以淋巴结转移为主的晚期胃癌的FLEP法新辅助化疗

目的:研究采用经动静脉联合给药的FLEP化疗法,对以淋巴结严重转移为主而不能切除的胃癌进行新辅助化疗,使病人能重新获得手术切除的机会。方法:对14例以淋巴结转移为主的晚期胃癌,以FLEP法进行新辅助化疗。内9例系未经治疗的初诊病人,术前CT检查发现第3、7、9、12组及14、16组淋巴结严重转移,难以手术治疗;5例为术后淋巴结转移性复发,或因淋巴结严重转移而进行过剖腹探查者。FLEP方案为:5-FU 370 mg/m2,iv,第1～5天;Leukovorin 30 mg,第1～5天;CDDP 70 mg/m2与Epotoside 70 mg/m2,ia,第6、20天,每5周重复1次。每一病例视病情进行2～3个疗程的治疗。结果:所有病例症状都明显改善。初次就诊的9例CT评价无变化(NC)1例,未行手术;部分缓解(PR)8例,均进行了胃次全、全胃或联合脏器切除,淋巴结清扫采取了D2加重点淋巴结、D3加第16组淋巴结手术,手术切除率为88.9%,手术治疗的病例均生存至今,最长者已达26个月。在3例术后出现淋巴结转移性复发者及2例因淋巴结严重转移初次手术未能切除者影象学评价PR 3例,病变进展PD 1例,均未再手术治疗。其中2例分别于治疗开始后的8、15个月死亡,另3例至今已生存3～15个月。结论:FLEP新辅助化疗法对于以淋巴结严重转移为主的胃癌具非常显著的治疗效果,可使严重或有远处淋巴结转移的胃癌病人重新获得手术治疗的机会。     

奥沙利铂联合亚叶酸钙和5-氟尿嘧啶一线治疗晚期胃肠道肿瘤的研究

目的：评价奥沙利铂（OXA）联合亚叶酸钙（LV）和5-氟尿嘧啶（5-Fu）一线治疗晚期胃肠道肿瘤疗效与安全性。方法：OXA130mg／m^2，第1天；LV200mg，第1～5天；5-Fu450mg／m^2，第1～5天。每3周为1周期，至少2周期后评价疗效。结果：58例，均为术后转移或不能手术切除患者，其中CR2例（3．4％）。PR26例（44．8％），SD21例（36．2％），PD9例（15．5％），总有效率（CR＋PR）48．3％。有手术史者有效率54．5％，不能手术者有效率40．0％；胃癌有效率44．4％，大肠癌有效率51．6％。主要不良反应为恶心呕吐、轻度周围神经毒性及白细胞和血小板减少，无化疗相关死亡。结论：OXA联合LV和5-Fu一线治疗晚期胃肠道肿瘤有较好的疗效和耐受性。     

胃、结、直肠癌术中门静脉置管术后化疗预防肝转移

目的研究观察在中、晚期胃癌、结、直肠癌根治术中门静脉置管术后化疗对预防肿瘤肝转移的临床疗效。方法选取1998～2002年可行根治性切除的中、晚期胃癌、结、直肠癌患者96例，其中42例术中经胃网膜右静脉置管进入门静脉，1周后经此管给醛氢叶酸（CF）200mg／m^2，第1天，第14天，顺铂（DDP）50mg／m^2滴注，第1天，5～氟脲嘧啶（5-FU）2500mg／m^2，第1天，第14天，以便携式输液泵持续滴注72h。另外54例仅行根治性切除作为对照。结果两组病人全部随访1～3年，观察组中1例出现肝转移，对照组9例出现肝转移。观察组主要不良反应为肝功能损害、发热及胃肠道反应等，经相应对症处理可缓解。结论术中门静脉置管术后化疗对中、晚期胃肠癌术后肝转移的预防有明显效果。     

