结直肠癌的新辅助化疗

新辅助治疗(neoadjuvant therapy)是指术前采用的一些治疗方法,包括新辅助化疗(neoadjuvant chemotherapy,NC)、新辅助放疗(neoadjuvant radiotherapy)和新辅助放化疗(neoadjuvant chemoradiotherapy)。结直肠癌近年来手术效果仍不满意,术后的5年生存率仍徘徊在50%左右。NC可以     

结直肠癌辅助化疗的历史回顾

希罗达专家论坛介绍:欢迎来到希罗达专家论坛。在这里,您可以通过专家的笔触充分了解肿瘤学科发展的最新信息,了解希罗达在肿瘤治疗领域的最新进展。希望论坛能成为您了解国际先进技术的窗口,随时随地与世界互动,同时,上海罗氏制药有限公司准备了一些相关问题,使您在参加有奖问答的同时对希罗达有进一步的了解。(有奖问答见封3插页)     

新辅助化疗对结直肠癌肝转移老年患者的效果及安全性

目的 探讨新辅助化疗对结直肠癌肝转移老年患者的有效性和安全性。方法 对2016年2月至2019年5月就诊于安徽省庐江县中医院（46例）和河南省人民医院（34例）的80例结直肠癌同时性肝转移老年患者的临床资料进行回顾性分析。对照组（n=40）行腹腔镜原发灶切除+肝转移灶同期/分期切除手术+术后XELOX方案化疗,观察组（n=40）在对照组基础上术前行XELOX方案新辅助化疗,术后随访12个月。结果 观察组新辅助化疗后原发灶的临床分期较化疗前明显好转（χ²=5.12,P=0.021）,肝转移灶直径缩小[（6.4±3.8）cm vs （4.2±3.0）cm,t=2.74,P=0.008]。两组手术时间、排气时间比较,差异无统计学意义（P>0.05）,观察组术中出血量少于对照组[（725.4±61.8）mL vs （842.6±167.1）mL,t=3.33,P=0.001],术后不良反应发生率高于对照组[47.50%（19/40） vs 12.50%（5/40）,χ²=11.67,P<0.001];术后6个月KPS评分高于对照组[（67.38±12.39）vs （51.03±10.55）,t=6.35,P<0.001];术后12个月肿瘤复发率低于对照组[15.38%（6/39） vs 37.50%（15/40）,χ²=4.9,P=0.026],两组术后12个月病死率无统计学差异[7.69%（3/39） vs12.5%（5/40）,P>0.05]。结论 新辅助化疗可提高结直肠癌肝转移老年患者客观缓解率,降低近期肿瘤复发率,改善患者术后功能状态,但会增加患者术后不良反应,能否在临床推广仍需进一步大样本研究。     

SOX方案化疗联合艾迪注射液治疗晚期结直肠癌的临床研究

目的:探讨SOX方案化疗联合艾迪注射液治疗晚期结直肠癌的临床效果.方法:选取2018年4月至2020年6月我科收治的66例晚期结直肠癌患者为研究对象,按随机数字表法分为对照组和观察组,各33例.对照组采用SOX方案化疗,观察组在SOX方案化疗基础上予以艾迪注射液50 mL+5％ 葡萄糖注射液500 mL静脉滴注,治疗2...     

多学科协作诊治模式下老年结直肠癌患者应用新辅助化疗联合手术治疗的临床效果

目的探讨在多学科协作（multi—disciplinary team，MDT）诊治模式下，新辅助化疗联合手术的综合治疗策略在老年人群中应用的安全性和临床差异性。方法回顾性研究2007年6月～12月期间就诊于四川大学华西医院肛肠外科专业组的结直肠癌患者的资料，分析比较老年组（≥60岁）和非老年组（〈60岁）之间应用综合治疗策略的临床疗效差异。结果在术前指标中，老年组患者合并心血管系统、内分泌系统以及其他系统疾病的构成比均明显高于非老年组（P〈0．05），其中老年组术前患有高血压和糖尿病患者的构成比均明显高于非老年组（P〈0．05），其余术前指标差异无统计学意义（P〉0．05）。各项术中指标的差异在2组间均无统计学意义（P〉0．05）。而在术后指标中，老年组术后并发症发生率高于非老年组（P〈0．05），老年组患者术后拔除胃管、尿管和引流管的时间和非老年组之间的差异无统计学意义（P〉0．05）；同时老年组患者术后进食时间、经肛门排气／排便时间以及下床活动时间与非老年组比较，差异也无统计学意义（P〉0．05）。在化疗相关并发症方面，2组间差异也无统计学意义（P〉0．05）。结论尽管老年患者可能术前基础情况更差、治疗难度更大，但新辅助化疗联合手术的综合治疗策略并不会导致老年组患者手术治疗的延误，而且手术干预过程中的术式选择也并不会受到影响，术后近期治疗效果满意。因此在老年群体中应用该策略是具有一定临床效果和安全性的。     

