晚期卵巢癌新辅助化疗疗效分析

目的 探讨新辅助化疗在治疗晚期卵巢癌中的作用和意义.方法 对45例晚期卵巢癌患者,20例采用新辅助化疗,然后进行肿瘤减灭术(新辅助化疗组);25例首先行肿瘤减灭术(先期手术组).所有患者术后均化疗.结果 新辅助化疗组满意肿瘤减灭率70.0%,先期手术组为36.0%,两组比较有明显差异(P＜0.05);新辅助化疗组术中出血量及手术时间较先期手术组少,两组比较均有明显差异(P＜0.05);新辅助化疗组的中位生存时间(34个月)较先期手术组(28个月)长.结论 对于初次手术不能达到满意减瘤或不能进行手术的晚期卵巢癌患者,新辅助化疗能提高减瘤术的成功率,有延长患者生存时间的趋势.     

Clinical Outcome of Iranian Patients with Advanced Ovarian Cancer with Neoadjuvant Chemotherapy versus Primary Debulking Surgery

Objective: The aim of this study is to evaluate the results of neoadjuvant chemotherapy (NACT) and theimpact of interval debulking surgery (IDS) on clinical outcomes of patients with advanced-stage ovarian cancer.Methods: We performed a retrospective analysis on 92 patients with advanced ovarian cancer admitted to Vali-Asr Gynecologic oncology departments during 1996–2002. Comparison was made with results of neoadjuvantchemotherapy of 24 patients with unresectable advanced epithelial ovarian cancer treated with platinum- basedNACT followed by IDS and clinical outcomes of 68 consecutive stage III and IV ovarian cancer patients treatedwith primary cytoreduction followed by platinum-based adjuvant chemotherapy. Results: Primary cytoreductivesurgery caused longer survival compared to neoadjuvant chemotherapy. Patients who underwent optimal intervaldebulking surgery (IDS) had a better progression free survival (PFS) (p=0.002) and overall survival (p=0.03)than those who did not. There were not significant differences between the two groups in complications ofsurgery. Conclusion: NACT followed by successful IDS can lead to high survival percentage in patients withchemoresponsive advanced ovarian cancer; although the result is more effective in those with optimal primarycytoreduction, we still got the same results with those with suboptimal primary cytoreduction.     

新辅助化疗在晚期卵巢癌治疗中的作用

目的:探讨新辅助化疗在晚期卵巢癌治疗中的临床意义。方法:分析我院63例曾行肿瘤细胞减灭术的晚期卵巢癌患者,其中24例行术前化疗,采用以铂类药物为主的化疗1～3个疗程;39例未行术前化疗,比较两组患者的疗效及5年生存率。结果:术前化疗组,手术基本切净率83.3%,术后并发症12.5%;术前未化疗组,手术基本切净率59.0%,术后并发症35.9%,两组比较差异具有显著意义(P<0.05)。两组5年生存率分别为41.7%、43.6%,两组比较差异无显著意义(P>0.05)。结论:新辅助化疗可提高晚期卵巢癌的基本切净率,减少术后并发症的发生率,但并未延长患者的生存期。     

晚期上皮性卵巢癌术前新辅助化疗的临床总结

探讨晚期卵巢癌能否行手术治疗的预测因素及新辅助化疗在晚期卵巢癌中的临床价值。方法：回顾性分析了大连医科大学附属第一医院1996年1月至2008年12月收治的Ⅲ～Ⅳ期晚期卵巢癌病例92例,其中18例接受新辅助化疗（NAC组）,74例接受初次手术（PCS组）。结果：使初次肿瘤细胞减灭术满意率降低的因素：伴有合并症（P=0.022）;初次治疗时存在胸腔积液（P=0.011）;CA125>1 000 U/L（P=0.030）;有肝、肺转移的Ⅳ期患者（P=0.031）。新辅助化疗的总有效率为66.7%。新辅助化疗可以提高肿瘤细胞减灭术的满意率（P=0.022）,缩短引流管置留天数（P=0.011）,减少腹水量（P=0.005）、术中出血量（P=0.048）,但在手术时间、输血量、平均住院天数、患者生存时间方面,NAC组与PCS组的差异无统计学意义（P>0.05）。结论：伴有合并症、胸腔积液、CA125>1 000 U/L、临床分期为Ⅳ期、表现为肝、肺转移的患者适合新辅助化疗。新辅助化疗可以提高肿瘤细胞减灭术的满意率,减少术中、术后并发症,可能会改善患者预后。     

