Combination chemotherapy with cisplatin and gemcitabine in malignant peritoneal mesothelioma

Malignant peritoneal mesothelioma is a rare neoplasm with a rapidly fatal course. The response of this disease to treatment is poor because it tends to be advanced at diagnosis and tends to have inherent resistance to chemotherapeutic treatment. We describe three patients with malignant peritoneal mesothelioma who received combination chemotherapy with cisplatin and gemcitabine. After a histopathological diagnosis of epithelial-type malignant peritoneal mesothelioma, all patients underwent systemic chemotherapy because of the advanced disease stage. Moreover, one patient would have been at high risk of cardiac events, because of congenital heart malformation if complete surgical resection had been performed. This chemotherapy achieved a partial response in two patients, but had no effect in one. Combination chemotherapy with cisplatin and gemcitabine may prove to be one of the recommended treatments for patients with malignant peritoneal mesothelioma in the near future.     

血清TSGF在恶性肿瘤高能聚束热疗联合化疗中的表达及意义

目的：观察恶性肿瘤相关物质群（TSGF）在恶性肿瘤高能聚束热疗联合化疗（热化疗）、单纯化疗中的表达并探讨其临床意义。方法：采用比色法测定123例恶性肿瘤患者进行热化疗治疗前后TSGF的水平，并与120例配对对照组纯化疗治疗前后TSGF的水平进行比对。结果：恶性肿瘤患者治疗后TSGF水平明显下降，热化疗与纯化疗相比下降有显著性差异（P〈0．05）。结论：热化疗较纯化疗治疗恶性肿瘤有更好的疗效，血清TSGF可作为观察恶性肿瘤热化疗疗效和预后的指标之一。     

Case report of metastatic familial pheochromocytoma treated with cisplatin and 5-fluorouracil

Summary We report on a rare case of malignant pheochromocytoma in a patient with a family history of this disease. After three cycles of treatment with cisplatin and 5-fluorouracil, a decrease in the need for antihypertensive treatment occurred, which lasted almost 2 years despite the discontinuation of chemotherapy. The patient showed an objective response, which was technically a minor response, although in this slow-growing tumor it was of major clinical significance. This chemotherapy regimen may play a role in the management of malignant pheochromocytoma.     

恶性肿瘤患者化疗前后血小板功能的变化观察

目的:观察恶性肿瘤患者化疗前后血小板计数及血小板功能的变化,了解化疗对恶性肿瘤患者血小板功能的影响.方法:采用比浊法和电阻抗法利用血小板聚集仪测定63名恶性肿瘤患者化疗前后血小板聚集功能.结果:恶性肿瘤患者化疗后血小板计数明显降低,差异有统计学意义(P<0.05);血小板聚集率较化疗前亦明显下降,差异有统计学意义,(P<0.05);且化疗前后血小板计数差值与血小板聚集功能差值呈正性相关(P<0.05).结论:化疗药物会导致恶性肿瘤患者血小板聚集功能下降,可能会增加患者的出血风险.     

Treatment of infants with malignant gliomas: The Pediatric Oncology Group Experience

Although survivals of infants with malignant brain tumors are worse than any other age group, one possible exception to this rule are the malignant gliomas. Eighteen children less than 3 years of age with malignant gliomas (glioblastoma multiforme, anaplastic astrocytoma and malignant glioma) were treated on the Pediatric Oncology Group regimen of prolonged postoperative chemotherapy and delayed irradiation, (1986–1990). Of 10 children evaluable for neuroradiologic response, 6 had partial responses (> 50% reduction) to two cycles of cyclophosphamide and vincristine. Progression free survivals at l, 3 and 5 years were 54.25% ± 12, 43% ± 16 and 43% ± 23 respectively. Survivals at 5 years were 50% ± 14. Four children were not irradiated after 24 months of chemotherapy due to parental refusal and none have developed recurrent disease. Neither degree of surgical resection, presence or absence of metastases, nor pathology influenced survival but this may reflect small sample size. This study suggests that some malignant gliomas in infants are chemotherapy sensitive and may be associated with a good prognosis. Why infants with these high-grade gliomas fare better than adults is not clear. It is likely that there is something intrinsically different about them that cannot be identified on routine pathologic examination.     

New chemotherapy options for the treatment of malignant gliomas.

