脑肿瘤超选择性脑动脉灌注化疗的临床分析

目的：研究超选择性脑动脉插管灌注嘧啶亚硝脲(ACNU)或卡氮芥(BCNU)治疗恶性脑肿瘤的近期疗效及其并发症的防治。方法：对67例经组织学确诊的恶性脑肿瘤采用超选择性脑动脉插管灌注嘧啶亚硝脲或卡氮芥化疗，并对照化疗前后的影像学表现，评价该化疗对恶性脑肿瘤的疗效。结果：本组67例病人治疗后完全缓解10例(14．9％)，部分缓解43例(64．2％)，稳定11例(16．4％)，恶化3例(4．5％)。对部分病例行免疫组化和神经病理研究，证实超选择性脑动脉灌注化疗可诱导肿瘤的凋亡。超选择性脑动脉插管灌注化疗可明显降低常规化疗的并发症和毒性反应，并发症和毒性反应的发生率明显低于献报道。结论：超选择性脑动咏插管灌注化疗浩疗恶性脑肿瘤可明显降低药物毒性．近期疗效良好。     

脑肿瘤超选择性脑动脉灌注化疗的临床分析

目的:研究超选择性脑动脉插管灌注嘧啶亚硝脲(ACNU)或卡氮芥(BCNU)治疗恶性脑肿瘤的近期疗效及其并发症的防治。方法:对67例经组织学确诊的恶性脑肿瘤采用超选择性脑动脉插管灌注嘧啶亚硝脲或卡氮芥化疗,并对照化疗前后的影像学表现,评价该化疗对恶性脑肿瘤的疗效。结果:本组67例病人治疗后完全缓解10例(14.9％),部分缓解43例(64.2％),稳定11例(16.4％),恶化3例(4.5％)。对部分病例行免疫组化和神经病理研究,证实超选择性脑动脉灌注化疗可诱导肿瘤的凋亡。超选择性脑动脉插管灌注化疗可明显降低常规化疗的并发症和毒性反应,并发症和毒性反应的发生率明显低于文献报道。结论:超选择性脑动脉插管灌注化疗治疗恶性脑肿瘤可明显降低药物毒性,近期疗效良好。     

经颈动脉灌注ACNU、VM-26联合治疗复发性脑胶质瘤的临床研究

目的研究经颈动脉灌注盐酸尼莫司汀（ACNU）和替尼泊苷（VM-26）联合治疗复发性脑胶质瘤的效果及相关问题。方法治疗组选择幕上颈内动脉供血范围的复发性脑胶质瘤164例，肿瘤同侧颈总动脉ACNU和VM-26联合灌注化疗。对照组选择复发性脑胶质瘤26例，口服司莫司汀治疗，并行疗效对比。结果治疗组完全缓解率和部分缓解率明显高于对照组（P〈0．05），恶化率明显低于对照组（P〈0.05），生存期明显长于对照组（P〈0.05）。结论经颈动脉灌注ACNU、VM-26治疗复发性脑胶质瘤疗效好，副作用小，安全可靠，可作为常规化疗手段。     

复发性脑胶质瘤的手术治疗

目的探讨复发性脑胶质瘤的手术特点。方法回顾性分析86例复发性脑胶质瘤手术患者的临床资料,归纳其临床、影像学、病理学的特点、分析其手术治疗效果。结果复发性脑胶质瘤的诊断并不困难,再次手术全切除率较高,无死亡率。但是判断手术效果的关键是观察患者手术后是否会改善症状或者是延长生命。结论复发性脑胶质瘤的其生物学行为常常发生明显的变化,多呈浸润性生长,而且生长迅速。病人的生存时间与肿瘤复发后的分级,第一次手术到复发的时间,颅内的部位,肿瘤的形态学的特点和病人的年龄与全身情况有关。但目前对复发性脑胶质瘤通常采用的治疗方案仍以手术为主结合放疗和化疗的综合治疗。精确的手术治疗虽然不能显著提高生存时间,但是可有效地减少死亡率和致残率。     

58例脑胶质瘤术后同步放化疗的疗效观察

目的：评价脑胶质瘤术后行同步放化疗的疗效.方法：58例脑胶质瘤患者术后随机分为放疗组29例及放疗＋ 化疗组29例.放疗组术后仅行三维适形放疗,总剂量DT 60 Gy/4～6周;放疗＋化疗组给予同样三维适形放疗,并同步于术后10～15 d（平均12 d）开始行超选介入动脉灌注尼莫司汀化疗,每4周1次,每次2.5 mg·kg^-1,共进行4～6次结束.结果：放疗＋化疗组总有效率（肿瘤消失＋肿瘤明显缩小） 75.9%（22/29例）,1年生存率（75.86%）,2年生存率（51.72%）,与放疗组相比差异有统计学意义（P〈0.05）;结论：脑胶质瘤术后行同步放化疗,对脑胶质瘤有明显疗效.     

