健择治疗晚期肝癌34例临床分析

健择是阿糖胞苷类似物 ,属抗代谢类抗癌药。它在体内被转化为 d Fd CTP(双氟脱氧三磷酸胞苷 ) ,可掺入 DNA使 DNA链断裂 ,从而起到细胞毒作用。2 0 0 1年 1月～ 2 0 0 1年 8月 ,我们对健择单药以及联合顺铂 (DDP)治疗肝癌的疗效及毒性进行验证研究 ,现报告如下。1　资料与方法1 .1　一般资料　选择晚期肝癌患者 3 4例 ,均符合以下收治标准 :1影像学、血清学证实的晚期肝癌 ,已不能手术切除或栓塞者 (TACE)或无水酒精注射(PEI) ;2过去未经化疗 (包括健择治疗 ) ;3身体功能状况 (KPS)卡氏 70分以上 ;4有可测肿瘤病灶 ;5预期寿命 1 2…     

晚期肝癌中西医综合个体化治疗研究

目的探索中西医综合个体化治疗晚期肝癌的临床疗效.方法根据每位病人的具体情况,用介入治疗、抗癌中药等"攻邪",用中医药辨证施治汤剂、药膳等"扶正".结果完全缓解(CR)、部分缓解(PR)、稳定(SD)和恶化(DP)分别为7.50%、35.00%、40.00%和17.50%,生存时间为20.83±16.42个月,1、3、5年生存率分别为63.75%、31.82%和22.22%.结论中西医综合个体化治疗晚期肝癌可取得较好的临床效果,显著延长病人的生命.     

晚期原发性肝癌靶向及免疫治疗的研究进展

肝细胞癌（HCC）是原发性肝癌的主要组织学类型,占原发性肝癌的75%～85%。由于HCC起病隐匿,大多数患者初诊时即为晚期,手术切除、射频消融、肝动脉化疗栓塞等治疗效果有限,5年生存率较低。随着肿瘤分子信号通路和肿瘤微环境研究的不断深入,靶向治疗成为晚期HCC临床研究的热点,相继研发出了一系列靶向药物,如一线治疗的索拉非尼、仑伐替尼、多纳非尼以及二线治疗的瑞戈非尼、卡博替尼、雷莫芦单抗。除了靶向治疗外,近年来免疫检查点抑制剂在晚期HCC治疗中亦取得了突破性进展,相继研发出了一系列免疫检查点抑制剂,如纳武利尤单抗、帕博利珠单抗、卡瑞利珠单抗。这些新型靶向药物及免疫检查点抑制剂相继被批准用于晚期HCC治疗,为患者带来了更多的临床获益。     

索拉非尼治疗晚期肝癌8例临床疗效观察

原发性肝癌是常见的恶性肿瘤之一,发病率较高且逐年增长,全球发病人数超过62．6万／年,占全球癌症死亡原因第3位,仅次于肺癌和胃癌。手术切除被公认为早期肝癌的最佳治疗选择,但由于原发性肝癌起病隐匿,早期无明显症状,     

华蟾素联合化疗治疗晚期肝癌46例

我们从1992年1月～1996年5月共收治46例晚期原发性肝癌患者,他们均失去手术治疗机会,又不愿接受放疗、介入治疗。经使用华蟾素配合化疗,取得较好疗效,现报道如下。 1 一般资料 88例患者均为Ⅱ、Ⅲ期原发性肝癌患者,随机分为A、B两组。A组46人,其中男35例,女11例,年龄在32～64岁,平均49岁。经CT、B超检测诊为巨块型12例,结节型18例,弥漫型16例。B组42人,其中男32例,女10例,平均年龄48岁。其中巨块型13例,结节型18例,弥漫型11例。所有病例的诊断、分型均符合1997年全国肝癌协会制订的肝癌诊断及分型标准。     

肝动脉化疗加栓塞治疗晚期肝癌65例分析

1997～ 2 0 0 0年 ,我院应用肝动脉化疗加栓塞治疗晚期肝癌患者 65例现报告如下。临床资料 :本组男 5 7例 ,女 8例 ,年龄 5 2 .5± 11.3岁。其中原发性肝癌 5 8例 ,转移性肝癌 7例 ,均经 CT、B超、AFP确诊。癌肿≤ 10 cm者 2 8例 ;>10 cm者 3 7例。肝癌分期 : 期者17例 , 期者 4 5例 , 期者 3例。肿瘤类型 :巨块型 3 9例 ,结节弥漫型 2 6例。 AFP≥ 2 0 0 ng/ml者 4 1例 ,AFP<2 0 0 ng/ml者 2 4例。门静脉癌栓者 2 8例。方法 :采用 Seldingers方法 ,经股动脉穿刺 ,将肝动脉导管选择性插管到肝固有动脉以远 ,行血管造影术 ,然后灌注化…     