Chemotherapy remains part of the treatment triad that includes surgery and radiation therapy for the management of malignant gliomas. In recent years there has been an increased understanding of the molecular pathways of malignant transformation. Based on this research, new drugs have been evaluated, with specific cellular targets in mind that can be modified or inhibited. Many of these agents are now being tested in phase I and II clinical trials and have shown some promising results. Clearly, not all patients with malignant gliomas respond equally to chemotherapy. Recent evidence suggests that certain molecular markers may predict chemosensitivity in some tumor types, particularly anaplastic oligodendroglioma. This article reviews recent trends in the use of chemotherapy and clinical trials of new therapies for adults with malignant gliomas.     

Management of Malignant Phaeochromocytoma: A Retrospective Review of the use of MIBG and Chemotherapy in the West Midlands

Metastatic malignant phaeochromocytoma is a rare disorder, with no randomized and few prospective data to facilitate choice between the two main treatment modalities, chemotherapy and radiolabelled metaiodobenzylguanidine (MIBG). In the last decade the latter modality has been preferred and radiological response rates of 30% have been reported. There are fewer patients described in the literature who have received chemotherapy but one prospective trial of chemotherapy reported radiological response rates of 57%. A recent prospective trial combining the two modalities has been disappointing with only one patient completing the treatment schedule. We present six patients with malignant phaeochromocytoma or paraganglioma who received MIBG therapy. Four patients also received chemotherapy.A retrospective review of the case notes was performed. Radiological and hormonal responses were determined and the time to progression after each modality was calculated. One partial hormonal response was seen with MIBG treatment. One complete and one partial hormonal response and one partial radiological response were seen with chemotherapy. The median time to disease progression from commencement of MIBG was 12 months (range 3–44) and from commencement of chemotherapy used as first or second line treatment was 22.5 months (range 7–25).Chemotherapy may be a more active modality in this disease than previously considered. MIBG uptake may increase after a partial radiological response to chemotherapy, enabling subsequent MIBG therapy. Researchers carrying out future trials on combined therapy should consider administering chemotherapy prior to MIBG for the reasons that we outline in this article.     

体外药物敏感性试验指导下腹腔化疗的研究

目的 探讨体外药敏试验指导下对晚期肿瘤进行腹腔化疗的可行性及效果。方法 分离51例恶性肿瘤患者腹水中的肿瘤细胞,MTT法测定肿瘤细胞对化疗药物的敏感性,选择对肿瘤细胞抑制率最高或次高的一种化疗药物进行腹腔化疗,观察药敏结果与癌性腹水疗效的一致性,及其与临床病例特征、KPS评分和预后的关系。结果 MTT法显示TXT和HCPT是最敏感的化疗药物,而HCPT用于腹腔化疗最多（56．9％）。全组共有24例患者癌性腹水治疗有效（CR7例,PR17例）,药敏结果与癌性腹水疗效之间存在低度一致性（P=0．014）,癌性腹水有效组的行为状态评分（KPS）改善程度明显优于无效组（P〈0．001）。癌性腹水治疗是否有效,系本组患者的独立预后因素（P=0．035）。结论 MTT法药敏试验指导下腹腔化疗是一种简便、有效、安全的方法,癌性腹水治疗有效者的KPS及预后可明显改善。     

Non-Hodgkin's lymphoma followed by plasmacytoma, both arising in A thyroid gland with Hashimoto's disease

We describe here a rare case of malignant lymphoma followed by plasmacytoma in Hashimoto's thyroiditis. The patient developed malignant lymphoma (small, non-cleaved cell, and non Burkitt's type by Working Formulation classification), and remained in remission for 2 years after receiving combination chemotherapy, and then developed plasmacytoma in the same lesion. Rearrangement bands for IgH from both specimens showed different bands, indicating that both were of monoclonal type but of a different clonal origin. Considering the clinical course in this case, thyroidectomy may be indicated for lymphoproliferative diseases in Hashimoto's thyroiditis treated with chemotherapy.     

恶性血液病患者游离Fas的检测及意义

目的　了解游离Ｆａｓ（ｓＦａｓ）在恶性血液病中的水平及临床意义。方法　用酶联免疫吸附法测定６０ 例恶性血液病患者血清中ｓＦａｓ水平。结果　恶性血液病患者血清ｓＦａｓ水平高于正常人，治疗后ｓＦａｓ水平下降，下降的程度与疗效有关，但治疗前水平高低与疗效无关。结论　ｓＦａｓ对恶性血液病的诊断及疗效判定有一定意义，并可能对其发病机制产生影响。     

Evolution of malignant lymphoma in agnogenic myeloid metaplasia

Two young arab patients are described in whom malignant lymphoma developed within less than 1 year of the diagnosis of agnogenic myeloid metaplasia. Both patients showed a satisfactory response to combined chemotherapy. One of them died of hepatitis B at 10 months and the other is alive and in clinical remission 25 months after initial diagnosis. These observations demonstrate the close relation between myeloproliferative and lymphoproliferative syndromes and illustrate the diversity of malignant lymphoproliferative disorders into which agnogenic myeloid metaplasia may evolve in the course of disease. Our experience also demonstrates the ease with which some patients with an 'end stage' myeloproliferative disorder may respond to standard chemotherapy designed for the treatment of malignant lymphoma.     

