卵巢癌术后腹腔温热灌注联合化疗疗效观察

目的:观察中晚期卵巢癌术后,行腹腔温热灌注联合静脉双途径化疗的临床疗效。方法:中晚期卵巢癌41例,随机分为观察组20例,于术后第7天行腹腔温热灌注联合静脉双途径化疗;对照组21例,术后第7天单纯行腹腔化疗。化疗方案为PC或PAC(顺铂 环磷酰胺 多柔比星),观察两组疗效及不良反应。结果:两组病例均随访3年,治疗组1、2、3年生存率分别为95%、85%和65%;对照组分别为80.9%、71.4%和33.3%。两组1、2年生存率比较,差异不显著(P>0.05);3年生存率比较,差异显著(P<0.05)。术后早期使用腹腔温热灌注联合静脉化疗均未出现严重不良反应。结论:中晚期卵巢癌术后行腹腔温热灌注联合静脉双途径化疗,可提高疗效,延长病人生存时间。     

紫杉醇联合顺铂腹腔灌注治疗卵巢癌临床疗效及不良反应分析

目的探讨紫杉醇联合顺铂腹腔灌注治疗卵巢癌的临床疗效及不良反应。方法选取沈阳军区总医院2014年1月至2016年12月收治的具有完整病例资料的卵巢癌患者42例,将患者随机分为A、B两组,每组各21例。A组采用紫杉醇静脉给药联合顺铂腹腔灌注化疗,B组采用紫杉醇及顺铂单纯静脉化疗,两组给药剂量相同。治疗6个周期,比较两组患者的治疗疗效、不良反应发生情况及肿瘤标志物CA125下降水平。结果 A组近期有效率为95.2%,显著高于B组的81.0%,两组比较,差异有统计学意义(P<0.05)。两组CA125水平均显著下降,且A组下降更明显,两组比较,差异有统计学意义(P<0.05)。两组消化道反应及骨髓抑制发生率比较,差异均有统计学差异(P<0.05);肝肾功能损伤发生率比较,差异无统计学意义(P>0.05)。结论紫杉醇联合顺铂腹腔灌注对于卵巢癌的治疗具有一定的临床疗效,相比单纯静脉化疗,不良反应小,值得临床应用。     

腹腔热灌注联合紫杉醇化疗在卵巢癌晚期患者中应用临床观察

目的探讨晚期卵巢癌患者在临床中行腹腔热灌注联合紫杉醇化疗治疗的临床疗效。方法选取自2016年7月至2018年6月在沈阳市妇婴医院治疗的110例晚期卵巢癌患者作为研究对象,根据治疗方案不同分为A、B两组,每组各55例患者。其中,A组接受紫杉醇联合顺铂静脉注射方式治疗,B组接受腹腔热灌注联合紫杉醇静脉注射治疗,观察并比较两组患者临床疗效、不良反应发生率以及治疗前后血清指标、T细胞亚群(CD4+CD25+、CD4+/CD8+)指标水平。结果治疗后,B组患者临床疗效、腹水控制率、不良反应发生率情况均显著优于A组(P<0.05)。治疗后,两组患者的血管内皮生长因子(VEGF)、人附睾蛋白4(HE4)、甲胎蛋白(AFP)、碱性成纤维细胞生长因子(bFGF)、癌胚抗原(CEA)、糖类抗原125(CA125)水平及CD4+CD25+、CD4+/CD8+水平比较,差异均有统计学意义(P<0.05)。结论对于晚期卵巢癌患者,在临床中予以腹腔热灌注联合紫杉醇化疗进行治疗,能够有效控制腹水,抑制血管形成,降低不良反应发生率,改善血清多项指标的表达水平,从而提升整体治疗效果。     