动脉内灌注替尼泊甙和嘧啶亚硝脲治疗脑胶质瘤的体会

目的:观察动脉内交替灌注替尼泊甙(VM_(26))和嘧啶亚硝脲(ACNU)治疗脑胶质瘤的临床疗效。方法:经颞浅动脉逆行插管、留置,然后采用微泵交替灌注VM_(26)和ACNU治疗脑胶质瘤7例,术后4～8周采用CT检查肿瘤体积的变化,评估疗效。结果:显效2例,有效4例,无效1例。结论:经颞浅动脉逆行插管序贯增强化疗是治疗脑胶质瘤的一种简便、安全、有效的手段。     

MRA在脑动静脉畸形急性脑出血的应用(附10例报告)

目的　探讨对脑动静脉畸形 (AVM)破裂所致脑出血的磁共振血管成像 (MRA)诊断 ,并依此为早期手术清除脑内血肿及一期AVM清除术提供依据的可行性。方法　对怀疑为脑AVM破裂出血的患者行MRA筛查 ,对其中 10例手术指征明确者以MRA结果决定手术方案 ,行急诊手术。结果　所筛查出的 10例患者均显示AVM的供血动脉及畸形团的部位、形状及与周围结构的关系 ,在手术中可依据MRA结果找到供血动脉及AVM团 ,手术行一期脑内血肿清除AVM切除术 ,手术后效果满意。结论　MRA可显示AVM主体及主要供血动脉 ,较DSA ,检查无创、快捷而且安全。它可三维旋转以观察AVM主体位置及主要供血动脉走行 ,以在短期内设计较合理的手术方案。能够对AVM破裂所致急性脑出血诊断及急诊手术提供有价值的影像学资料     

脑胶质瘤术后复发再手术的疗效观察

目的对脑胶质瘤术后复发再手术的临床疗效进行分析,为今后的临床治疗工作提供可靠的参考依据。方法随机抽取2009-01—2012-12我院收治的复发性脑胶质瘤患者56例,回顾性分析再次手术后的临床疗效。结果首次术后距复发时间越长者再次手术后生存期也越长;术前病理分级越低者,复发后再次手术生存期也越长。结论对复发性脑胶质瘤患者行再次手术治疗过程中,首次手术距复发时间、术前病理分型以及首次手术切除情况等因素会对再次手术的临床疗效产生影响,值得关注。     

立体定向引导氩氦刀靶向冷冻治疗脑胶质瘤

目的 探索应用氩氦外科冷冻系统结合脑立体定向外科治疗脑胶质瘤的手术疗效。方法使用ＣＲＷ立体定向仪，行头颅计算机体层摄影扫描（ＣＴ）确定脑胶质瘤中心及边缘点坐标。以氩氦超冷治疗探针在限定靶区进行冷冻－复温－冷冻治疗４例复发性胶质瘤。结果 １例直径４．５ｃｍ的颞部肿瘤行钻孔肿瘤中心靶点冷冻治疗；余３例直径８￣１５ｃｍ枕顶部肿瘤行立体定向等体积切除手术，术中冷冻后切除冷冻瘤组织；术后ＣＴ扫描显示：３例肿     

恶性脑肿瘤超选择性灌注化疗临床分析

报告５４例经组织学确诊的恶性脑肿瘤采用超选择性脑动脉插管灌注ＡＣＮＵ和（或）ＢＣＮＵ化疗的近期疗效。本组患者治疗后完全缓解６／５４（１１％），部分缓解３８／５４（７０％），稳定８／５４（１５％），恶化２／５４（４％）。对部分患者的免疫组化和神经病理研究证实超选择性脑动脉灌注化疗可诱导肿瘤的细胞凋亡。本文还讨论了脑动脉灌注化疗导致局部毒性反应和并发症的有关因素及其防治措施。     

