经颞浅动脉灌注PDD-Fudr/5Fu治疗头颈部鳞状细胞癌

 目的　观察经颞浅动脉灌注PDD +Fudr/ 5 Fu治疗头颈部鳞状细胞癌的疗效。方法　从 1996年 1月～ 2 0 0 0年 12月有 89例头颈部鳞状细胞癌给予动脉化疗 ,A组 4 9例予PDD +Fudr方案 ,B组 4 0例予PDD + 5Fu方案 ,方法与剂量两组相同。结果　A组的总有效率为 83.7% (41/ 4 9) ,其中CR10 .2 % ,PR73.5 % ,SD16 .3% ;B组的总有效率为 75 .0 % (30 / 4 0 ) ,其中CR2 .5 % ,PR72 .5 % ,SD2 5 % ,统计学上两组有效率无明显差异 (P >0 .0 5 )。而口腔溃疡在A组的发生率明显低于B组 ,经 χ2 检验 ,两组有显著差异。结论Fudr在头颈部鳞状细胞癌的辅助化疗中是安全、低毒、高效的 ,值得推荐。     

颞浅动脉插管灌注化疗并发症82例分析

颞浅动脉插管灌注化疗并发症８２例分析湖北省蕲春县三医院王端焱对头颈部恶性肿瘤行颞浅动脉插管药物治疗已广泛开展。插管化疗与放射治疗、手术治疗的综合使用，可使手术切除率明显提高，复发率明显降低，因此它是头颈部恶性肿瘤综合治疗的主要手段之一。然而因灌注方法...     

动脉插管栓塞治疗妇科恶性肿瘤

目的 对29例进展期或复发性妇科恶性肿瘤应用动脉插管及栓塞治疗。方法 采用Seldinger插管法行动脉插管29例70次。结果 完全有效(CR)2例,部分有效(PR)8例,总有效率34.5％。1年生存率20.7％(6/29),半年生存率51.7％(15/29)。栓塞后相关不良反应包括:2例轻微下肢酸痛,2例臀部疼痛。结论 动脉插管栓塞治疗对中晚期妇科恶性肿瘤患者是一较为安全有效的治疗手段。     

颞浅动脉插管化疗36例临床分析

目的 对颞浅动脉插管操作中易发生的问题及术后并发症作了临床分析。方法 利用36例(40侧)经颞浅动脉插管化疗的插管操作方法及肿瘤发病部位与导管深度的关系。结果 本组病人插管给药后出现疼痛24例,区域性水肿12例,偏瘫1例。结论 只要了解插管的并发症及其处理方法,并采取适当的监控如造影或亚甲蓝染色,该并发症即可明显的降低。     

经颞浅动脉逆行插管治疗脑恶性肿瘤八例报告

经颞浅动脉逆行插管交替灌注替尼泊甙（ＶＭ－２６）、尼莫司汀（ＡＣＮＵ）、白细胞介素２和２０％甘露醇治疗恶性脑胶质瘤７例和淋巴瘤１例。化疗后４～８周，结果显效２例，有效５例，无效１例。并发脑积水２例，血白细胞下降１例。此法比较简便、安全、有效，且并发症少，全身反应轻     

超选择性动脉插管持续灌注化疗在妇科恶性肿瘤中的应用

目的探讨超选择性动脉插管持续灌注化疗对妇科恶性肿瘤的应用价值和效果。材料和方法对47例晚期妇科恶性肿瘤进行了超选择动脉持续灌注化疗,其中36例宫颈癌（Ⅱb－Ⅳ期）,6例卵巢癌（Ⅲ期一Ⅳ期）,5例子宫内膜癌（Ⅲ期）。平均年龄52岁,采用经皮穿刺股动脉置管于患侧骼内动脉之肿瘤供血动脉内、连接蠕动式动脉输液泵、进行持续性两天大剂量化疗药物灌注治疗。结果47例中完全缓解1例,部分缓解44例,稳定2例,总有效率95％,5例局部臂部皮肤发生缺血后改变占1％。结论超选择性动脉插管持续性灌注化疗对妇科恶性肿瘤的治疗是一种有效的治疗手段,不但能控制和治疗晚期肿瘤,同时可能为不能手术病人提供了再次手术切除的机会。     