结直肠癌的辅助治疗

结直肠癌是消化道最常见的恶性肿瘤之一。在西方国家 ,结直肠癌是引起癌症相关死亡的主要因素。据统计 ,全世界每年有 4 0 0 0 0 0人死于结直肠癌。近 60年来 ,结直肠癌根治术后的总体生存率并无明显升高的趋势。近年来 ,国外各研究机构如ＮＳＡＢＰ、ＮＣＣＴＧ以及ＮＣＩＣ、ＧＩＴＳＧ等经过大规模随机抽样对比治疗研究最佳辅助治疗方案 ,并取得了令人鼓舞的成绩。一、放射治疗对于直肠癌来说 ,放射治疗并非是一个新方法。但是到目前为止 ,在这一领域仍有待继续研究。对于结肠癌来说 ,虽然曾有报道 ,放疗导致结肠癌局部复发率降低 ,但总…     

应用腹腔镜结直肠癌根治术治疗老年结直肠癌的效果研究

目的 探究腹腔镜结直肠癌根治术治疗老年结直肠癌的临床效果。方法 选取江苏大学附属武进医院2016年12月至2021年3月收治的100例老年结直肠癌患者为研究对象,根据手术方式不同分为对照组（n=50）与研究组（n=50）,对照组患者采用传统开腹手术,研究组患者应用腹腔镜结直肠癌根治术。对比两组患者手术实施情况及术后并发症发生情况,以及生活质量水平以及胃肠功能情况。结果 两组患者术后生活质量评分较干预前都有明显提升,且研究组患者评分高于对照组（P <0.05）;研究组患者术后并发症发生率为14.00%,明显低于对照组（P <0.05）;在手术实施中,研究组患者手术时间、术中出血量、术后排气时间、术后住院时间、切除长度均明显优于对照组（P <0.05）;研究组患者术后胃动素及胃泌素水平较术前有明显增高,且高于对照组（P <0.05）。结论 对老年结直肠癌患者应用腹腔镜结直肠癌根治术临床效果更好,能有效降低老年患者的并发症发生率,且手术创伤较小,安全性更高,对提升老年结直肠癌患者的生活质量有积极意义。     

结直肠癌肝转移新辅助化疗的相关问题分析

肝脏是结直肠癌最常见的转移部位,肝转移也是影响其预后的主要因素,如果不进行治疗.大部分病人自然生存期不超过12个月,接受系统化疗的病人中位生存期不足24个月,5年存活率《8%.     

多学科协作诊治模式下新辅助/辅助化疗联合结直肠癌手术的临床效果

目的 探讨多学科协作(multi-disciplinary team, MDT)诊治模式下,结直肠癌手术围手术期不同新辅助/辅助化疗治疗策略的临床效果.方法 回顾性分析2007年1～12月期间四川大学华西医院肛肠外科专业组收治确诊为结直肠癌患者的临床资料,将患者分为非辅助化疗组(新辅助化疗 手术治疗)和辅助化疗组(新辅助化疗 手术治疗 辅助化疗),比较2组的治疗效果.结果 共收治了789例结直肠疾病患者,其中明确诊断为结直肠癌并符合纳入研究条件的患者195例,其中男109例,女86例; 年龄为25～84岁,中位年龄60.00岁,平均59.98岁; 结肠癌59例,直肠癌136例.随访时间为5～17个月,全部195例患者中失访3例,成功随访率为98.5%,随访期间无复发和死亡.2组患者基线基本一致,2组间术前内科合并症、肿瘤并发梗阻症状和术前是否输血的差异无统计学意义(P＞0.05); 2组在术中是否输血和Dukes分期方面的差异有统计学意义(P＜0.05),而其他手术相关指标和病理指标间差异无统计学意义(P＞0.05); 在术后治疗中,2组间是否输血的差异有统计学意义(P＜0.05); 术后住院期间康复指标在2组间差异无统计学意义(P＞0.05); 2组间术后并发症和排便情况差异无统计学意义(P＞0.05).术后1和3个月随访中发现,2组间CEA和CA19-9值差异有统计学意义(P＜0.05).结论 在MDT诊治模式下,进行新辅助化疗 手术治疗 辅助化疗方案并不影响患者的康复,也不增加患者术后并发症的风险,并可能提高患者术后对排便习惯的接受程度,具有一定的安全性和临床价值,但是否能提高临床效果有待进一步研究.     