多西紫杉醇／顺铂／5—氟脲嘧啶新辅助化疗方案治疗局部进展期胃癌的临床研究

目的 了解多西紫杉醇加顺铂及5—氟脲嘧啶的联合新辅助化疗方案治疗局部进展期胃癌的疗效和毒副作用。方法 自2001年10月—2003年9月，有37例局部进展期胃癌病人入组本次临床研究。入组病例术前接受的新辅助化疗方案为：多西紫杉醇75mg／m^2，第1天；顺铂75mg/m^2，第1天；5-氟脲嘧啶500mg/m^2，第1—5天，每三周为一周期，共三个周期。观察新辅助化疗后肿瘤原发病灶的缓解情况，并观察新辅助化疗的毒副反应。结果 新辅助化疗后所有病人进行了根治性手术治疗，临床有效率为51．4％，其中完全缓解(CR)占8．1％(3例)，部分缓解(PR)占43．2％(16例)，疾病稳定(SD)占27．0％(10例)，疾病进展(PD)占21．6％(8例)，术后病理水平缓解率为10．8％(4/37)，其中2例达到完全缓解。毒副反应主要为白细胞减少症、腹泻、恶心，呕吐、脱发，共有8例病人发生了Ⅲ—Ⅳ级的白细胞减少症，但未有因此而发生的败血症和死亡病例。结论 多西紫杉醇加顺铂及5—氟脲嘧啶的新辅助化疗方案在进展期胃癌的治疗中近期疗效显著，耐受性良好。     

静脉结合给药的FLEP法治疗难以切除的晚期胃癌

目的:为提高胃癌新辅助化疗的效果,观察动静脉结合的FLEP化疗方法对难以切除局部晚期胃癌的疗效.方法:2003年1月至2006年1月选择30例难以切除的晚期胃癌,以FLEP法化疗.FLEP方案:5-FU 370 mg/(m2·d),持续静脉滴注20h,第1～5天;四氢叶酸钙30mg/(m2·d),静脉滴注,第1～5天;...     

奥沙利铂联合甲酰四氢叶酸钙和氟尿嘧啶新辅助化疗方案治疗进展期胃癌的研究

目的评价奥沙利铂（OXA）联合甲酰四氢叶酸钙（LV）和氟尿嘧啶（5-FU）新辅助化疗方案（OXA-LV5FU2）治疗进展期胃癌的疗效与毒副作用。方法27例进展期胃癌患者接受OXA-LV5FU2治疗：OXA 100mg／m^2,静脉滴注2h,第1天;LV 200mg／m^2,静脉滴注2h后推注5-FU 400mg／m^2,后续5-FU 1g／m^2以麻醉镇痛泵持续48-72h恒速静脉输入,第1、2天。每2-3周为1个疗程,共3～4个疗程。观察新辅助化疗后肿瘤原发病灶的缓解情况及其不良反应。结果新辅助化疗后27例患者中24例获得手术切除,其中14例获得根治性切除。临床有效率为48．1％,其中3．7％（1例）完全缓解,44．4％（12例）部分缓解,33．3％（9例）病情稳定,18．5％（5例）病情进展。8例肿瘤TNM分期降低。不良反应主要为恶心呕吐、外周感觉神经异常、自细胞减少症、脱发、肝功能异常,对症治疗可缓解。无化疗相关死亡者。结论OXA-LV5FU2新辅助化疗方案在进展期胃癌的治疗中近期疗效显著,耐受性良好。     

动静脉结合给药的FLEEOX方案对以淋巴结转移为主晚期胃癌的新辅助化疗

动静脉结合给药的FLEEOX新辅助化疗对于以淋巴结转移为主的晚期胃癌具有较好的疗效,动静脉不同的给药途径是提高胃癌新辅助化疗疗效的一种办法.     

大肝癌切除术后化疗的临床分析

目的探讨肝癌术后化疗的作用,提高手术治疗效果。方法分析25例原发性肝癌患者术后辅助化疗的临床资料,化疗采用FAP方案：四氢叶酸钙（CF）200mg／m^2,5-氟尿嘧啶（5-FU）500mg／m^2,静脉滴注,第1—5天;阿霉素（ADM）40mg／m^2,顺铂（CDDP）30mg／m^2,静脉滴注第1天,在护理上,应加强静脉、口腔及心理护理,预防感染,以提高患者的生活质量。结果25例患者至今存活23例,最长36个月,死亡2例,生存期均超过了1年,其中1例死于术后11个月,1例死于20个月,死亡原因均为肿瘤转移。化疗毒副反应轻。结论肝癌患者术后辅助化疗是可行的、副作用小;对患者做好心理护理,营养支持及早预防,及时处理化疗药的毒副作用,可有效减轻患者痛苦,提高生存质量,延长患者生存期。     