Antitumor effect and peritumoral brain edema formation in relation to MX2, ACNU,and doxorubicin therapy: A comparative analysis using rodent models of gliomas

Abstract

The potential antitumor effect of MX2, a new lipophilic morpholino anthracycline, was compared with those of ACNU or doxorubicin (DOX) using two different rodent glioma models. A mouse subcutaneous glioma model (203 glioma) was used to measure the effect of each drug on reducing the glioma size and a rat 9L intracerebral glioma model (9L glioma) was used to assess the antitumor effect on survival rate in a clinically similar fashion. Treatment with ACNU inhibited tumor growth by 94.6% ip ? 0.0001) and complete regression of the tumor was observed in 3 of 25 (12.0%) of the ACNU-treated cases. Tumor growth was inhibited by 32.4% with DOX despite a tendency (p?0.16) and by 59.4% with MX-2 7p ? 0.001); neither of these drugs resulted in complete tumor regression. In the intracerebral glioma rats, only ACNU tended to ameliorate survival rate, but there was no statistical significance. These results suggest that ACNU has the most potent effect but MX2 can be an option for chemotherapy of malignant gliomas. Interestingly, all three drugs significantly elevated the brain water content on both the ipsilateral and contralateral sides of the tumor, although they did not induce brain edema in the normal rat brains. Careful management of brain edema might be required regardless of the drug used during chemotherapy to maximize the prognosis of glioma patients. [Neurol Res 2000; 22: 819-824]     

Antitumor effect and peritumoral brain edema formation in relation to MX2, ACNU, and doxorubicin therapy: a comparative analysis using rodent models of gliomas

The potential antitumor effect of MX2, a new lipophilic morpholino anthracycline, was compared with those of ACNU or doxorubicin (DOX) using two different rodent glioma models. A mouse subcutaneous glioma model (203 glioma) was used to measure the effect of each drug on reducing the glioma size and a rat 9L intracerebral glioma model (9L glioma) was used to assess the antitumor effect on survival rate in a clinically similar fashion. Treatment with ACNU inhibited tumor growth by 94.6% (p < 0.0001) and complete regression of the tumor was observed in 3 of 25 (12.0%) of the ACNU-treated cases. Tumor growth was inhibited by 32.4% with DOX despite a tendency (p < 0.16) and by 59.4% with MX-2 (p < 0.001); neither of these drugs resulted in complete tumor regression. In the intracerebral glioma rats, only ACNU tended to ameliorate survival rate, but there was no statistical significance. These results suggest that ACNU has the most potent effect but MX2 can be an option for chemotherapy of malignant gliomas. Interestingly, all three drugs significantly elevated the brain water content on both the ipsilateral and contralateral sides of the tumor, although they did not induce brain edema in the normal rat brains. Careful management of brain edema might be required regardless of the drug used during chemotherapy to maximize the prognosis of glioma patients.     

人胶质瘤干细胞样抗原致敏树突状细胞疫苗Ⅰ期临床试验研究

目的 探讨胶质瘤干细胞样抗原致敏DC疫苗在临床应用的可行性、安全性及有效性.方法 选取5例复发胶质瘤患者;二次手术后体外无血清培养胶质瘤细胞,CD133磁珠分选和X线照射后获取干细胞样抗原;同体外周血单核细胞经GM-CSF、IL-4诱导后再与干细胞样抗原共孵育获得成熟DC疫苗;每周1次皮下接种DC疫苗,共3次,联合替莫唑胺化疗.观察不良反应,头颅MRI增强随访及生存期评估疗效.结果 5例胶质瘤标本中均含有不同比率的CD133+细胞,DC疫苗接种后患者无明显不良反应,患者平均生存期为72.2周.结论 干细胞样抗原致敏DC疫苗对于胶质瘤患者安全可行,联合化疗能延长患者生存期.

Abstract：

Objective To investigate the feasibility ,safety and efficiency of dendritic cells (DCs) vaccine pulsed with tumor stem - like associated antigens against malignant glioma in recurrent patients.Method Cells derived from fresh specimens of recurrent gliomas in serum - free medium were magenetically sorted with CD133 -antibody and irradiated with X -ray to attain freeze -thaw lysates.Autologous DCs from mononuclear cells with GM-CSF and IL-4 were matured by the lysates.Five patients with recurrent glioma received the DCs vaccine once a week (3 times ) followed combination with chemotherapy after recurrent tumor resection.Follow - up was procedured with MRI scans and clinical protocol.Results Five malignant glioma cell lines contained different ratio of CD133 + cells.DCs were successfully prepared and applied in all patients.No side -effect was observed.Mean survival time was 72.2 weeks.Conclusions Combination of DCs vaccine and chemotherapy is safe and may benefit the patients with malignant glioma.     