全身热疗联合腹腔灌注化疗治疗晚期胃肠道恶性肿瘤疗效分析

目的观察全身热疗联合腹腔内灌注化疗治疗晚期胃肠道恶性肿瘤与全身静脉化疗的近期疗效和毒副反应。方法将我科2006年1月—2010年10月收治的晚期胃肠道恶性肿瘤患者36例,随机分为全身热疗联合腹腔内灌注化疗组(A组)和全身静脉化疗组(B组),治疗4周期后观察两组患者的近期疗效及毒副作用。结果近期疗效两组的有效率分别为:A组63.2%、B组17.6%,A组明显优于B组(P<0.05);毒副反应恶心、呕吐等消化道反应和骨髓抑制症状两组分别为:A组15.8%、B组64.7%,A组低于B组(P<0.05);腹痛腹胀症状,A组36.8%、B组5.9%,A组多于B组(P<0.05)。结论对晚期胃肠道恶性肿瘤,采用全身热疗联合腹腔内灌注化疗疗效确切、毒副作用轻,有利于提高患者生活质量。     

腹腔热灌注化疗方案用于子宫内膜癌根治术后的疗效观察

目的 探讨子宫内膜癌患者在根治术后采用腹腔热灌注化疗的效果及安全性。方法 以2017年1月-2017年12月就诊的64例子宫内膜癌患者为研究对象,均接受根治术治疗,按照其术后辅助化疗方式不同分组展开分析,将根治术后采用静脉化疗的32例患者作为对照组,将根治术后采用腹腔热灌注化疗的32例患者作为观察组,对比两组临床疗效、不良反应及3年内复发率与生存率。结果 观察组治疗总有效率为84.37%,CA125为(33.39±6.51)U/ml, HE4为(28.17±12.34)ρmol/L,治疗后3年内复发率为6.25%,生存率为90.62%;对照组治疗总有效率为65.62%,CA125为(40.06±8.33)U/ml, HE4为(39.46±14.98)ρmol/L,治疗后3年内复发率为21.87%,生存率为71.87%,对比均有显著差异性(P<0.05)。观察组患者的各项生活评分与对照组相比显著较高(P<0.05),两组不良反应发生率对比无显著差异(P>0.05)。结论 根治术后腹腔热灌注化疗方案用于子宫内膜癌患者不仅近期疗效显著,还能减少术后复发率,提高远期患者疾病无...     

进展期胃癌术后患者腹腔热灌注辅助化疗的临床疗效观察

目的 分析和探讨腹腔热灌注化疗在进展期胃癌术后的临床应用效果.方法 将2011年8月—2013年3月在我院接受进展期胃癌术后治疗的96例患者作为研究对象,并随机、双盲分为观察组和对照组,两组患者术后接受相同的全身辅助化疗,观察组患者在全身辅助化疗的基础上给予腹腔热灌注化疗.随访3年,比较两组患者临床疗效.结果 观察组患者治疗后血清标志物指标CEA、CA199以及VEGF、MMP水平低于对照组(P﹤0.05);观察组患者3年生存率、复发率优于对照组(68.75%vs 37.50%、6.25%vs 27.08%、P﹤0.05);组间比较不良反应发生率、毒副反应发生情况无显著差异(P﹥0.05).结论 腹腔热灌注化疗是提高进展期胃癌术后患者治疗质量的有效途径,有效避免胃癌复发,提高患者生存率,推荐临床使用.     

腹腔化疗与静脉水化相结合治疗卵巢癌28例

目的：探讨用套管针腹腔化疗与静脉水化相结合治疗卵巢癌的疗效。方法：28例卵巢癌病人均用PAC方案，第一天给予表阿霉素60mg静脉注射；第二天用顺铂100mg给予腹腔化疗；第三天给予CTX600mg静脉注射。结果：21例I期及Ⅱ期患者采用该方法化疗，随访五年中16例存活，5例死亡，存活率达76．2％。7例晚期卵巢癌，1例存活，6例死亡。结论：腹腔化疗与静脉水化相结合治疗I期及Ⅱ期卵巢癌，较单纯静脉化疗全身副反应低，安全范围大，能够增强抗肿瘤效果，提高五年存活率，是一条理想的给药途径。     