局部进展期乳腺癌新辅助化疗后保乳手术31例报告

目的探讨局部进展期乳腺癌新辅助化疗降期后保乳手术治疗的可行性。方法2002年1月-2005年6月我院接受新辅助化疗后行保乳治疗的31例局部进展期乳腺癌。化疗方案：①TE：表阿霉素60mg／m^2，紫杉醇150mg／m^2，21d为1个周期；②CEF：表阿霉素60mg／m^2，环磷酰胺600mg／m^2，5-FU600mg／m^2，21d为1个周期，共3～4周期。在新辅助化疗完成后，临床体检、B超和钼靶乳房x线检查评估新辅助化疗疗效，符合保乳条件且病人有保留乳房的愿望可接受保乳治疗。手术方式为象限切除或肿块局部广泛切除联合腋窝淋巴结清扫。术后常规行辅助放疔、化疗和内分泌治疗。结果新辅助化疗总有效率（overaul response rate，ORR）90．3％（28／31）；临床完全缓解（complete response，CR）25．8％（8／31），其中病理完全缓解（pathologic complete response，pCR）4例（12．9％，4／31），临床部分缓解（partial response，PR）20例（64．5％，20／31），无进展病例。经过34个月中位随访期（4～46个月），局部复发率6．5％（2／31）；3例术后发生远处转移，转移部位分别为肺、肝脏、脑膜和骨，远处转移率9．7％（3／31），其中1例死亡。对保乳综合治疗结束后满1年的25例进行乳腺外形的评估，外形优16．0％（4／25），良40．0％（10／25），差44．0％（11／25）。结论经新辅助化疗降期后的局部进展期乳腺癌进行保乳手术治疗效果满意，规范化的切除和术后放疗、全身综合治疗是保乳治疗成功的关键。     

新辅助治疗低位局部进展期直肠癌35例结果分析

目的 探讨新辅助治疗对低位局部进展期直肠癌的临床治疗价值。方法 对35例低位局部进展期直肠癌患者，采用新辅助治疗方案。常规分割放疗，放疗总剂量DT：46Gy，每次2Gy，每周5次。全身化疗2个疗程，每次予以奥沙利铂130mg／m^2，第1天静脉点滴；甲酰四氢叶酸钙(CF)200mg／m^3，第1～3天静脉点滴；氟尿嘧啶(5-FU)500mg／m^2，第1～3天静脉点滴。治疗结束后4～6周进行手术。结果 经新辅助治疗后，病理完全缓解7例，肿瘤平均缩小34．4％，65．7％的病例T分期下降，淋巴结阴转率为55．6％。根治切除34例，其中腹会阴联合切除18例，保肛手术16例，保肛率为45．7％。姑息性Hartmann术1例。随访至今，肝转移2例，根治切除术后无1例局部复发。保肛患者肛门功能良好。结论 对低位局部进展期直肠癌患者采用新辅助治疗，可使肿瘤分期降低，提高手术切除率和保肛率。     

Neoadjuvant chemotherapy for gastric adenocarcinoma in Japan

Surgery had been and remains a mainstay in the treatment of gastric cancer. The Japanese surgical oncologists employed surgery-first approach to treat gastric cancer because of the widespread use of D2 lymph node dissection and the high incidence of oncologically resectable cancer, and early attempts at the multimodality treatment strategy featured surgery followed by postoperative chemotherapy. Although evidence to treat Stage II/III gastric cancer with this strategy is now abundant in the Far East, poor compliance of the post-gastrectomy patients to intense combination chemotherapies has been a limitation associated with this strategy. Evidence in support of neoadjuvant chemotherapy in the West and in various other types of cancer prompted the Japan Clinical Oncology Group (JCOG) researchers to explore this strategy, primarily for a selected population of locally advanced cancer that could either be unresectable by the surgery-first approach or is known to suffer from a poor prognosis; cancers with bulky lymph node metastases or those with a scirrhous phenotype. Encouraged by some promising results from these neoadjuvant trials and taking into account the aforementioned limitations associated with postoperative chemotherapy, the JCOG researchers decided to embark on a phase III trial to explore neoadjuvant chemotherapy among patients with clinically Stage III cancer. This review describes the development of the neoadjuvant strategy for gastric cancer in Japan, mainly by going through a series of clinical trials conducted by the JCOG.     