颞浅动脉插管化疗治疗72例晚期口腔颌面部恶性肿瘤的临床观察

目的:观察口腔颌面部晚期恶性肿瘤颞浅动脉插管化疗的近期疗效、影响因素及毒副反应。方法:对72例口腔颌面部晚期恶性肿瘤采用 TDP方案进行插管化疗,THP 20 mg, 静脉推注,d1;DDP 30mg,静脉推注,d2 ~d4;PYM 8 mg,静脉推注,d5~d9。21 d为 1 个周期,满 2 个周期以上进行疗效评价。结果:总有效率(CR+PR) 为 90 .28% ( 65/72 ), 其中 CR 为16 .67%(12/72), PR为 73 .61 % (53/72)。Ⅲ期有效率 93. 75% (30/32),Ⅳ期有效率87 50%(35/40),两组比较差异无统计学意义,P=0. 62。初治的有效率 100 00%(38/38),复治的有效率为79 .41%(27/34),两组比较差异有统计学意义,P=0. 01。化疗 2个周期有效率为 86 .36%(38/44),化疗>2个周期有效率为 96 43%(27/28),两组比较差异无统计学意义,P>0. 32。结论: 颞浅动脉插管化疗对晚期口腔颌面部恶性肿瘤疗效好,安全且不良反应轻。初治与复治是影响疗效的主要因素。     

超选择性动脉插管持续灌注化疗有妇科恶性肿瘤中的应用

目的 探讨超选择性动态插管持续灌注化疗对妇科恶性肿瘤的反应价值和效果。材料和方法对４７例晚期妇科恶性肿瘤进行了超选择动脉持续灌注化疗,其中３６例宫颈癌（Ⅱｂ－Ⅳ期,）６例卵巢癌（Ⅲ期－Ⅳ期）,５例子宫内膜癌（Ⅲ期）。平均年龄５２岁,采用经皮穿刺股动脉置管于患侧髂内动脉之肿瘤供血动脉内、连接蠕动式动脉输液泵、进行持续性两天大剂量化疗药物灌注治疗。结果 ４７例中完全缓解１例,部分缓解４４例,稳定２例,     

经颞浅动脉灌注化疗治疗无法切除的晚期上颌恶性肿瘤的疗效分析

目的 观察经颞浅动脉灌注化疗治疗无法切除的晚期上颌恶性肿瘤的疗效和毒副反应。方法16例无法切除局部晚期上颌恶性肿瘤患者,行选择性颞浅动脉插管后,根据化疗方案用微量输液泵经导管远心端药池输注相应化疗药物：多西他赛60～75mg／m2匀速灌注2h,d1;顺铂75mg／m2大剂量冲击2h,d1;氟尿嘧啶500mg／m2连续灌注120h,d1～d5;吡柔比星25mg／m2匀速灌注2h,d1～d3;吉西他滨1000mg／m2连续滴注30min,d1、d8。21天为1个周期,2个周期分别采用RECIST 1.1标准和NCI CTC 3.0标准评价近期疗效和毒副反应并随访远期生存情况。结果16例均可评价近期疗效,其中CR 1例,PR 10例,SD 5例,RR为68.8％,DCR为100.0％。14例获随访（87.5％）,中位生存期和无进展生存期分别为26.0个月和4.0个月。全组未有4级毒副反应发生,无治疗相关性死亡,3级毒副反应主要为1例耳廓部分坏死、3例贫血及1例骨髓抑制,其余均为1～2级。结论 无法切除的晚期上颌恶性肿瘤经动脉灌注化疗后能够取得较为满意的治疗效果,毒副反应可耐受。     

颞浅动脉灌注化疗治疗上颌区小涎腺恶性肿瘤的近期疗效

目的对35例采用颞浅动脉逆行插管灌注化疗的原发于上颌骨区的小涎腺恶性肿瘤病例进行研究。对化疗疗效、毒副反应及影响化疗近期疗效的因素进行分析。方法上颌骨区小涎腺恶性肿瘤患者35例,T312例,T423例;M032例,M13例(肺转移2例,纵隔转移1例)。化疗方案采用顺铂(cisplatin),吡柔比星(pirarubicin),5-氟尿嘧啶(5-fluorouracil)。其中7例患者因病变累及双侧上颌骨,而采用了双侧颞浅动脉插管颌内动脉灌注化疗。结果所有患者经颞浅动脉插管颌内动脉灌注化疗1周期后,PR22例(62.9%),NC9例(25.7%),PD4例(11.4%)。无CR病例。毒副反应以血液毒性为主。未见其他毒性反应。无因毒性反应而延迟手术的病例。结论本文资料表明,颞浅动脉灌注化疗治疗原发于上颌骨区的小涎腺恶性肿瘤具有良好的临床疗效,RR62.9%。吡柔比星(THP)与PDD及5-Fu有协同增效作用可能是本组病例疗效较高的原因之一。对转移患者,灌注区原发病灶缩小大于转移灶,提示动脉灌注化疗的高效性。病理类型、既往手术或放疗史是影响化疗效果的重要因素。     

