastasis (ORs, 0.61 and 0.38; 95% CI, 0.37–0.99 and 0.20–0.73) than PST in all studies and RCTs. Furthermore, NCS reduced the need of adjuvant radiotherapy (RT) in all studies (OR, 0.57; 95% CI, 0.33–0.98), and distant metastasis in all studies and RCTs (ORs, 0.61 and 0.61; 95% CI, 0.42–0.89 and 0.38–0.97). However, overall and loco-regional recurrences and progression-free survival were not different between the 2 treatments. On the other hand, NCS was associated with poorer overall survival in observational studies when compared with PST (HR, 1.68; 95% CI, 1.12–2.53).

Conclusions

Although NCS reduced the need of adjuvant RT by decreasing tumor size and lymph node metastasis, and distant metastasis, it failed to improve survival when compared with PST in patients with FIGO stage IB1 to IIA cervical cancer.     

宫颈癌术前介入化疗栓塞的临床应用

目的探讨Ⅰb～Ⅱb期宫颈癌术前介入化疗栓塞的临床疗效及病理学改变。方法对2005年1月至2009年1月在我院就诊的55例宫颈癌患者实施术前动脉介入化疗,抗癌药物为顺铂、表阿霉素、5-Fu,灌注化疗后用明胶海绵颗粒栓塞肿瘤供血动脉。结果55例宫颈癌患者经1～2次术前介入化疗后顺利手术切除,术后标本病理切片中可见大量坏死组织及淋巴细胞浸润,其中组织学完全缓解8例。结论宫颈癌术前介入化疗栓塞可有效缩小肿瘤体积,减少术中出血,部分患者可达到组织学完全缓解的效果。     

介入治疗局部晚期宫颈癌的临床疗效分析

目的 探讨局部晚期宫颈癌介入治疗的临床疗效及安全性。方法 经病理证实的122例局部晚期宫颈癌患者均行子宫动脉化疗栓塞或髂内动脉灌注化疗+瘤体靶血管栓塞,化疗方案采用以顺铂为基础的联合方案,栓塞剂选用明胶海绵,并与丝裂霉素或表柔比星制成药物微球。介入治疗后2周进行妇科检查、盆腔CT或B超,观察肿瘤病灶的变化,评价临床疗效及不良反应。结果 122例患者的临床症状缓解率为100.0％,获CR 22例,PR 66例,SD 28例,PD 6例,有效率为72.1％。其中行1次介入治疗者29例,行2次者42例,行3次者35例,行4次者16例。98例患者介入治疗后行手术切除,手术切除率为80.3％（98／122）。主要毒副反应包括发热、消化道反应、白细胞减少、腹痛等,经对症处理后均好转。全组有86例患者获随访,3年及5年生存率分别为81.4％和68.6％。结论 介入治疗对局部晚期宫颈癌安全有效,能使大部分宫颈癌的瘤体缩小,降低部分肿瘤分期,提高手术切除率。     

新辅助介入化疗对巨块型子宫颈癌的疗效观察

 目的 观察新辅助介入化疗对巨块型子宫颈癌的作用。方法 对1999年1月至2004年12月收治的126例巨块型宫颈癌患者，随机分为2组，介入组74例，采用Seldinger技术髂内动脉插管注药。鳞癌采用顺铂+博来霉素加长春新碱（VBP）方案，腺癌采用顺铂+阿霉素+长春新碱（AVP）方案。放疗组52例，按照宫颈癌放疗常规用6 Mev加速器行全盆腔体外照射，总剂量24 Gy，中间档野后继续照25 Gy，穿插Ir192后装腔内放疗，每周2次，每次A点剂量5 Gy，总剂量40 Gy。两组患者术后2周决定下一步治疗。结果 介入化疗组肿块消退（CR）12例（12／74），占16.21 %，肿块缩小≥50 %（PR）57例（57／74），占77.02 %。适宜2期手术67例（67／74），占90.54 %；放疗组CR6例（6／52），占11.53 %；PR31例（31／52），占59.61 %。适宜2期手术37例，占71.15 %（37／52）。两组比较，PR、2期手术率差异有统计学意义。介入化疗2年复发率6 %，3年复发率8 %；放疗组2年复发率8 %，3年复发率23 %；介入组3年总生存率79 %，放疗组3年总生存率71 %。两组2年复发率与3年总生存率比较，无统计学意义（P＞0.05）；3年复发率差异有统计学意义（P＜0.05）。结论 新辅助介入化疗可有效缩小肿瘤，增加2期手术率，减少3年复发率，能否减低5年复发率、增加5年生存率，有待进一步随访。     