腹腔热灌注化疗治疗胃癌的护理

目的：探讨胃癌术后温热灌注化疗护理,提高成功率、降低并发症发生率。方法：灌注过程中严格消毒,畅通管道,保持灌注温度,严密观察病情,并给予对症处理。结果：灌注均顺利,无管道周围感染和脱落现象。结论：严格遵守操作规程,可减少并发症及各种意外,保证灌注顺利。     

恶性腹腔积液内生场热疗联合腹腔灌注化疗的疗效观察

目的探讨内生场热疗联合腹腔顺铂灌注化疗治疗恶性腹腔积液的疗效。方法将我科2007年5月～2009年10月确诊的130例恶性腹腔积液患者随机分成治疗组、对照组各65例,比较热疗联合腹腔顺铂灌注化疗与单纯腹腔顺铂灌注化疗的近期疗效。结果治疗组治疗后有效率70.8%,对照组治疗后有效率43.1%,两组间差异有显著性（P〈0.01）;治疗组生活质量改善率73.8%,对照组生活质量改善率46.2%,两组间差异有显著性（P〈0.01）。两组130例患者都顺利完成治疗,治疗组中有21例出现Ⅰ度皮肤灼伤,3例出现浅Ⅱ度烫伤,经处理恢复良好。结论内生场热疗联合腹腔顺铂灌注化疗能提高对恶性腹腔积液的疗效,是恶性腹腔积液安全、有效的治疗手段,做好护理工作是治疗成功的关键。     

胃癌术中腹腔灌注术后动脉插管化疗效果观察

1994～1996年,我院对胃癌手术切除的病人,关腹前采用温热蒸馏水灌注腹腔、术后腹腔动脉插管化疗,并与单纯手术切除、术后静脉化疗进行比较。证明前者可使肝、腹腔内转移率减少,生存率提高。1对象和方法1．1对象同期手术切除胃癌146例,随机分为：术中腹腔灌注术后动脉插管化疗组（A组）89例,其中男68例,女21例,平均58岁;单纯手术切除术后静脉化疗组（B组）57例,其中男41例,女16例,平均55岁。两组性别、TNM分期、病变部位及手术方式具有可比性。1．2方法根治性手术A组sl例,B组52;姑息性手术A组8例,B组5例。术式：I。期行R…     

卵巢癌患者术后力朴素与顺铂联合静脉化疗的疗效观察

目的观察卵巢癌患者术后应用力朴素与顺铂联合静脉化疗的疗效及毒副反应。方法 24例患者术后采用力朴素与顺铂联合静脉化疗。3周1个疗程,共4~6个疗程。化疗后通过患者的临床症状及化验指标等判断治疗效果及化疗毒副作用。结果治疗有效率为91.67%（22/24）,血肿瘤标志物CA125下降率91.67%（22/24）。白细胞下降发生率为45.83%（11/24）,胃肠道反应率为70.83%（17/24）。所有患者均未因化疗毒副作用中断或退出治疗。结论力朴素与顺铂联合静脉化疗对术后卵巢恶性肿瘤治疗效果好,毒副反应轻。     

妊娠合并卵巢肿瘤的临床诊治和妊娠结局分析

目的总结妊娠合并卵巢肿瘤患者的临床表现、处理和对妊娠结局的影响。方法我院2007年1月～2012年1月诊治54例妊娠合并卵巢肿瘤患者,现回顾性分析其临床资料、诊治和妊娠结局。结果妊娠合并卵巢肿瘤和卵巢瘤样病变的总发病率为0.68%,超声检查发现48例,磁共振发现4例,剖宫产术中探查2例;18例在孕期行手术治疗,36例保守治疗;足月产42例,早产4例,流产8例。结论超声检查及MRI检查在妊娠合并卵巢肿瘤的诊断中具有重要临床意义,治疗时期以孕中期最适合,治疗方式以肿瘤切除术为常见。     