The present status of postoperative adjuvant chemotherapy for completely resected non-small cell lung cancer.

Non-small cell lung cancer (NSCLC) constitutes approximately 85% of all lung cancers, with patients having a poor prognosis. Approximately one third of NSCLC patients present with early-stage disease in which potentially curative resection and multi-modality therapy. Although adjuvant chemotherapy is the standard practice for patients with stages I-III breast and colorectal cancer, the therapeutic efficacy of adjuvant chemotherapy, following complete surgical resection of early stage NSCLC, has not been fully established. Several prospective randomized trials for patients with early stage NSCLC (stages I-IIIA) have confirmed a survival benefit with cisplatin-based adjuvant chemotherapy, as demonstrated in the 1995 meta-analysis performed by the NSCLC Collaborative Group. Studies from Japan have reported that adjuvant therapy with uracil-tegaful (UFT) afforded an improvement of 4% in the 5-year survival rate and a relative risk reduction of 26% in mortality at 5 years among patients with T1-2N0 (stage I) disease. In particular, the Japan Lung Cancer Research Group has demonstrated an improvement in the 5-year survival rate of 11%, favoring chemotherapy with UFT in the subset of patients with T2N0 (stage IB) disease. Two published meta-analyses based on abstracts have estimated a relative risk reduction in mortality of 11-13% at 5 years. The Lung Adjuvant Cisplatin Evaluation (LACE), which was based on a pooled analysis of five randomized trials, has demonstrated that cisplatin-based adjuvant chemotherapy improved survival in patients with completely resected NSCLC. This benefit depended on stage, being greatest in patients with stage II or IIIA disease. This analysis has suggested that platinum-based adjuvant chemotherapy may have no benefit for patients with stage IA and only a marginal benefit for patients with stage IB. Thus, the information available at the current time supports the administration of adjuvant chemotherapy for patients who have undergone complete resection of stages IB-IIIA NSCLC. Further research is needed to define the role of adjuvant platinum-based chemotherapy and its use, in conjunction with chest radiotherapy as the treatment for patients with resected stages IB and IIIA NSCLC.     

Cisplatin combination chemotherapy for elderly patients with urothelial tumours

The proportion of cancer patients who receive potentially curative therapy declines with increasing chronological age. Between January 1979 and January 1988, 36 patients aged from 76 to 84 years (median 78) consented to cisplatin combination chemotherapy. Eighteen patients received 1 to 7 cycles of adjuvant chemotherapy (median 5). This resulted in a drop in creatinine clearance rate from 70 +/- 28.5 ml/min to 49 +/- 20 ml/min. Eight patients (44%) are alive without evidence of disease, with a whole group median survival of 23 months. The dose intensity of cisplatin was found to predict recurrence. Eighteen other patients were treated for metastatic disease; 39% had an objective response after receiving 2 to 9 cycles (median 7). Only 2 patients (11%) are alive and free of disease. In this group no significant kidney damage occurred and the dose intensity of cisplatin did not predict response. Treatment resulted in a significant sepsis rate (39%) and 6 patients (17%) withdrew from treatment because of toxicity. It was concluded that cisplatin combination chemotherapy can be administered without treatment-related death and its efficacy is similar to that in younger patients. Age should not exclude patients from the potential benefit of such therapy. An important cause of reduced benefit from chemotherapy among elderly patients may be the reduced dosage of cisplatin.     

Stage III colon cancers: why adjuvant chemotherapy is not offered to elderly patients

HYPOTHESIS: Adjuvant chemotherapy is not offered to elderly patients with stage III colon cancer. DESIGN: A retrospective review of hospital and office records. SETTING: A suburban community hospital. PATIENTS: The medical records of 69 patients with stage III colon cancer were reviewed. All identified from the Tumor Registry at Jersey Shore Medical Center, Neptune, NJ, were included in this study. RESULTS: Thirty-five patients (51%) did not receive adjuvant chemotherapy. After adjusting for age, women were 5.8 times less likely to receive chemotherapy (P = .002). Patients not receiving chemotherapy were significantly older (78.7 vs 70.4 years; P = .003) than those who received adjuvant chemotherapy. There was no relation found between the year of diagnosis and the administration of chemotherapy. There were 4 major reasons for not receiving chemotherapy: (1) not offered (n = 12, 34%), (2) refused (n = 11, 31%), (3) too old (n = 7, 20%), and (4) significant concomitant disease (n = 5, 14%). CONCLUSIONS: A large group of elderly patients who had been surgically treated for colon cancer and who were eligible for adjuvant chemotherapy either were not referred for treatment or refused treatment. This suggests a bias on the part of surgeons, primary care physicians, and patients against the use of chemotherapy in elderly patients.     

