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摘 要:术前辅助化疗是将化疗应用于根治性手术之前的综合治疗策略。胃癌的术前辅助化疗包括可切除的进展期胃癌新辅助化疗,以及临界可切除、部分不可切除进展期胃癌的术前辅助转化治疗。近十年来,随着胃癌手术标准化确立、新药开发、辅助化疗方案不断优化、多学科协作诊疗模式和系统治疗的进一步推广,进展期胃癌的治疗成绩得到显著提高。依据胃癌术前辅助化疗积累的临床证据,本文回顾了局部进展期胃癌术前辅助化疗的发展历程,探讨了胃癌术前辅助化疗的常用化疗方案及疗程、术前辅助化疗的临床应用价值、如何精准选择可能通过术前辅助化疗获益的进展期胃癌病例以及术前辅助化疗的疗效评估方法等重要问题。并对胃癌术前辅助治疗存在的问题及远景进行了展望。 相似文献
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目的对改良FOLFOX6新辅助化疗与术后化疗治疗进展期胃癌的临床疗效进行对比分析。方法选取200例进展期胃癌患者,并将其随机分为2组,改良FOLFOX6新辅助化疗组和改良FOLFOX6术后辅助化疗组,以进行单纯手术的100例为对照组,对比观察术后的临床疗效以及围术期并发症情况。结果改良FOLFOX6新辅助化疗组治疗后患者的总有效率(87.00%)明显高于改良FOLFOX6术后辅助化疗组患者的总有效率(57.00%),统计学上有意义(P<0.05)。同时,改良FOLFOX6新辅助化疗组患者的手术后围术期并发症发生率(22.00%)明显低于单纯手术治疗组并发症发生率(49.00%),差异在统计学上有意义(P<0.05)。结论改良FOLFOX6新辅助化疗对进展期胃癌的临床治疗效果较改良FOLFOX6术后辅助化疗的治疗效果显著,围术期并发症较少,安全可靠,可以在临床上广泛应用。 相似文献
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在中国,多数胃癌患者初诊时就已经为局部进展期及晚期,手术仍是局部进展期胃癌患者的主要治疗方法,但新辅助化疗已经逐渐成为标准治疗模式的一部分.有效的新辅助化疗能够提高局部进展期胃癌患者的生存期,但并非所有患者均能具有良好的化疗疗效.有效预测新辅助化疗的疗效,不仅能够避免疾病进展,也能降低因化疗带来的身体创伤及社会经济压力,因此,高效准确的预测新辅助化疗疗效是当下亟待解决的临床难题.本文对影像检查技术、分子标志物、临床指标及预测模型等对新辅助化疗的疗效预测进展进行综述. 相似文献
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多学科综合治疗是局限期胃癌现代诊疗的模式,选择何种治疗方案应根据患者的特征而个体化选择。接受了标准D2术后胃癌患者,Ⅱ期患者可选择口服S-1或者XELOX联合化疗,而Ⅲb期及以上给与同步放化疗。单纯术前新辅助化疗可能不是一个理想的提高生存的策略,而围手术辅助化疗更为合理。目前尚无证据证明胃癌术前新辅助化疗/围手术化疗较单纯术后化疗有更好的生存,新辅助化疗的价值更多体现在降期和使不可R0切除的局部晚期肿瘤转化为可切除肿瘤。术前同步放化疗因降期和转化效率高而在不可切除局限期胃癌中更具探索价值。 相似文献
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胃食管交界部腺癌(gastroesophageal junction adenocarcinoma,GEJA)具有独特的生物学特性和预后,且发病率显著增加,但其诊断和治疗仍存在争议。新辅助治疗和辅助治疗联合手术治疗较单纯手术均可改善局部进展期GEJA患者生存。而新辅助治疗中的新辅助放化疗较新辅助化疗可提高患者手术切除率和局部控制率,改善患者生活质量,联合分子靶向药物可进一步增加疗效。局部进展期GEJA患者的综合治疗数据多来源于食管癌或胃癌的随机临床研究,应开展更多大样本前瞻性随机对照研究,优化新辅助和辅助综合治疗,改善局部进展期GEJA患者的生存。本文对局部进展期GEJA综合治疗的研究进展进行综述。 相似文献
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改良FOLFOX方案用于进展期胃癌新辅助化疗的近期疗效 总被引:1,自引:0,他引:1
目的:新辅助化疗可以提高进展期胃癌的手术切除率及根治率.本研究旨在评估进展期胃癌行新辅助化疗后的临床疗效.方法:选择2006年9月~2008年9月天津医科大学附属肿瘤医院治疗进展期胃癌患者共80例,分为常规手术组和新辅助化疗+手术组,每组40例.新辅助化疗+手术组患者化疗2个周期,具体方案:奥沙利铂(乐沙定)100mg/m2 iv d1(2h),亚叶酸钙400mg/m2 iv d1(2h).5-Fu 2 400mg/m2 civ d1(46h).每2周为1个周期,共化疗2个周期.化疗后复查CT,了解肿瘤变化后行手术治疗.结果:新辅助化疗十手术组化疗临床有效率(完全缓解+部分缓解)52.5%(21例),疾病稳定37.5%(15例),疾病进展10.0%(4例).手术总切除率92.5%(37/40),获得根治性切除率77.5%(31/40),剖腹探查率7.5%(3/40).常规手术组手术总切除率75.0%(30/40),获得根治性切除率52.5%(21/40),剖腹探查率22.5%(9/40).两组均无手术死亡病例,术后并发症差异无统计学意义.结论:进展期胃癌患者采用改良FOLFOX方案行新辅助化疗具有较高的安全性,并且可以提高手术切除率及根治率以及改善部分患者的临床症状. 相似文献
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Mario Scartozzi Mirco Pistelli Alessandro Bittoni Riccardo Giampieri Eva Galizia Rossana Berardi Luca Faloppi Michela Del Prete Stefano Cascinu 《Current oncology reports》2010,12(3):175-185
Although recent advances have been made, surgery still remains the mainstay of any curative treatment for gastric cancer patients,
with radical gastrectomy representing the procedure of choice. However, patients with locally advanced disease show high rates
of locoregional or distant recurrence even after potentially curative resections. According to global results presented in
the setting of locally advanced resectable gastric carcinoma, perioperative chemotherapy may be considered a valuable option.
On the other hand, clinical trials for advanced gastric cancer seem to suggest that a limit in efficacy has been reached for
standard chemotherapy. Interesting data are expected from the development of targeted agents that, similarly to other cancer