动态监测血清VEGF在宫颈鳞癌化疗前后的变化

目的研究宫颈癌化疗前后血管内皮生长因子（vascular endothelial growth factor,VEGF）的改变,探讨VEGF能否作为评判化疗近期疗效的预测指标,为制定合理的治疗方案提供参考。方法采用酶联免疫吸附法（ELlSA）检测60例宫颈鳞癌患者及20例正常健康妇女血清中VEGF水平并进行对照分析。结果宫颈癌患者血清中VEGF水平显著高于正常健康妇女血清中VEGF水平（P〈0．01）,且宫颈癌Ⅰ期血清VEGF值低于Ⅱ期者（P〈0．05）;宫颈癌患者术后血清VEGF表达较术前明显上升（P〈0．01）,术后化疗后血清VEGF水平较术后明显下降（P〈0．01）;宫颈癌Ⅰ期患者术后化疗后血清VEGF水平与术前比较差异无统计学意义（P〉0．05）,宫颈癌Ⅱ。期、Ⅱ。期患者术后化疗后血清VEGF水平均低于术前（P〈0．05）;宫颈癌Ⅱ。期患者新辅助化疗（neoadjuvant chemotherapy,NACT）后血清VEGF浓度较NACT前降低（P〈0．05）。结论VEGF可作为预测宫颈癌化疗近期疗效和判断术后是否需要辅助化疗及化疗疗程数的参考指标。     

放疗合并化疗治疗晚期宫颈癌的疗效观察

对60例晚期宫颈癌患者分别采用常规根治量放疗加VPB方案化疗（治疗组）和单行根治量放疗（对照组）、结果表明：治疗组患者的宫颈局部肿瘤缩小和消失时间校对照组明显缩短,宫颈局部肿瘤缩小50％所需放射剂量亦校对照组减少;治疗组未出现严重毒性反应,患者对治疗耐受性良好。     

宫颈癌化疗心血管毒性预防的间断时间序列试验

目的 在已知有效措施的基础上构建一套实用可行的宫颈癌化疗CVT综合防治方案,为临床治疗提供科学指导与依据。方法 2016年11月—2018年1月对164例研究对象进行化疗前CVT发生风险及化疗后CVT评估,构建干预前后CVT发生率改变情况的ITS模型;同时比较ITS模型中干预后患者化疗前后CVT生物标志物和临床检查结果,评价干预措施的效果。结果 干预前后CVT发生率改变情况的ITS模型无统计学意义(P＞0.05);超声心动图检查结果中二尖瓣E峰流速和E/A比值增大,差异均有统计学意义(P＜0.05),LVEF、FS、SV、二尖瓣A峰流速均无统计学差异(P＞0.05);心电图和双下肢动静脉超声检查结果均无统计学差异(P＞0.05);生物标志物检测结果中sICAM-1、sTM、vWF、h-FABP水平出现下降,NO、eNOS水平出现上升,差异均有统计学意义(P＜0.05);hs-CRP、E-selectin水平变化均无统计学差异(P＞0.05)。结论 本研究构建的综合防治方案可在微观上改善宫颈癌化疗CVT,应扩大样本量开展进一步研究。     

Weekly low-dose paclitaxel and carboplatin in the treatment of advanced or recurrent cervical and endometrial cancer