The results of liver transplantation with adjuvant chemotherapy for hepatobiliary surgery

This is an update of a pilot trial in which doxorubicin 10 mg/m² was used pre-, intra-, and postoperatively as adjuvant chemotherapy during liver transplant for unresectable hepatocellular carcinoma. The patients had advanced disease, with 17 of 20 having tumors that were multifocal, larger than 5 cm diameter unifocal, or tumors with vascular invasion. Individual followup is now 35–76 months, with a median observation time of 46 months. Eleven of the patients are alive (55%), 2 with recurrences (45% tumor free). Six patients have died from recurrent tumor and 3 from recurrent hepatitis B without evidence of malignancy. Of the eight patients with recurrent tumor, only 1 presented in the grafted liver.     

Current status of adjuvant chemotherapy of invasive bladder cancer]

The current status of adjuvant chemotherapy for clinically localized but invasive transitional cell carcinoma of the bladder is reported. Since 1986, a prospective randomized study has been conducted to examine the effects of neoadjuvant cyclophosphamide + doxorubicin + cisplatin (CAP) and radiation therapy for T2-3N0-3M0. A total of 47 patients were entered. However, 4 patients were excluded from the study. All eligible patients were randomized into two groups: neoadjuvant CAP plus radiation and control group. In the neoadjuvant treated-group, a 55% complete response plus partial response rate and a 88% downstaging were noted. Both the 12- and 36-month disease-free survival rates of neoadjuvant treated-group were 94.7%, and were higher than those of the control group (p less than 0.1). As for T4N0-3M0 cases, a total of 6 patients were treated with neoadjuvant methotrexate + vinblastine + doxorubicin + cisplatin (M-VAC) therapy. Favorable results were not obtained in this study at this point, because full dose M-VAC and planned recycling were not performed sufficiently. These findings suggests that neoadjuvant CAP plus radiation therapy would be useful for T2-3 invasive cancer of the bladder. Methods to administer full dose M-VAC; such as developments of new chemotherapeutic agents and of new anti-toxic agents, should be developed. In addition, a more successful regimen than M-VAC should be considered for T4 localized invasive bladder cancer.     

老年肺癌化疗患者营养状态及与癌因性疲乏的相关性

目的探讨老年非小细胞肺癌患者化疗期间营养状态变化特点及与癌因性疲乏的相关性,为制定缓解癌因性疲乏干预措施提供参考。方法选取115例老年非小细胞肺癌化疗患者,在化疗第1个周期前1 d(T0)及第7天(T1)、第2个周期前1 d(T2)及第7天(T3)、第4个周期结束后第7天(T4)采用营养风险评估表(NRS-2002)进行营养状态评估,在T4同时采用癌因性疲乏量表(CRF)评估。结果在T0、T1、T2、T3、T4 NRS-2002评分分别为(3.05±1.19)、(3.80±1.24)、(2.85±1.22)、(3.19±1.21)、(3.06±1.09)分,各时间点评分比较,差异有统计学意义(P0.01);营养不良发生率分别为10.4%、27.8%、8.7%、18.3%、14.8%。T4时间点CRF总分及躯体疲乏、情感疲乏、认知疲乏维度评分分别为(40.60±6.48)、(14.58±3.87)、(14.28±1.17)、(11.74±2.84)分。各时间点NRS-2002评分与T4时间点躯体疲乏、认知疲乏及CRF总分呈正相关性(均P0.05)。结论老年非小细胞肺癌患者化疗期间营养不良及营养风险比例较高,其变化趋势呈现"波浪"形;营养状态与CRF发生有关,需积极开展营养支持,以降低CRF程度。     

Ⅲ期乳腺癌术前新辅助化疗的临床观察

目的　研究Ⅲ期乳腺癌术前新辅助化疗的临床效果。方法　 1999年～ 2 0 0 1年 6月住院手术治疗的Ш期乳腺癌患者 62例 ,术前行辅助化疗 ,回顾分析 1997～ 1998年间收治的 3 7例Ш期乳腺癌未作辅助化疗而直接手术作为对照组。从手术切除后病理切片观察细胞变化及术后局部复发 ,远处转移等方面进行比较。结果　手术后病理切片观察癌细胞坏死情况 ,新辅助化疗组有效率为 67.7% ,而对照组仅 6例癌细胞有轻度局灶坏死。术后三年局部复发或远处转移新辅助化疗组为 11.4% ,对照组 2 4.3 %。结论　手术前辅助化疗能大量杀伤肿瘤细胞 ,缩小肿瘤便于手术 ,减少远处播散机会