新辅助化疗在晚期卵巢癌治疗中的应用效果及对卵巢血流参数的影响

目的 探讨新辅助化疗在晚期卵巢癌治疗中的应用效果及对卵巢血流参数的影响.方法 将58例晚期卵巢癌患者随机分为对照组29例和观察组29例.对照组进行常规卵巢癌治疗,观察组则在常规治疗前进行新辅助化疗,然后将2组患者的治疗总有效率及治疗前后的血清肿瘤标志物、血流参数及血管参数进行比较.结果 观察组的治疗总有效率高于对照组,治疗后不同时间的血清肿瘤标志物水平均低于对照组,血流参数及血管参数均好于对照组,P均<0.05.结论 新辅助化疗在晚期卵巢癌治疗中的应用效果较好,对卵巢血流参数的影响也较为积极,应用价值高.     

Hyperthermic Intraperitoneal Chemotherapy Versus Systemic Chemotherapy in Recurrent Platinum-Sensitive Ovarian Cancer NCI Case Control Study

Objectives: To assess the efficacy of cytoreductive surgery (CRS) combined with hyperthermic intraperitonealchemotherapy (HIPEC) in recurrent platinum-sensitive ovarian cancer patients in comparison with standard intravenouschemotherapy in terms of progression free survival and overall survival. Methods: Retrospective case control studymatching 15 cases with 20 controls with at least 24 months of follow up. Results: The two groups were comparableand well matched in all aspects. Median follow up was 36 months in cases and 38 months in controls. The PFS2revealed a median of 6 months (range 2-14) in cases and 5 months (range 2-18) in controls. The median OS was 36and 38 months in cases and controls respectively. No statistically significant difference between the cases and controlswere observed in progression free survival (PFS2) and overall survival OS (P-value, 0.350 and 0.711 respectively).However, the PFS2 was in favor of cases and OS was in favor of controls without reaching significance. The percentageof patients who survived 5 years or more was 20% in cases and 35% in controls. The only issue in favor of HIPECis the significant reduction in chemotherapeutic toxicity when given by the intraperitoneal way (P- value 0.003).Conclusion: According to our study, CRS and HIPEC do not seem to have impact on OS and PFS in the setting ofrecurrent platinum sensitive ovarian cancer. However, we recommend on going researches with much more refinedselection criteria and with larger sample size.     

先期化疗联合肿瘤细胞减灭术后腹腔热灌注化疗治疗晚期卵巢癌的临床疗效分析

目的 探讨先期化疗联合肿瘤细胞减灭术后腹腔热灌注化疗治疗晚期卵巢癌的临床疗效.方法 将58例卵巢癌患者随机分为对照组和实验组.对照组采用常规肿瘤细胞减灭术联合术后腹腔热灌注化疗(TC/TP方案),实验组在对照组基础上于术前行新型辅助化疗,对比分析2组患者临床治疗效果.结果 实验组手术时间、术中出血量、腹水量以及术后感染率明显优于对照组,差异有统计学意义(P＜0.05),但2组患者在住院时间上差异无统计学意义(P＞0.05).实验组患者治疗疗程结束后外周血免疫相关指标因子CD3+ CD4+、CD3+ CD56+以及CD3+ CD4 +/CD3+ CD8+与对照组相比,上升趋势更明显,差异具有统计学意义(P＜0.05).实验组治疗疗程结束后总有效率为72.4％,显著高于对照组(41.4％),具有统计学意义(P＜0.05);实验组与对照组在癌肿的复发率、死亡率以及1年生存率上差异不具统计学意义(P＞0.05).结论 先期化疗联合肿瘤细胞减灭术后腹腔热灌注化疗对晚期卵巢癌的近期疗效显著,可有效改善患者免疫抑制现象.     