宫颈癌卵巢移位术后VMAT与IMRT卵巢放疗剂量的比较

目的:比较行卵巢移位术后的宫颈癌患者固定野调强(IMRT)和容积旋转调强(VMAT)计划中卵巢的剂量学差异。方法:31例接受宫颈癌根治术和卵巢移位术,术后需放射治疗的患者,设计9野均分IMRT计划和双弧VMAT计划,在保证靶区处方剂量及危及器官限量的情况下,尽量降低卵巢剂量。分析两种技术卵巢平均剂量的差异,以及卵巢-靶...     

新疆部分地区卵巢肿瘤656例临床分析

目的 :探讨新疆北部卵巢肿瘤的发病与防治。方法 :对 656例卵巢肿瘤的临床与病理特点进行分析。结果 :卵巢肿瘤检出率占妇科住院患者的 1 1 .0 %。 2 0～ 39岁年龄组为卵巢肿瘤的高发时段 (72 .1 % ) ,<2 0岁未产女性恶性肿瘤明显高于良性(P <0 .0 5) ,良性肿瘤中生殖细胞瘤 (2 5 .0 % )居首位 ,恶性肿瘤中上皮细胞肿瘤占第一位。B超诊断符合率为 97.0 %。结论 :新疆北部恶性卵巢肿瘤比 (4.9% )明显低于其他地区水平 (2 4 % ) ,青春期与老年妇女为恶性卵巢肿瘤的高发人群     

Survivin在卵巢癌中的表达与化疗耐药和预后关系

目的探讨卵巢癌中survivin表达与化疗耐药和预后的关系。方法用免疫组化S—P法检测了20例正常卵巢和45例卵巢癌组织中survivin的表达情况,并与临床、病理因素、化疗耐药和预后资料进行分析。结果survivin在正常卵巢和卵巢癌中表达的阳性率分别为0％和71．11％（P〈0．01）。survivin表达与临床分期成正相关（P〈0．05）,与患者年龄、肿瘤类型、组织分级、残瘤大小无关。32例survivin阳性的卵巢癌者中有20例为化疗耐药,13例阴性者中有2例耐药,差异有显著性（P〈0．01）。survivin阳性组的三年生存率显著低于阴性组（P〈0．05）,且是独立的预后因素。结论卵巢癌是survivin高表达的肿瘤。survivin阳性表达与化疗耐药有关,是预后不良的指标。     

Integrated PET/CT as a first-line re-staging modality in patients with suspected recurrence of ovarian cancer

Purpose The aims of this study were to compare CT with PET/CT results in patients with suspected ovarian cancer recurrence and to assess the impact of the PET/CT findings on their clinical management. Methods Thirty-two consecutive patients with suspected ovarian cancer recurrence were retrospectively included in the study. Abdominal contrast-enhanced CT and PET/CT with [¹⁸F]FDG, in addition to conventional follow-up, were performed in all 32 patients. After the comparison between CT and PET/CT results, based on clinical reports, changes in the clinical management of patients (intermodality changes) due to PET/CT information were analysed. Results Twenty of the 32 patients were positive at CT (62.5%) versus 29 (90.6%) at PET/CT. Intermodality changes in management, i.e. use of a different treatment modality, after PET/CT examination were indicated in 14/32 (44%) patients. In particular, before PET/CT study, the planned management was as follows: wait-and-see in 7/32 (22%), further instrumental examinations in 4/32 (12%), chemotherapy in 10/32 (31%), diagnostic surgical treatment in 6/32 (19%) and surgical treatment in the remaining 5/32 (16%). After PET/CT study, wait-and-see was indicated in 1/32 (3%), further instrumental examinations in 7/32 (22%), chemotherapy in 16/32 (50%), diagnostic surgical treatment in 2/32 (6%) and surgical treatment in the remaining 6/32 (19%). Conclusion Integrated PET/CT could detect tumour relapse in a higher percentage of patients than could CT. A change in the clinical management was observed in 44% of cases when PET/CT information was added to conventional follow-up findings. G. Mangili and M. Picchio contributed equally to this work.     