sites, showed appealing results in gastric cancer as well. Along with new effective therapeutic opportunities, better clinical
and molecularly driven patient selection will represent the cornerstone of the global care for these patients. 相似文献
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鼻咽癌(NPC)是常见的头颈部恶性肿瘤之一,放疗是NPC的主要治疗方法。化疗策略(诱导、同期、辅助)在放疗中的综合应用提高了局部晚期NPC的疗效。目前同期放化疗联合辅助或诱导化疗已被推荐为局部晚期NPC标准治疗方法。然而,标准治疗仍有许多不足之处,诱导及辅助化疗仍有许多争议,建立更加理想及个体化的局部晚期NPC放化疗方案仍是未来研究的方向。 相似文献
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Andrew D. Newton Jashodeep Datta Arturo Loaiza-Bonilla Giorgos C. Karakousis Robert E. Roses 《Journal of gastrointestinal oncology.》2015,6(5):534-543
Although surgical resection remains the only potentially curative treatment for gastric cancer (GC), poor long-term outcomes with resection alone compel a multimodality approach to this disease. Multimodality strategies vary widely; while adjuvant approaches are typically favored in Asia and the United States (USA), a growing body of evidence supports neoadjuvant and/or perioperative strategies in locally advanced tumors. Neoadjuvant approaches are particularly attractive given the morbidity associated with surgical management of GC and the substantial risk of omission of adjuvant therapy. The specific advantages of chemoradiotherapy (CRT) compared to chemotherapy have not been well defined, particularly in the preoperative setting and trials aimed at determining the optimal elements and sequencing of therapy are underway. Future studies will also define the role of targeted and biologic therapies. 相似文献
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目前,晚期胃癌的主要治疗手段仍以化疗为主,但其效果并不让人满意,近年来,出现了新的化疗药物及化疗方案,如三氟吡啶/替普拉西酯、FLOT化疗方案等。随着肿瘤分子生物学的不断深入,越来越多的靶向药物在胃癌的治疗中被证明有效,如VEGFR-2抑制剂阿帕替尼、抗VEGFR-2抗体雷莫芦单抗、酪氨酸激酶抑制剂阿法替尼等。免疫治疗也是胃癌综合治疗的热点之一,主要为免疫检查点抑制剂,包括程序性细胞死亡受体1检查点抑制剂纳武单抗、派姆单抗等。新药物的出现给晚期胃癌的治疗带来了新的机遇,本文将对目前晚期胃癌的化疗、靶向治疗、免疫治疗等研究进展进行综述。 相似文献
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Radical surgery with extended lymph-node dissection is the treatment of first choice and the only curative treatment for locally
advanced gastric cancer. While recent combination chemotherapy with S-1 (a combination of tegafur with two biomodulators,
gimeracil and oteracil) has achieved high response rates, controversy still remains regarding the significance of adjuvant
cancer chemotherapy after surgery. We have been applying chemosensitivity testing in evaluating the appropriate adjuvant cancer
chemotherapy for advanced gastric cancer. Our multiple studies have indicated that this chemosensitivity testing would be
useful to improve the results of adjuvant chemotherapy, by increasing survivals in the sensitive group. The chemosensitivity
testing is approved as “advanced clinical medicine” by the Japanese Ministry of Health, Welfare, and Labor at 11 institutes
at present. While complete lymph-node dissection and chemosensitivity test-guided adjuvant chemotherapy has been reported
to result in a survival benefit for patients with advanced gastrointestinal cancer, the clinical utility of the testing should
be established by means of prospective, randomized clinical trials. Two pivotal clinical trials have been initiated to clarify
the utility of chemosensitivity testing in the selection of the appropriate adjuvant cancer chemotherapy for gastric cancer. 相似文献