Surgical management of metastatic peritoneal or pleural disease

The surgeon's role in the treatment of malignant peritoneal disease has expanded over time, stemming from a better understanding of tumor biology. For the majority of patients, carcinomatosis is a terminal process with surgical intervention being reserved for palliation of bowel obstruction or symptomatic ascites. However, for select patients with favorable tumor biologies, aggressive surgical approaches may result in long-term survival. This review describes the patterns of peritoneal tumor dissemination, surgical palliation of malignant bowel obstruction or ascites, and the principles, indications, toxicities, and overall results of cytoreductive surgery with intraperitoneal hyperthermic chemotherapy. On the other hand, long-term survival is rarely expected for malignant pleural disease unless the causal tumor is highly responsive to systemic chemotherapy. There are controversies and considerable geographic variations in the management of malignant pleural effusions. However, less invasive ambulatory palliative treatments for patients so afflicted are gaining popularity.     

Bevacizumab for the Treatment of Non-Resectable Pseudomyxoma peritonei Associated with Mucinous Ovarian Tumor of Low Malignant Potential – A Comparison of Two Cases

Pseudomyxoma peritonei (PMP) is a rare tumor syndrome that can be diagnosed in association with mucinous ovarian tumors of low malignant potential. Surgical debulking is the primary treatment modality as chemotherapy has generally proven ineffective in this slowly progressive tumor. When patients with PMP are not surgical candidates, there is no effective treatment, and patients will die of progressive disease. We report two patients with PMP with associated mucinous ovarian tumor of low malignant potential treated with Bevacizumab therapy. Both patients demonstrated disease response to single agent Bevacizumab therapy. One patient had a prolonged response while on therapy, remained stable for 6 months when treatment was held, and then after progressing responded to a second course of therapy. We discuss here (1) the clinical features which may predict a better response to Bevacizumab therapy, and (2) evidence for the use of chemotherapy for inoperable PMP. These cases suggest that Bevacizumab may represent a rare effective therapy for patients with inoperable PMP with ovarian involvement and should be considered for clinical trials in this patient population.Key Words: Pseudomyxoma, Ovarian tumor of low malignant potential, Bevacizumab     

NF-κB信号通路在恶性肿瘤化疗耐药中的作用

恶性肿瘤已然成为影响人们健康的最主要原因,化疗是应用最广泛最有效的抗肿瘤治疗手段之一。然而,随着化疗药物的使用,肿瘤细胞会产生耐药性,成为影响化疗效果的主要原因。耐药的产生可能涉及众多机制,包括细胞周期调控异常、凋亡信号通路受阻、耐药基因的异常表达等。近年来的研究表明,细胞存活信号通路在肿瘤化疗耐药中有着重要作用。核转录因子κB(Nuclear factor kappa B,NF-κB)信号通路的异常是恶性肿瘤耐药的主要机制之一。因此,NF-κB信号通路也可能成为克服恶性肿瘤耐药的有效靶点。本综述简要归纳NF-κB信号通路在恶性肿瘤化疗耐药中的作用和研究进展。     

Successful treatment of metastatic thymic carcinoma with cisplatin, vinblastine, bleomycin, and etoposide chemotherapy.

Thymic carcinomas are rare malignant neoplasms of the thymic epithelium that are distinguished from the malignant thymomas by the presence of cytologic atypia. Thymic carcinomas may metastasize outside of the thorax and are associated with a very poor prognosis. Complete responses of thymic carcinoma to chemotherapy alone have not been reported. A 21-year-old man with metastatic undifferentiated carcinoma of probable thymic origin is presented who achieved a pathologic complete response with cisplatin, vinblastine, and bleomycin chemotherapy. Additional consolidative chemotherapy with cisplatin and etoposide was administered. The patient remains disease-free 5 years after diagnosis. Cisplatin, vinblastine, and bleomycin chemotherapy appears to have significant activity against thymic carcinoma.     