5-FU多聚缓释体植入技术治疗脑胶质瘤

目的观察5-氟尿嘧啶(5-FU)多聚缓释体植入胶质瘤内化疗的临床效果,探索化疗药物的新剂型和新途径。方法在60例胶质瘤病人在开颅术中或以立体定向方式植入5-FU多聚缓释体,5-FU含量100～150mg。随访5～24周,通过影像学检查,计算肿瘤平均径。比较手术前及各随访时间段肿瘤平均径的变化,并观察瘤周水肿情况。结果38例病人术后病情稳定。无化疗不良反应。肿瘤平均径在术后5、12和24周以上均有显著缩小。其中第12周随访病例肿瘤平均径缩小最显著。肿瘤周边水肿带在开颅手术的病人比较宽,而在立体定向手术病人无明显加重表现。结论低剂量5-FU瘤内缓释体植入术治疗脑胶质瘤安全有效,无明显不良反应。     

颅内动脉瘤破裂并脑内血肿的急诊手术治疗

目的探讨颅内动脉瘤破裂并脑内血肿的手术治疗时机和方法,以提高手术疗效。方法回顾性分析2002年4月至2006年10月在我科行急诊手术治疗的32例破裂颅内动脉瘤并脑内血肿患者的临床资料。32例颅内动脉瘤中,大脑中动脉瘤13例,前交通动脉瘤8例,后交通动脉瘤6例,大脑前动脉瘤3例,颈内动脉瘤2例。所有患者术前均行CT检查,28例术前行DSA检查。均在24h内行急诊手术,直视下夹闭动脉瘤并清除血肿。结果按GOS评分,术后恢复良好19例,轻度残废6例,重度残废5例,死亡2例。结论颅内动脉瘤破裂并脑内血肿的急诊手术效果明显,可有效降低病死率,提高恢复等级。     

Treatment of malignant glioma using hyperthermia

Thirty pathologically diagnosed patients with grade III–IV primary or recurrent malignant glioma(tumor diameter 3–7 cm)were randomly divided into two groups.The control group underwent conventional radiotherapy and chemotherapy.In the hyperthermia group,primary cases received hyperthermia treatment,and patients with recurrent tumors were treated with hyperthermia in combination with radiotherapy and chemotherapy.Hyperthermia treatment was administered using a13.56-MHz radio frequency hyperthermia device.Electrodes were inserted into the tumor with the aid of a CT-guided stereotactic apparatus and heat was applied for 1 hour.During 3 months after hyperthermia,patients were evaluated with head CT or MRI every month.Gliomas in the hyperthermia group exhibited growth retardation or growth termination.Necrosis was evident in 80%of the heated tumor tissue and there was a decrease in tumor diameter.Our findings indicate that radio frequency hyperthermia has a beneficial effect in the treatment of malignant glioma.     