旋髂浅动脉穿支皮瓣的术前彩色多普勒超声与CT血管造影辅助设计研究

目的：研究彩色多普勒超声（colorduplexsonography ,CDS ）与CT血管造影（computertomographyangiography ,CTA ）两种常用术前穿支血管定位技术在旋髂浅动脉穿支皮瓣辅助设计及其准确度、敏感度对比的应用,为游离旋髂浅动脉穿支皮瓣修复口腔颌面部肿瘤术后缺损提供理论支持。方法：选取罹患口腔颌面部恶性肿瘤患者需行手术及同期软组织修复29例,术前应用CDS 、CTA 技术对患者双侧腹股沟区旋髂浅动脉穿支进行检测,并记录血管相关检查结果,对检查数据进行统计分析。制备18例游离旋髂浅动脉穿支皮瓣,以术中解剖证实结果为金标准,设计诊断试验,探讨CDS 、CTA 两种技术用于诊断旋髂浅动脉穿支是否存在及管径大小的准确性。结果：18例患者行皮瓣制备,其中1 例术中未探及血管、17例术中行旋髂浅动脉管径测量,平均管径为（0.69± 0.20）mm。在诊断血管有无的试验中,CDS 敏感度为75.0% 、特异度为82.4% ,ROC 曲线下面积为0.79;CTA 敏感度为75.0% 、特异度为94.2% ,ROC 曲线下面积为0.85。术前测量的CDS 、CTA 平均管径分别为（0.84± 0.14）、（ 1.01± 0.19）mm,将CDS 、CTA 技术术前测量的管径大小分别与术中对比,穿支动脉管径（D）分别与CDS 、CTA 测量的管径值两两间比较,差异具有统计学意义（P < 0.05）。 结论：CDS 、CTA 是用于术前检测穿支血管相对可靠的技术。利用CDS 、CTA 术前为旋髂浅动脉穿支皮瓣定位穿支血管,可为术者提供与该穿支血管的走行、毗邻以及穿出点的精确信息,并一定程度反映血管管径大小。     

Combination chemotherapy as induction therapy for advanced resectable head and neck cancer

Fifty-four previously untreated patients with locally advanced resectable squamous cell carcinoma of the head and neck (SCCHN) were enrolled into a prospective randomized controlled trial to evaluate whether induction chemotherapy improves the disease-free survival compared to the standard treatment (surgery + radiation). Thirty patients received chemotherapy, which consisted of cisplatin 20 mg/m² day 1–5, bleomycin 10 mg/m², continuous infusion from day 3–7, and methotrexate 40 mg/m² given on day 15 and day 22. The cycle was repeated on day 29 for two cycles. Twenty patients completed chemotherapy courses. Overall response rate was 77% (23 of 30). No survival improvement was observed. Kaplan-Meier analysis indicated survival (and 95% confidence interval) at 3 years was 57% (29%-84%) for the control group and 60% (34%-87%) for the chemotherapy group, and 57% (29%-84%) and 45% (12%-78%) at 4 years (P = 0.736). However, patients who had a complete response were significantly better in terms of long-term survivors (5 of 7 patients were still alive), in contrast to patients who had partial responses among whom only 4 of 16 were alive. Toxicities of this induction protocol are tolerable; one chemotherapy-related death occurred from profound thrombocytopenia. If efforts in determining a chemotherapy-sensitive patient were successfully established, along with a better sequence and the discovery of new and safter drugs, survival of SCCHN should be much improved.     

5-FU经颞浅动脉120小时持续灌注治疗高T分期鼻咽癌的Ⅰ期临床试验

目的 研究5-FU经颞浅动脉120h持续化疗高T分期鼻咽癌的最大耐受剂量(MTD).方法 对29例病理确诊为鼻咽癌的初治高T分期(T3或T4)患者采用颞浅动脉插管化疗.化疗方案:5-FU+顺铂,观察5-FU持续120h动脉灌注化疗的不良反应以及最大的耐受剂量.5-FU的剂量分别为200、300、350、400、450、500mg/m2,120h持续动脉滴注;顺铂20mg,第1～5天动脉快速滴注;21d为1疗程,共2个疗程.结果 不良反应: 29例病人均出现口腔黏膜反应,其中Ⅰ度1例为200mg/m2组;Ⅱ度12例200mg/m2组中5例,300mg/m2组5例,350mg/m2组2例;Ⅲ度11例300mg/m2组中1例,350mg/m2组3例,400mg/m2组5例,450mg/m2组2例;Ⅳ度5例450mg/m2组中3例,500mg/m2组2例;5例出现局部疼痛,对症治疗后好转.29例病人出现的骨髓抑制、消化道反应以及肝肾功能损害均在Ⅰ度和Ⅱ度.疗后原发灶CR 2例,PR 25例,SD 2例;有效率(CR+PR)为93%.颈部淋巴结CR 1例,PR 16例,SD 0例,余12例患者颈淋巴结为阴性,有效率(CR+PR)为100%.结论 5-FU经颞浅动脉持续化疗高T分期鼻咽癌,患者耐受尚可,最大耐受剂量为350mg/m2.     