XRCC 1多态性与肿瘤化疗敏感性和预后的研究

化疗是恶性肿瘤最重要的治疗手段,对肿瘤化疗耐药机制以及化疗效果预测一直是肿瘤学研究的热点.DNA修复能力是影响化疗疗效的重要因素,修复基因的单核苷酸多态性可改变修复能力,X线修复交叉互补基因1(XRCC1)是参与DNA修复的重要成分,检测XRCC 1基因的单核苷酸多态性可以预测治疗疗效.     

儿童恶性淋巴瘤化疗后胸腺反应性增生的临床分析

背景与目的：恶性肿瘤患者化疗后胸腺反应性增生不易与肿瘤残留或复发鉴别。常被误诊为肿瘤残留或复发而过度治疗。本研究通过分析儿童恶性淋巴瘤化疗后胸腺反应性增生的病例．探讨化疗后胸腺反应性增生的临床特征,以加深对此种病征的认识。方法：收集1999年3月至2004年3月初治淋巴瘤患者经化疗后胸腺反应性增生者共13例。其中霍奇金淋巴瘤5例。非霍奇金淋巴瘤8例。确诊后均予化疗。常规行CT检查评价疗效或追踪观察。纵隔出现新增肿块后,部分患者行正电子发射计算机断层扫描（positive electron tomography computed tomography,PET／CT）检查,明确肿块性质,再决定进一步的治疗;因经济条件所限而不能做PET／CT检查者,予密切追踪观察。结果：10例患者起病时肿瘤即侵犯纵隔,3例患者起病时纵隔无肿瘤侵犯。9例在化疗结束后随诊期间出现胸腺增生,4例在维持治疗期间出现（均为淋巴母细胞性非霍奇金淋巴瘤患者）。CT显示纵隔新增肿块影最大横径为2．2～6．0cm。平均3．7cm。胸腺增生距离上次化疗结束时间2～12个月,平均4个月。5例患者行PET／CT检查,均显示纵隔肿块无肿瘤活性。3例胸腺增生患者被误诊为肿瘤进展或复发,予二线治疗。所有患者随访1-6年（中位时间4年）,无肿瘤复发征象。结论：儿童淋巴瘤患者在强烈化疗后胸腺可出现反应性增生．临床上须避免误诊为胸腺恶性肿瘤而过度治疗。     

A case report of malignant pleural mesothelioma with long-term disease control after chemotherapy

Long duration of responses to chemotherapy in patients with malignant pleural mesothelioma (MPM) is rare. The authors report a patient with inoperable MPM who achieved complete remission with combination chemotherapy of cyclophosphamide, doxorubicin, and cisplatin. 5-fluorouracil and mitomycin C (FM) induced another remission after recurrence of the tumor. Retreatment with FM after chemotherapy had been stopped for 20 months yielded another continuing response. The overall tumor-control time is more than 4 years. Literature reviews and the authors' results suggest that MPM may be a chemosensitive tumor in some patients. Additional evaluations of CAP, FM, and methotrexate combination regimens in this disease should be considered.     

XRCC 1多态性与肿瘤化疗敏感性和预后的研究

化疗是恶性肿瘤最重要的治疗手段,对肿瘤化疗耐药机制以及化疗效果预测一直是肿瘤学研究的热点.DNA修复能力是影响化疗疗效的重要因素,修复基因的单核苷酸多态性可改变修复能力,X线修复交叉互补基因1(XRCC1)是参与DNA修复的重要成分,检测XRCC 1基因的单核苷酸多态性可以预测治疗疗效.     

Malignant fibrous histiocytoma in the craniocervical junction presenting with severe occipitalgia

We report a patient who complained of severe occipitalgia caused by destruction of the atlantooccipital joint by tumor invasion. Her symptoms were relieved by tumor resection and occipitocervical fixation. Histological examination of the resected tumor revealed that the tumor cells had an irregular arrangement, remarkable atypia, and pleomorphism with multinucleated bizarre giant cells. The tumor demonstrated no definitive sarcoma differentiation and was identified as malignant fibrous histiocytoma. After tumor resection, the patient received adjuvant radiation and chemotherapy. The tumor regrew outside the radiation field. Chemotherapy with ifosfamide, cisplatin, and etoposide caused remarkable tumor reduction, but suspension of chemotherapy resulted in tumor recurrence. The results of our drug protocol suggest that this regimen is feasible as postoperative adjuvant chemotherapy for malignant fibrous histiocytoma. The role of adjuvant chemotherapy and radiation therapy for this highly malignant rare tumor should be evaluated in a prospective study with precise histological diagnosis.