Negative F-2-fluorodeoxyglucose PET/CT predicts good cancer specific survival in patients with a suspicion of recurrent ovarian cancer

Aim

The aim of the present study was to investigate the diagnostic and prognostic value of combined ¹⁸F-2-fluorodeoxyglucose positron emission tomography and contrast enhanced X-ray computed tomography (FDG-PET/CT) in women with a suspicion of recurrent ovarian cancer.

Patients and methods

We retrospectively reviewed 48 patients with a suspicion of recurrent ovarian cancer who were referred to our department for combined FDG-PET/CT.

Results

Median follow-up was 25 months. 38/48 (79%) patients showed pathological findings on PET/CT. 17/48 (35%) of patients died of ovarian cancer. One FDG-PET/CT was false positive and one was false negative, leading to a sensitivity and positive predictive value of 97% and a specificity and negative predictive value of 90%. 33/48 (69%) underwent a change in therapy following FDG-PET/CT. There was a significantly better survival in FDG-PET/CT negative than in positive patients (p = 0.04). In the FDG-PET/CT negative group no patients had died of ovarian cancer during follow-up. Remarkably, there was no difference in survival between patients who only had peritoneal metastases on FDG-PET/CT and those who also had extraperitoneal metastases (p = 0.71).

Conclusion

A negative FDG-PET/CT has a high negative predictive value for the presence of disease and, more importantly, is associated with a very good disease-specific survival rate.     

Clinical benefit of bone-targeted radiometabolic therapy with 153Sm-EDTMP combined with chemotherapy in patients with metastatic hormone-refractory prostate cancer

Background Bone metastases are responsible for most of the morbidity associated with hormone-refractory prostate cancer (HRPC). ¹⁵³Sm-ethylenediaminetetramethylene phosphonate (¹⁵³Sm-EDTMP) has been approved for palliation of painful skeletal metastases. We retrospectively investigated the possible synergistic effect on survival of ¹⁵³Sm-EDTMP (given to HRPC patients for bone pain palliation) and chemotherapy. Methods Forty-five HRPC patients were evaluated, with a median age of 71 years. The number of metastatic bone sites was ≤10 in 25 patients and >10 in 20 patients. Median serum PSA was 224 ng/ml. Bone pain was mild in 6 patients, moderate in 16, severe in 22 and intolerable in 1. Fifteen patients were only treated with ¹⁵³Sm-EDTMP (group A), while 30 patients also received chemotherapy (estramustine phosphate or mitoxantrone plus prednisone) at variable times: between 3 and 5 months after ¹⁵³Sm-EDTMP (14 patients, group B) or within 1 month after ¹⁵³Sm-EDTMP (16 patients, group C). Results Haematological toxicities observed after either regimen were in general mild, consistent with common observations after either ¹⁵³Sm-EDTMP or chemotherapy, and without any additive adverse effects in the patients receiving both ¹⁵³Sm-EDTMP and chemotherapy. Bone pain palliation to some degree was induced by ¹⁵³Sm-EDTMP in 32/45 patients (71.1%), the proportion of patients with a favourable clinical response being significantly higher in group C than in group A (87.5% vs 53.3%, p = 0.0388). Also in terms of biochemical response (serum PSA levels), patients of group C performed significantly better than patients of group A (p = 0.0235). Overall median survival from the time of administration of ¹⁵³Sm-EDTMP was 15 months in the total cohort of 45 patients, and was significantly longer in group C than in either group B (30 months vs 11 months, p = 0.023) or group A (30 months vs 10 months, p = 0.008). Conclusion The results of this study confirm that ¹⁵³Sm-EDTMP is effective in terms of pain relief and PSA response, with minimal toxicity. When it was administered in combination with chemotherapy, prolonged survival indicated actual clinical benefit, while there were no additive toxicities. These results provide the rationale for future prospective evaluation of combined therapeutic strategies.     