40例晚期血吸虫病并发肝癌患者临床资料分析

本文对40例晚期血吸虫病并发肝癌患者的临床资料进行了分析。     

抗癌药物腹腔灌注治疗晚期肝癌20例

原发性肝癌是我国常见癌种之一,早期症状不明显,一旦出现症状,大多数已属晚期,是原块型或弥漫性改变合并门静脉癌栓和伴有不同程度的腹水,治疗十分困难。     

中西医结合治疗晚期肝癌30例

原发性肝癌晚期患者不宜手术,现多采用肝动脉化疗进行治疗。由于患者一般情况较差,而化疗的毒副作用又较大,为了提高临床疗效,我们采用肝动脉化疗配合中药治疗此类患者30例,并与单纯采用化疗的30例患者进行对比观察,现将结果报告如下。 1 一般资料 1997年1月至1999年8月我们收治了60例晚期肝癌患者。均取肝脏活组织进行病理检测,证实为原发性肝癌,诊断符合《现代肿癌学》中的诊断标准。其中肝细胞肝癌56例,胆管细胞癌1例,混合型肝癌3例。60例患者中男性54     

challenges of advanced hepatocellular carcinoma

Hepatocellular carcinoma(HCC) is an aggressive malignancy,resulting as the third cause of death by cancer each year. The management of patients with HCC is complex,as both the tumour stage and any underlying liver disease must be considered conjointly. Although surveillance by imaging,clinical and biochemical parameters is routinely performed,a lot of patients suffering from cirrhosis have an advanced stage HCC at the first diagnosis. Advanced stage HCC includes heterogeneous groups of patients with different clinical condition and radiological features and sorafenib is the only approved treatment according to Barcelona Clinic Liver Cancer. Since the introduction of sorafenib in clinical practice,several phase Ⅲ clinical trials have failed to demonstrate any superiority over sorafenib in the frontline setting. Locoregional therapies have also been tested as first line treatment,but their role in advanced HCC is still matter of debate. No single agent or combination therapies have been shown to impact outcomes after sorafenib failure. Therefore this review will focus on the range of experimental therapeutics for patients with advanced HCC and highlights the successes and failures of these treatments as well as areas for future development. Specifics such as dose limiting toxicity and safety profile in patients with liver dysfunction related to the underlying chronic liver disease should be considered when developing therapies in HCC. Finally,robust validated and reproducible surrogate end-points as well as predictive biomarkers should be defined in future randomized trials.     

Evolution of systemic therapy of advanced hepatocellular carcinoma

Hepatocellular carcinoma （HCC） commonly occurs in hepatitis B endemic areas, especially in Asian countries. HCC is highly refractory to cytotoxic chemotherapy. This resistance is partly related to its tumor biology, pharmacokinetic properties, and both intrinsic and acquired drug resistance. There is no convincing evidence thus far that systemic chemotherapy improves overall survival in advanced HCC patients. Other systemic approaches, such as hormonal therapy and immunotherapy, have also disappointing results. Recently, encouraging results have been shown in using sorafenib in the treatment of advanced HCC patients. In this review, we concisely summarize the evolution of developments in the systemic therapy of advanced HCC.     

Hepatic artery infusion chemotherapy for advanced hepatocellular carcinoma

Hepatocellular carcinoma(HCC) is one of the most common cancers worldwide. Surgery, percutaneous ablation and liver transplantation are the only curative treatment modalities for HCC. However, the majority of patients have unresectable disease at diagnosis. Therefore, effective treatment options for patients with advanced HCC are required. In advanced HCC, according to current international guidelines, sorafenib, a molecular targeted agent, is the standard treatment. However, alternative treatment modalities are required because of the low response rates and unsuitability of molecular agents in real practice. In various treatment modalities, mostly in Asia, hepatic arterial infusion chemotherapy(HAIC) has been applied to advanced HCC with a view to increasing the therapeutic efficacy. HAIC provides direct drug delivery into the tumor feeding vessels and also minimizes systemic toxicities through a greater first-pass effect in the liver. However, the sample sizes of studies on HAIC have been small and large randomized trials are still lacking. In this article, we describe the treatment efficacy of HAIC for advanced stage HCC and discuss future therapeutic possibilities.     

Management of ruptured hepatocellular carcinoma:Implications for therapy

AIM:To assess the treatment and tumor-related variables associated with outcome after treatment of spontaneously ruptured hepatocellular carcinoma (HCC).METHODS: Patients with ruptured HCC were identif ied. The complications, mortality and survival were assessed. The relationship between tumor size and the severity of hemoperitoneum and between tumor size and grade were examined.RESULTS: From January 1993 to January 2008, 556 patients with HCC with or without cirrhosis were evaluated; of which, 16 (2.87%) p...     