Gastric Cancer with Virchow's and Multiple Lung Metastases Showing a Remarkable Response to Preoperative Chemotherapy: Report of a Case

We report herein a rare case with advanced gastric cancer combined with group 4 lymph node and lung metastases that responded remarkably to neo-adjuvant chemotherapy. A 65-year-old man was found to have a well-differentiated type 3 gastric cancer that invaded the duodenum locally and was accompanied with Virchow's, para-aortic lymph nodes, and multiple lung metastases based on physical, endoscopic, and radiological examinations. In addition, his carbohydrate antigen (CA) 19-9 was elevated to 3965 U/ml, and CA72-4 to 46 U/ml. Prior to surgery, he was treated with 5-fluorouracil (5-FU; 500 mg/body per day) and low-dose cisplatinum (CDDP; 10 mg/body per day) as neoadjuvant chemotherapy for 6 weeks. As a result, a partial response was obtained in all lesions, and CA19-9 and CA72-4 decreased to 463 U/ml and 9.4 U/ml, respectively. Four weeks after the completion of neoadjuvant chemotherapy, a distal gastrectomy was performed, and a histopathological examination of the resected specimen showed a grade 2 response to chemotherapy. Immunohistochemically, the thymidylate synthase expression level was very low in the tumor tissues, which might account for the good response to the combination chemotherapy with 5-FU and CDDP observed in the present case. Received: April 18, 2000 / Accepted: September 26, 2000     

Multimodality therapy in penile cancer: when and which treatments?

Objectives  Metastatic penile cancer typically comes to attention while the clinical extent of disease is limited to the inguinal or pelvic lymph nodes. Primary surgical management of lymph node metastases achieves tumor control and long-term survival for only a small percentage of these patients. To determine the optimal use of multimodality treatment in locally advanced penile cancer, we conducted a literature review. Methods  Relevant English-language literature was identified with the use of Medline; additional cited works not detected on the initial search were also reviewed. Results  There is an emerging strategy of preoperative (neoadjuvant) combination chemotherapy to improve the progression-free survival of penile cancer patients with bulky regional lymph node metastases. Radiotherapy for inguinal metastases and postoperative (adjuvant) radiation for selected patients has also been effective in this setting. Conclusions  In patients with lymph node metastases, the benefit of ilioinguinal lymphadenectomy may be extended by the addition of neoadjuvant chemotherapy. Postoperative radiotherapy can be offered depending on the amount of residual disease after chemotherapy. Chemo-radiotherapy has been successful in squamous cell cancers from other sites (vulva and anal canal) and may be considered for unresectable penile cancer.     

Neoadjuvant Docetaxel, Capecitabine and Cisplatin (DXP) in Patients with Unresectable Locally Advanced or Metastatic Gastric Cancer

Background

This phase II study was conducted to evaluate the efficacy of neoadjuvant chemotherapy with docetaxel, cisplatin and capecitabine (DXP) in patients with unresectable locally advanced and/or intra-abdominal metastatic gastric cancers.

Methods

Patients with advanced gastric cancer (AGC), clinically unresectable because of local invasion or limited intra-abdominal metastasis in para-aortic lymph nodes and/or the peritoneum based on multidetector row computed tomography, were enrolled. DXP consisted of docetaxel 60 mg/m² i.v. and cisplatin 60 mg/m² i.v. on day 1, and capecitabine 937.5 mg/m² twice daily p.o. on days 1–14 every 21 days. Surgery was performed after 4–6 cycles of DXP.

Results

Thirty-six (74%) of the 49 patients enrolled underwent surgery, and 31 (63%) had an R0 resection. R0 resection was possible in 15 of 21 patients (71%) with unresectable locally advanced lesions, 12 of 17 patients (70%) with para-aortic lymph node metastasis but only 4 of 11 patients (36%) with peritoneal metastasis. Grade 3/4 toxicities included neutropenia (69%), febrile neutropenia (4%) and hand–foot syndrome (8%).

Conclusions

Neoadjuvant DXP may offer a reasonable chance of curative surgery in AGC patients with unresectable locally advanced or para-aortic lymph node metastasis.     

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??In regard to japanese gastric cancer treatment guidelines-the 3rd Edition HU Xiang. Department of General Surgery??the first Affiliated Hospital??Dalian Medical University??Dalian 116011??China Abstract The Japanese Gastric Cancer Association will issue a revised edition of gastric cancer treatment guidelines in Jan, 1st, 2010. Distinctive features of this revision are lymph node grading based on the removal effect, lymphadenectomy according to the D1/D2 dissection. Based on a high level evidence-based medicine, the Para-aortic lymph node dissection in D3 dissection was excluded in this edition. According to JCOG9912 and SPIRITS trials, neoadjuvant chemotherapy with CDDP and TS-1 has become a standard option in unresectable or recurrent gastric cancer. So the revised edition of gastric cancer treatment guidelines provided more advanced and scientific treatment programs.     