新疆女性乳腺癌患者临床表现与病理特点分析

目的分析新疆女性乳腺癌患者的TNM分期、ER、PR和C-erbB-2特点,为新疆乳腺癌的综合治疗提供参照。方法收集我院2006年1月～2007年1月行手术治疗的Ⅰ～Ⅲ期女性乳腺癌患者资料,其中汉族394例,维吾尔族80例,按患者TNM分期、ER、PR和C-erbB-2的表达状况等资料进行比较分析。结果与汉族乳腺癌患者相比,维吾尔族患者的肿瘤TNM分期以Ⅱ、Ⅲ期常见,ER、PR阳性表达者所占的比重小,C-erbB-2阳性表达者所占的比重大,Ⅰ期维、汉族间PR阳性表达率有明显差异,在ER、PR阳性表达者中,C-erbB-2阳性表达者较少。结论维吾尔族女性乳腺癌患者的预后指标提示较汉族差。     

Dosimetric analysis of chimeric monoclonal antibody cMOv18 IgG in ovarian carcinoma patients after intraperitoneal and intravenous administration

In this study the potential of intraperitoneal (i.p.) and intravenous (i.v.) administration of chimeric iodine-131-labelled MOv18 IgG for radioimmunotherapy was determined. The dosimetry associated with both routes of administration of cMOv18 IgG was studied in patients. Eight patients suspected of having ovarian carcinoma received 150 MBq ¹³¹I-cMOv18 IgG i.p. Blood and urine were collected and serial gamma camera images were acquired. Another group of four patients received 7.5 MBq ¹³¹I-cMOv18 IgG i.v. For all patients, tissue biopsies were obtained at surgery. Activity in the blood after i.p. administration was described by a bi-exponential curve with a mean uptake and elimination half-life of 6.9±3.2 h and 160±45 h, respectively. For i.v. infusion the mean half-life for the elimination phase was 103±12 h. Cumulative excretion in the urine was 17%±3% ID and 21%±7% ID in 96 h for i.p. and i.v. administration, respectively. Scintigraphic images after i.p. administration showed accumulation in ovarian cancer lesions, while all other tissues showed decreasing activity with time. Tumour uptake determined in the ovarian cancer tissue specimens ranged from 3.4% to 12.3% ID/kg for i.p. administration and from 3.6% to 5.4% ID/kg for i.v. administration. Dosimetric analysis of the data indicated that 1.7–4.3 mGy/MBq and 1.7–2.2 mGy/MBq can be guided to solid or ascites cells after i.p. and i.v. administration, respectively. Assuming that an absorbed dose to the bone marrow of 2 Gy will be dose limiting, a total activity of 4.1 GBq ¹³¹I-cMOv18 IgG can be administered safely via the i.p. route and 3.5 GBq via the i.v. route. At this maximal tolerated dose, a maximum absorbed dose to 1-g tumours in the peritoneal cavity of 18 and 8 Gy can be reached after i.p. and i.v. administration, respectively. For the i.p. route of administration, dose estimates for the tumour are even higher when the electron dose of the peritoneal activity is also taken into account: total doses to the tumour of 30 Gy and 22 Gy will be absorbed at the tumour surface and at 0.2 mm depth, respectively. In conclusion, therapeutic tumour doses can be achieved with ¹³¹I-cMOv18 IgG in patients with intraperitoneal ovarian cancer lesions with no normal organ toxicity. The i.p. route of administration seems to be preferable to i.v. administration. Received 10 July and in revised form 17 August 1998