Background The purpose of this study was to evaluate the toxicity profile of weekly low-dose paclitaxel and carboplatin in patients with gynecologic malignancies. Methods Patients had measurable disease defined by clinical examination or radiographic studies. Each cycle of treatment consisted of carboplatin at an AUC of 2 and paclitaxel at 80 mg/m² on days 1, 8, and 15 of a 28-day cycle. Results Twenty-eight patients with advanced or recurrent cervical and endometrial cancers were included in this study. The overall response rate (ORR) was 39% (2 CR, 9 PR). Among the 15 cervical cancers the ORR was 20%, while the 13 endometrial cancers had a 62% ORR. Median time to progression and overall survival was 3.4 and 7.6 months for those with cervical cancer and 5.5 and 15.4 months for those with endometrial cancer. Grade 3 or 4 hematologic toxicity was uncommon (7% grade 3 anemia, 21% grade 3 or 4 neutropenia, 7% grade 3 or 4 thrombocytopenia). Conclusion A regimen of weekly low-dose paclitaxel and carboplatin has an acceptable toxicity profile that is easily managed by dose adjustment and the use of erythropoietic therapy. This regimen appears to have activity in advanced or recurrent endometrial cancer which warrants further evaluation.     

青年人宫颈癌临床病理特征和预后的研究

目的：深入探讨青年宫颈癌患的临床病理特点及预后情况。方法：回顾性分析128例宫颈癌患青中年组的临床病理情况，用Kaplan—Meier进行生存分析。结果：与中年组相比，青年组患具有以下特点：①婚前性生活史比例高。②症状以接触性出血为主，宫颈多为糜烂，其次是赘生物，但其直径多在1cm左右。③患患腺癌比例高(P≤0．05)，细胞分级低比例明显较高(P≤0．05)，易发生淋巴结转移及宫旁转移。④中位生存期及5年生存率明显低于中年组(P≤0．05)。结论：青年宫颈癌患具有特定的临床病理特点，且其生存率低于中年组，病理类型、病理分级、有无脉管浸润淋巴转移及肌层浸润深度是影响预后的独立因素。     

Aortitis during intraarterial chemotherapy for cervical cancer

A 76-year-old woman with stage IIb cervical cancer with a bulky tumor experienced aortitis during continuous intraarterial cisplatin-based chemotherapy. The chemotherapy was administered through a catheter tip placed in the aorta abdominalis, utilizing an external infusion pump. During the third course of chemotherapy, she complained of left-sided lower back pain and moderate fever was observed. Elevated white blood cell count (WBC) and C-reactive protein (CRP) level were noted, and an abdominal X-ray and urgent computed tomography (CT) were performed. The catheter tip was displaced against the arterial blood flow. At this level of the aortic wall, soft tissue density surrounded the aorta completely. Aortitis caused by the intraarterial chemotherapy, was strongly suspected. It was thought that the maldistribution of drugs and changes in the drug flow occurrred due to the vertebral height movement of the catheter tip against the aortic blood flow, and there, flow to the vasa vasorum may have occurred. Chemical vasculitis of the vasa vasorum due to the anticancer drugs was strongly suspected as a contributing factor of the aortitis. Because of the long-term use of an intraarterial catheter, the maldistribution of drugs and changes in the drug flow occurred physically and biologically during the course of the chemotherapy. We recommend occasional monitoring of the location of the catheter tip and a repeat evaluation with contrast medium in regard to flow to the vasa vasorum. Received: August 29, 2001 / Accepted: December 17, 2001     

电化学治疗宫颈癌的临床病理分析

作者对６６例接受了电化学治疗的中晚期宫颈癌患者进行临床病理分析，结果显示：①电化学治疗组的近期有效率为９２．４２％，明显高于对照组，其疗效以菜花型、病灶直径相对较小者的疗效为佳；②治疗后病灶的病理改变，阳极以凝固性坏死为主，阴极以溶解性坏死为主；并有明显的炎细胞浸润；③治疗后机体细胞免疫指标较治疗前有明显提高。     

宫颈癌的新辅助化疗

随着肿瘤化疗临床研究的迅速进展、化疗药物的不断开发、给药途径及方法的改进,新辅助化疗对宫颈癌的疗效逐渐被证实和肯定,成为局部晚期宫颈癌必要的治疗。