复发胶质瘤的病理学特征及其预后分析

目的探讨复发胶质瘤的病理学特征及其与患者预后的关系。方法回顾性分析2002年8月到2016年12月中山大学肿瘤防治中心神经外科收治的54例复发胶质瘤患者的临床资料。所有患者均再次行肿瘤切除术治疗,术后行病理学检测,包括肿瘤的世界卫生组织(WHO)分级、Ki-67指数、O6-甲基鸟嘌呤-DNA-甲基转移酶(MGMT)表达状态、异柠檬酸脱氢酶1(IDH1)状态;同时根据组织坏死程度、是否存在肿瘤细胞及肿瘤细胞活性情况进行病理学分型。采用Kaplan-Meier法分析患者的总生存期(OS)。进一步采用单因素和多因素Cox回归分析法判断影响复发胶质瘤患者OS的临床因素。结果54例患者的病理学检测结果,(1)WHO分级:Ⅱ级6例(11.1%)、Ⅲ级14例(25.9%)、Ⅳ级30例(55.6%),另4例(7.4%)未见肿瘤细胞。与初次手术比较,32例患者(59.2%)的WHO分级无变化,7例(13.0%)降低,15例(27.8%)升高。(2)Ki-67指数:共32例两次均行相关检测,其中15例的Ki-67指数降低、14例升高,另3例无改变。(3)IDH1状态:共29例两次均行相关检测,其中9例为突变型,20例为野生型;两次检测均未发生变化。(4)MGMT表达状态:共8例两次均行相关检测,6例无变化,其中3例表达阳性、3例表达阴性;另2例结果改变,均为初次表达阳性,二次表达阴性。(5)病理学分型:4例为坏死型,20例为混合型,30例为活性型。54例患者的随访时间为(16.1±3.2)个月(1.3~160.3)个月。Kaplan-Meier法分析结果显示,54例患者的中位OS(范围)为14.4个月(9.2~19.5个月)。多因素Cox回归分析结果显示,复发肿瘤WHO分级高(HR=2.80,95%CI:1.42~5.53,P<0.01)和术后未行放疗(HR=4.05,95%CI:1.41~11.64,P=0.01)是影响复发胶质瘤患者OS的独立危险因素。结论初步提示复发胶质瘤再次手术后的组织病理学会发生变化;再次手术后WHO病理分级低和术后行放疗是复发胶质瘤患者预后较好的临床因素。     

Bevacizumab/irinotecan. An active treatment for recurrent high grade gliomas: preliminary results of an ANOCEF Multicenter Study

RATIONALE: Second-line chemotherapy is disappointing in recurrent high-grade gliomas. Dramatic responses in recurrent high-grade gliomas have been reported in a recent monocentric trial with a novel association combining bevacizumab (anti-VEGF monoclonal antibody agent) and irinitecan. OBJECTIVE: To report the experience of the ANOCEF group (French speaking neuro-oncology association) using the bevacizumab-irinotecan combination in recurrent high-grade gliomas. METHODS: Eight centers were involved in this retrospective multicenter study. Bevacizumab-irinotecan was delivered as previously described in a compassional setting to non-selected patients suffering from a high-grade glioma (WHO grade III and IV). Response rate at two months of the onset of the treatment was analyzed using the Macdonald criteria. The toxicity profile of the treatment was also investigated. RESULTS: From 2006 to 2007, 77 patients were treated (median age: 52 years; median Karnofsky score: 70) for a recurrent high-grade glioma (49 grade IV, 28 grade III). At two months, the response rates were objective response=36% (54% in grade III and 27% in grade IV); stable disease=39%; progressive disease=13%; patients not evaluable because of a rapid fatal clinical deterioration=12%. Improvement was noted in 49% of patients. Among the main toxicities, we noted; intratumoral hemorrage (n=5 with spontaneous regression in three) and thromboembolic complications including venous thrombophlebitis (n=4), pulmonary embolism (n=2), myocardial infarction (n=1), grade III-IV hematotoxicity (n=2), reversible leukoencephalopathy (n=1). CONCLUSION: This retrospective multicenter study adds further arguments in favor of the promising results of this new combination and its potential rapidity of action in recurrent high-grade gliomas. Antiangiogenic agents expose the patients to a well-known risk of thromboembolic and hemorragic complications, necessitating careful follow-up and patient selection in light of the cardiovascular contraindications.     

CADASIL mimicking primary angiitis of the central nervous system

BACKGROUND: Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) and primary angiitis of the central nervous system (PACNS) share several clinical and radiological features. However, digital subtraction angiogram (DSA) is generally reported as normal in CADASIL, whereas lumen irregularities in distal cerebral arteries indicate PACNS. OBJECTIVE: To describe a potential pitfall of DSA interpretation, which led to the tentative diagnosis of PACNS in a CADASIL patient. PATIENT AND METHODS: Single case observation. RESULTS: A 47-year-old man sustained recurrent subcortical infarcts. He had mild hypercholesterolemia and migraine. His family history was unremarkable. The underlying cause of stroke could not be elucidated. Transcranial Doppler sonography revealed decreased intracranial blood flow velocities compatible with CADASIL. Lumen irregularities of several peripheral intracranial arteries were seen on DSA, which suggested PACNS. CADASIL was confirmed by results from skin biopsy and genetic testing. CONCLUSIONS: First, in patients with CADASIL, DSA can show segmental lumen irregularities in distal cerebral arteries suggestive of PACNS. Second, the potential role of transcranial Doppler sonography to distinguish CADASIL from PACNS deserves further testing.