Curative resection of carcinoma of the ampulla of Vater with lymph node metastases around the abdominal aorta after chemotherapy: A case report

IntroductionFor carcinoma of the ampulla of Vater, lymph node metastasis around the abdominal aorta is an inoperable factor equivalent to distant metastasis, such as hepatic metastasis or peritoneal carcinomatosis, making the cancer unresectable.Presentation of caseA 53-year-old man was referred to our hospital and was diagnosed as having carcinoma of the ampulla of Vater with lymph node metastases around the abdominal aorta. Although only chemotherapy was initially scheduled, the chemotherapy was effective, and the metastases were dramatically reduced after 4 cycles of chemotherapy. Curative surgical resection was performed.DiscussionThere were only eight case reports describing curative resections of initially unresectable biliary tract carcinomas excluding intrahepatic cholangiocellular carcinoma after chemotherapy.ConclusionCurative surgical resection after chemotherapy may be a feasible treatment plan in patients with unresectable biliary tract cancer.     

进展期胃癌的外科治疗

尽管胃癌发病率有下降的趋势．但其仍为全球范围内发病率占第4位、死亡人数占第2位的恶性肿瘤。胃癌的预后较差,外科手术目前仍然是获得痊愈的唯一途径。由于胃癌有很高的淋巴转移率及淋巴复发率,故淋巴结清扫在胃癌外科手术中占有重要地位。D2淋巴结清扫作为胃癌淋巴结清扫的标准已成为东西方专家的共识。一些临床试验显示,新辅助化疗应用于进展期胃癌有良好的效果．但仍需要大样本的随机对照试验加以证实。     

Systemic neoadjuvant chemotherapy in locally advanced gastric carcinoma: phase II study with 5-fluorouracil, epirubicin and etoposide

Locally advanced gastric adenocarcinomas have a poor prognosis, particularly when the tumours are bulky, located in the cardia or when they present local/regional lymph node involvement. Neoadjuvant chemotherapy for locally advanced gastric cancer is an experimental treatment strategy that may increase resectability and improve survival in patients suffering from an almost uniformly fatal neoplasm. At our institution 11 patients younger than 70 years of age in good physical and mental condition with non-resectable adenocarcinomas of the stomach as determined by endoscopy, computed tomography scans and pathology examinations, were treated with combination chemotherapy [5-fluorouracil (375 mg/m2 i.v. for 5 days, epirubicin (60 mg/m2 i.v. on day 1), etoposide 80 mg/m2 on days 1, 2 and 3, leucovorin 100 mg/m2 for 5 days] every 4 weeks as neoadjuvant chemotherapy. The response to chemotherapy was evaluated after three courses. After three courses, we had one complete response, 8 partial responses or stable disease, and no response in two cases. One patient was still alive 36 months postoperatively. These preliminary results suggest that this protocol is an effective form of neoadjuvant chemotherapy for locally advanced gastric carcinoma.     

Liver resection after downstaging with neoadjuvant chemotherapy for "unresectable" colorectal metastases

Hepatic resection is the only treatment that offers a chance of long-term survival in patients with metastases from colorectal cancer. Nevertheless, a curative resection can be performed in only 10-20 per cent of patients: multiple bilobar metastases or "unresectable" disease are the greatest obstacles to surgical radicality. Techniques such as preoperative portal embolisation, preoperative portal ligation, two-stage hepatectomy, and neoadjuvant chemotherapy, have extended the possibility of liver surgery to patients with advanced metastatic colorectal cancer. The outcomes of two patients treated successfully with neoadjuvant chemotherapy (one case with FOL-F-OX, and one with FOL-F-IRI) followed by liver resection were analyzed. In both patients neoadjuvant chemotherapy enabled a curative liver resection to be performed without significant complications. In some patients, neoadjuvant chemotherapy permits the "downsizing" of metastatic disease to such an extent that a surgical approach proves feasible. This advance can dramatically improve the prognosis of patients with multiple or unresectable liver metastases from colorectal cancer.