Splenectomy during Secondary Cytoreductive Surgery forEpithelial Ovarian Cancer

Splenic metastasis from ovarian cancer is unusual. Most splenic metastases are encountered in the settingof widespread visceral metastases. We present 6 cases of splenic metastasis of epithelial ovarian cancer. Threecases underwent a splenectomy as a part of interval debulking surgery, and the rest received a splenectomy asa surgery for recurrent disease. The splenectomies were well-tolerated in all patients and no serious morbidityor mortality resulted. Only one patient experienced a transient elevation in platelet count.     

新辅助化疗对晚期乳腺癌的影响

目的:探讨新辅助化疗是否能提高晚期乳腺癌患者的远期生存率。方法:对142例Ⅲb、Ⅳ期乳腺癌的临床资料进行总结。结果:新辅助化疗的75例中13例CR,其中5例达到病理完全缓解(pCR),44例PR。52例(69.3%)获得根治性手术(其中16例为Ⅳ期患者),2年总生存率为76.0%,无瘤生存率为48.0%。而未做术前化疗的67例中35例(52.2%)获得根治性手术,2年总生存率为56.7%,无瘤生存率为29.9%。结论:新辅助化疗能降低乳腺癌的术前TNM分期,并使部分Ⅳ期患者重新获得根治性手术的机会,并且能够改善晚期患者的生存率。     

进展期胃癌新辅助化疗的现状

胃癌是常见的恶性肿瘤之一,手术切除仍是主要的治疗手段。但进展期胃癌术后复发转移率很高,术胃癌是常见的恶性肿瘤之一,手术切除仍是主要的治疗手段。但进展期胃癌术后复发转移率很高,术后辅助化疗效果不佳。近年来,临床开展的新辅助化疗采用新的化疗药物(如多西紫杉醇)和新的化疗方案(如FOLFOX方案),效果满意,提高了手术切除率。本文对进展期胃癌的新辅助化疗现状做一综述。     

Insulin-Like Growth Factors and Their Binding Proteins in Tumors and Ascites of Ovarian Cancer Patients: Association With Response To Neoadjuvant Chemotherapy

Purpose: Tumor cell growth and sensitivity to chemotherapy depend on many factors, among which insulin-like growth factors (IGFs) may play important roles. The aim of the present study was to evaluate the levels of insulin-like growth factors (IGFs) and IGF binding proteins (IGFBPs) in primary tumors and ascites as predictors of response to neoadjuvant chemotherapy in ovarian cancer (OC) patients. Materials and Methods: Tumor tissue samples and ascitic fluid were obtained from 59 patients with advanced OC. The levels of IGF-I, IGF-II, IGFBP-3, IGFBP-4 and PAPP-A were determined using ELISA kits. Taking into account the data on expression of these IGF-related proteins and outcome, logistic regression was performed to identify predictors of response to neoajuvant chemotherapy. Results: Human ovarian tumors expressed IGFs, IGFBP-3, IGFBP-4 and PAPP-A and these proteins were also present in ascites fluid and associated with its volume. IGFs and IGFBPs in ascites and soluble PAPP-A might play a key role in ovarian cancer progression . However, levels of proteins of the IGF system in tumors were not significant predictors of objective clinical response (oCR). Univariate analysis showed that the level of IGF-I in ascites was the only independent predictor for oCR. Conclusion: The level of IGF-I in ascites was shown to be an independent predictor of objective clinical response to chemotherapy for OC patients treated with neoadjuvant chemotherapy and debulking surgery.     