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Menges M 《World journal of gastrointestinal oncology》2011,3(1):10-13
Gastric cancer remains a major health issue and a leading cause of death worldwide.While the incidence is decreasing in western countries,there has been a shift to more proximal cancers of the diffuse type,which are usually more aggressive and associated with a worse prognosis.Radical surgery still offers the only chance of long term survival,but surgery has reached a plateau of effectiveness and more aggressive approaches like"ultraradical" lymphadenectomy have not improved prognosis.There are three options to improve the situation:Earlier detection,neoadjuvant chemotherapy and adjuvant therapy.Whilst systematic gastroscopic screening makes sense in countries with a high incidence of gastric cancer,in other regions targeted investigation of risk groups including first-degree relatives of cancer patients,patients with a chronic corpusdominant gastritis or with defined genetic abnormalities may help to detect cancer at an earlier stage.Neoadjuvant chemotherapy has meanwhile proved to significantly improve the prognosis not only in patients with a locally advanced cancer who cannot be resected for cure but but also in those who are potentially amenable to curative resection.In the largest randomised study so far reported,perioperative chemotherapy raised overall survival after 5 years from 23%to 36%.The role of adjuvant chemotherapy has been discussed for over 30 years.Meta-analyses demonstrate a small but significant effect which,however,seems to be restricted to Asian patients.In a large USstudy,adjuvant radiochemotherapy appeared to significantly improve outcomes.However,less than 50%of the study patients underwent a systematic lymphadenectomy and so the results of the therapy group were not better to those of"only resected"patients in two large European studies.Thus,the indication of adjuvant(radio-)chemotherapy in gastric cancer currently remains uncertain.Endoscopists have found a therapeutic role through endoscopic resection of early cancers,introduced mainly by Japanese authors.With the development of high resolution endoscopy,endosonography and adequate equipment,the endoscopic curative resection of T1a-tumors(restricted to the mucosal layer) has been established. 相似文献
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Currently, there is no international consensus on the best treatment regimen for patients with advanced resectable gastric carcinoma. Three approaches exist abroad continents. In France and Europe, perioperative chemotherapy and gastrectomy with D1.5 lymph-node dissection is the current standard. In Japan and South Korea, postoperative adjuvant chemotherapy after surgery with D2 lymph-node dissection is the standard treatment. In the United States, where limited lymph-node dissection is frequently performed, adjuvant chemoradiotherapy after surgery is the standard treatment. In France, postoperative chemoradiotherapy indications are discussed in limited settings: patients with locally advanced gastric cancer or lymph node involvement discovered on the pathologic report of the gastrectomy without preoperative chemotherapy delivery or in case of non-carcinologic resection (R1). Exclusive chemoradiotherapy can be proposed in patients unfit for surgery. 相似文献