Concurrent chemoradiotherapy versus induction chemotherapy followed by chemoradiotherapy (sequential approach) in the management of head and neck cancer

Concurrent chemoradiation is considered the standard-of-care for locally advanced head and neck cancer of the hypopharynx, oropharynx and larynx, as well as unresectable disease. This paradigm was challenged by the introduction of induction chemotherapy (IC), which demonstrated non-inferiority in regards of overall survival (OS), along with increased organ preservation, when compared to the surgery and radiotherapy. More recently, IC followed by concurrent chemoradiation, the so-called sequential approach was developed in an attempt to decrease metastatic spread and improve locoregional control (LRC) rates, with much controversy amongst experts. A careful evaluation by a multidisciplinary team is necessary to recognize which patients should be offered this therapeutic approach due to a significantly greater rate of toxicity. Herein, we analyze the most current available evidence regarding the use of sequential therapy versus concurrent chemoradiation. Different factors including toxicity profile, adherence and patient characteristics play a major role in choosing the most appropriate treatment regimen.     

Combination chemotherapy with carboplatin and bleomycin for advanced and recurrent head and neck cancer: a phase II study

Carboplatin is a platinum analogue with activity reported in head and neck cancer. We conducted a phase II trial with 14 patients who had recurrent head and neck cancer. They were treated with carboplatin 300 mg/m2 intravenously (I.V.) and bleomycin 30 units I.V. every 4 weeks. No responses were observed in this group of patients. Dose intensity of carboplatin administration may be an important determinant of response.     

晚期转移性头颈部腺样囊性癌治疗进展

晚期转移性腺样囊性癌目前无标准的治疗方案,各个指南现在对头颈部腺样囊性癌的治疗规范较少,关于晚期转移性腺样囊性癌的治疗以全身治疗为主,化疗方案多采用以蒽环类和环磷酰胺为主的联合治疗方案,紫杉类和吉西他滨治疗无效,部分靶向药物治疗有效,但是有效率均不超过20％.我们总结现有的数据,为晚期转移性腺样囊性癌的治疗提供循证医学...     

动脉内插管灌注化疗治疗鼻型NK/T细胞淋巴瘤

目的:本文通过对12例采用颞浅动脉逆行插管灌注化疗治疗的鼻型NK/T细胞淋巴瘤病例进行研究,对化疗疗效、毒副反应情况进行分析.方法:12例患者,男性9例,女性3例;年龄最小22岁,最大65岁.病理确诊为鼻型NK/T细胞淋巴瘤8例;病理诊断为"慢性炎症",临床确诊为鼻型NK/T细胞淋巴瘤4例.10例患者因累及面部中线两侧,故采用双侧颞浅动脉插管颌内动脉灌注化疗.方案采用顺铂(Cisplatin)13-25mg/m2, d1-5, d29-33;足叶乙甙(Etopside)100mg·d-1, d1-5, d29-33;平阳霉素(Pinyangmaycin)10mg/d, d1-5, d29-33;甲环亚硝尿(Me-CCNU)100-150mg/d, d1;强的松(Prednisone)25mg/m2,d1-14.所有患者采用颞浅动脉插管灌注完成了一周期化疗.第56天评价疗效.结果:所有患者经动脉灌注化疗一周期后,CR:6例,PR:4例,NC:2例.本组患者毒性反应以血液毒性为主.无因毒性反应影响治疗或因毒性反应退出治疗者.结论: PDD Vp16 PYM Me-CCNU PED动脉内插管灌注化疗治疗鼻型NK/T细胞淋巴瘤具有较好的临床疗效,值得进一步研究.     

Long-term intraarterial chemotherapy infusion of ambulatory head and neck cancer patients

The complications of percutaneous intraarterial infusion chemotherapy of the head-and-neck-cancer patient has dampened enthusiasm for this approach. A totally implantable infusion pump system circumvents many of these complications and will in the long term enhance the opportunity to expand upon the advantages of infusion chemotherapy for the benefit of all cancer patients.     

Distant metatases of carcinoma of tonsillar region: A study of 475 patients

The records of 471 patients with carcinoma of the tonsillar region seen at the Veterans Administration Medical Center, Hines, Illinois, have been reviewed to determine the incidence and location of distant metastases. All patients were male and with histologically proved diagnosis. Seventy-two patients (15%) of 471 and 33(29%) of 115 patients who underwent autopsy were found to have distant metastases. Squamous cell carcinoma was by far the most common cell type (88 %); however lymphoepithelioma showed the highest incidence of distant metastases. Lung, liver, and bone were the most common anatomical sites of involvement, and thorough work-up of these organs is highly recommended before initiating definitive treatment and during follow-up care.