术前化疗在晚期卵巢癌治疗中的作用

[目的]探讨术前化疗在晚期卵巢黏液性和浆液性上皮癌治疗中的作用。[方法]回顾分析我院182例晚期卵巢黏液性和浆液性上皮癌病例。无术前化疗组(A组),先行手术切除,术后辅以铂类为主的联合化疗6～8个疗程;术前化疗组(B组),先行以铂类药物为主化疗1～3个疗程,然后行手术治疗,术后再辅以铂类为主的联合化疗6～8个疗程。术前化疗组在以下6项:Ⅳ期病例、低分化病例、合并腹水、胸水的病例、CA125中位值和锁骨上淋巴转移等不利因素高于无术前化疗组(P<0.05)。[结果]满意的手术切除率A组59.2%、B组85.7%(P<0.05);术后并发症A组25.9%、B组10.9%(P<0.05);术后中位无进展生存期A组14个月、B组12个月(P>0.05)。[结论]术前化疗可以减少术后并发症发生率、提高满意的手术切除率,而不影响中位无进展生存期。晚期不能手术切除的卵巢上皮癌进行术前化疗有积极意义。     

新辅助化疗治疗晚期上皮性卵巢癌手术情况及临床指标变化情况观察

目的 探讨新辅助化疗治疗晚期上皮性卵巢癌手术情况及临床指标变化情况.方法 将86例患者用随机数表法分为观察组、对照组.对照组直接采用手术治疗加术后常规化疗,观察组加之新辅助化疗治疗,对比分析其临床指标和治疗情况.结果 观察组的总有效率93.02％,对照组46.51％.观察组的手术时间、出血量和腹水量与CA125、HE4水平均要明显低于对照组;观察组的需要输血人数比对照组少15人;观察组的平均输血量、引流管滞留时间和平均入院天数都要比对照组低;观察组的残余病灶＜2占74.41％,明显高于对照组残余病灶＜2的比例34.88％.结论 新辅助化疗治疗晚期上皮性卵巢癌的效果良好,值得临床广泛推广和应用.     

术前新辅助化疗在局部晚期宫颈癌治疗中的临床价值

目的探讨术前新辅助化疗治疗局部晚期宫颈癌的临床效果。方法选择Ⅰb2、Ⅱa、Ⅱb期宫颈癌患者38例,进行紫杉醇联合顺铂化疗的新辅助化疗2~3个疗程,对患者病灶肿瘤直径变化情况、不良反应和化疗效果和手术情况等指标进行检测分析。结果新辅助化疗后,患者肿瘤直径有不同程度的减小(P<0.05)。化疗总有效率为84.21%(32/38),Ⅰb2、Ⅱa、Ⅱb期有效率分别为94.74%(18/19)、87.50%(7/8)、63.64%(7/11)(P<0.05)。化疗有效的32例均可进行手术,术后发现3例患者组织学检查结果为完全缓解,25例患者检测发现癌旁组织化疗反应明显,2例患者闭孔淋巴结阳性,1例患者出现宫旁浸润,1例患者出现脉管癌栓浸润。结论术前新辅助化疗局部晚期宫颈癌的临床效果良好,可较大程度减小病灶肿瘤直径,提高手术治疗效果,值得临床推广。     

以顺铂为主经腹腔内联合化疗治疗晚期卵巢癌的临床观察

晚期卵巢癌多合并腹水,临床上单靠全身用药效果不甚满意.我们于1988年初开始应用以顺铂为主的联合化疗行腹腔注射治疗晚期卵巢癌合并腹水,取得了较好效果,有效率达90％.DDP是卵巢癌化疗的关键药物,腹腔内注入比静脉更具优点,浓度比静脉高25倍,对组织渗透性好,不引起腹腔局部中毒,副作用也较轻;且与其它药物无交叉耐药性,值得临床推广.     

Neoadjuvant Intra-arterial Chemotherapy in Locally Advanced Breast Cancer: A Prospective Randomized Study

A prospective randomized study of neoadjuvant chemotherapy wascarried out on 73 patients with locally advanced breast cancer.Group A (n 26) received no neoadjuvant therapy, group B (n 22)received intra-arterial infusions of epirubicin and group C(n 25) received intravenous epirubicin. The regression of theprimary tumor was significantly higher in group B than in groupC (68.2 vs 36.0%, P<0.05). The post-operative survival ofresponders to neoadjuvant therapy was better than that of non-responders.Side effects were milder in group B than in group C. There was,however, no difference among the three groups in terms of overalland disease-free survivals. Thus, neoadjuvant intra-arterialchemotherapy was effective for achieving loco-regional controlof locally advanced breast cancer with a low toxicity, but couldnot improve survival.     