Management of advanced hepatocellular carcinoma in the era of targeted therapy

Systemic chemotherapy has had a disappointing track record in the management of advanced hepatocellular carcinoma (HCC). Single‐agent doxorubicin produces a response rate of 10–15%, but without any survival benefit, and combination chemotherapy has also yielded unimpressive results. With recent advances in the knowledge of hepato‐carcinogenesis, there has been encouraging development in the systemic therapy of advanced HCC patients, and particularly in the targeted therapy of advanced HCC. Among the newly identified targets, exciting results have been shown in targeting the anti‐angiogenic pathway and the Raf/mitogen‐activated protein kinase pathways. Bevacizumab, both as a single agent and in combination with other agents, has shown initial encouraging activity in treating advanced HCC. More recently, single‐agent sorafenib, a putative multitargeted kinase inhibitor, has shown to prolong the overall survival of patients with advanced HCC in the pivotal phase III Sorafenib HCC Assessment Randomized Protocol (SHARP) and Oriental study. Currently, sorafenib is the only approved targeted therapy for patients with advanced HCC. In addition, however, promising early results have been reported for other molecular‐targeted drugs including erlotinib and sunitinib. Future progress seems likely to depend on using controlled clinical trials to optimize synergistic combination treatments.     

Efficacy of hepatic arterial infusion chemotherapy in advanced hepatocellular carcinoma

AIM: To investigate the efficacy of hepatic arterial infusion chemotherapy (HAIC) using floxuridine (FUDR) in patients with advanced hepatocellular carcinoma (HCC) confined to the liver.METHODS: Thirty-four patients who had advanced HCC with unresectability or unsuccessful previous therapy in the absence of extrahepatic metastasis were treated with intra-arterial FUDR chemotherapy at our hospital between March 2005 and May 2008. Among the 34 patients, 9 patients were classified as Child class C, and 18 patients had portal vein tumor thrombus (PVTT). One course of chemotherapy consisted of continuous infusion of FUDR (0.3 mg/kg during day 1-14) and dexamethasone (10 mg on day 1, 4, 7 and 11), and this treatment was repeated every 28 d.RESULTS: Two patients (5.9%) displayed a complete response, and 12 patients (35.3%) had a partial response. The tumor control rate was 61.8%. The median overall survival times were 15.3 mo, 12.4 mo and 4.3 mo for the patients who were classified as Child class A, Child class B and Child class C, respectively (P = 0.0392). The progression-free survival was 12.9 mo, 7.7 mo and 2.6 mo for the patients who were classified as Child class A, Child class B and Child class C, respectively (P = 0.0443). The cumulative survival differed significantly according to the Child-Pugh classification and the presence of PVTT. In addition to hepatic reserve capacity and PVTT, the extent of HCC was an independent factor in determining a poor prognosis. The most common adverse reactions to HAIC were mucositis, diarrhea and peptic ulcer disease, but most of these complications were improved by medical treatment and/or a delay of HAIC.CONCLUSION: The present study demonstrates that intra-arterial FUDR chemotherapy is a safe and effective treatment for advanced HCC that is recalcitrant to other therapeutic modalities, even in patients with advanced cirrhosis.     

Chemotherapy with enteric-coated tegafur/uracil for advanced hepatocellular carcinoma

Hepatocellular carcinoma （HCC） is one of the most common malignancies worldwide, including Japan. Although the development of imaging modalities has made the early diagnosis of HCC possible, surgically resectable cases are relatively uncommon because of hepatic function reserve and/or an advanced stage at presentation. Several modalities, such as transcatheter arterial chemoembolization, percutaneous ethanol injection, microwave coagulation therapy and radiofrequency ablation are reportedly useful in treating patients with non-resectable disease. However, unfortunately, many HCC patients have tumor recurrence. The overall prognosis of patients with HCC is very poor, and treatment of the advanced form is still problematic. In this article, we review the clinical efficacy and toxicity of enteric-coated tegafur/uracil in the treatment of patients with advanced non-resectable HCC.     

Fibrolamellar hepatocellular carcinoma

Fibrolamellar hepatocellular carcinoma is an uncommon malignancy seen in young adults without underlying liver disease. Physical signs are minimal and laboratory values are noncontributory. Diagnosis is suggested by clinical history, supported by radiographic studies, and confirmed by histologic examination. Individuals with fibrolamellar carcinoma generally have a greater survival than those with hepatocellular carcinoma. Although most patients with fibrolamellar carcinoma undergo curative surgery, two of the three patients we report had inoperable tumors.