新辅助化疗联合全直肠系膜切除术治疗直肠癌的效果分析

目的 对直肠癌患者采取术前新辅助化疗联合全直肠系膜切除术治疗,分析其治疗效果.方法 实验组采取术前新辅助FOLFOX4方案化疗联合全直肠系膜切除术,对照组仅行全直肠系膜切除术.比较2组患者手术的基本情况;实验组患者治疗前后TNM分期的变化;实验组患者治疗前后癌胚抗原(CEA)及糖链抗原(CA19-9、CA242、CA724)等肿瘤标志物水平的变化;2组患者的治疗效果及并发症的发生.结果 实验组与对照组在手术时间、术中出血量、住院时间、肿瘤直径、总体费用等方面差异无统计学意义(P>0.05).与治疗前比较,实验组治疗后分期有所降低,肿瘤标志物CEA、CA19-9、CA242、CA724均下降(P<0.05).实验组患者根治率、保肛率、生存率均较对照组明显升高,复发率低于对照组(P<0.05);实验组患者并发症发生率低于对照组(P<0.05).结论 对直肠癌患者采取术前新辅助化疗联合手术治疗,能够降低临床分期,降低肿瘤标志物水平,提高根治率、保肛率、生存率,降低复发率及并发症发生率.     

The Role of Hyperthermic Intraperitoneal Chemotherapy (HIPEC) in Ovarian Cancer

Overall outcomes for women with epithelial ovarian cancer (EOC) remain relatively poor, and superior methods of treatment are needed. EOC is a peritoneal surface malignancy that is relatively sensitive to chemotherapy agents, making it a good target for i.p. chemotherapy. Because there is strong laboratory data demonstrating the ability of hyperthermia to increase the efficacy of chemotherapeutic agents, the addition of hyperthermia to i.p. chemotherapy, hyperthermic intraperitoneal chemotherapy (HIPEC), makes theoretical sense. This article reviews the current literature and discusses the possible role for HIPEC in EOC at significant natural history time points: front line, at the time of interval debulking, in consolidation, and for recurrent disease. The conclusion is that much further research is needed but that HIPEC could sensibly be researched at all the natural history time points in EOC.     

Neoadjuvant Chemotherapy for Locally Advanced Breast Cancer in a Malaysian Tertiary Hospital

Introduction: Neoadjuvant chemotherapy for locally advanced breast cancer is given with the aim of shrinkingthe disease sufficiently for surgery. However, many clinical trials investigating neoadjuvant chemotherapyregimens were conducted for operable breast cancer. Methods and Materials: Patients with T3-4, N2 M0 breastcancer diagnosed between January 2005 and December 2008 and who received at least one cycle of neoadjuvantchemotherapy were eligible for this study. Thirty-four patients were identified from the Chemotherapy DaycareRecords and their medical records were reviewed retrospectively. The neoadjuvant chemotherapy regimenadministered was at the discretion of the treating oncologist. Breast tumour size and nodal status was assessedat diagnosis, at each cycle and before surgery. Results: All 34 patients had invasive ductal cancer. The medianage was 52 years (range 27-69). 65% had T4 disease and 76% were clinically lymph node positive at diagnosis.The median size of the breast tumour at presentation was 80 mm (range 42-200 mm). Estrogen and progesteronereceptor positivity was seen in less than 40% and HER2 positivity, by immunohistochemistry, in 27%. Themajority (85%) of patients had anthracycline based chemotherapy, without taxanes. The overall response rate(clinical CR+PR) was 67.6% and pathological complete responses were apparent in two (5.9%). 17.6% ofpatients defaulted part of their planned treatment. Recurrent disease was seen in 44.1% and the median time torelapse was 11.3 months. The three year disease free and overall survival rates were 52.5% and 58% respectively.Conclusion: Neoadjuvant chemotherapy for locally advanced breast cancer in a Malaysian setting confersresponse and pCR rates comparable to published clinical trials. Patients undergoing neoadjuvant chemotherapyare at risk of defaulting part of their treatment and therefore their concerns need to be identified proactivelyand addressed in order to improve outcomes.