术前区域性动脉灌注联合化疗治疗进展期胃癌的初步报告

目的 探讨含紫杉醇脂质体(力朴素)的联合化疗方案行术前区域性动脉灌注治疗进展期胃癌的可行性.方法 84例临床诊断Ⅱ期以上进展期胃癌患者在手术前接受区域性动脉灌注化疗,方案为:5-氟尿嘧啶(5-FU)1.1 g/m2,顺铂60 mg/m2,力朴素135 mg/m2;10～14 d后接受手术(研究组).同期收治的78例Ⅱ期以上胃癌患者行常规手术治疗(对照组).观察新辅助化疗后肿瘤原发病灶的缓解情况、毒副反应,以及两组问的疗效差异.结果 对照手术组48例(61.5%)获得根治性切除,1年总生存率为74.3%.新辅助化疗组全部完成术前区域性动脉化疗,毒性作用主要为胃肠道反应和骨髓抑制,均属可控范围内(1～2级);其中66例(78.5%)获得根治性切除,较对照手术组提高17.0%(P=0.018);1年总生存率为80.9%,较对照手术组无显著提高(P=0.283).结论 针对进展期胃癌患者,术前以力朴素联合5-FU、顺铂的方案行动脉介入化疗是安全有效的,它能提高根治手术切除率,但两组近期疗效无显著差异,可能与病例数较少和随访时间有关,尚须继续深入研究.     

术前区域性动脉灌注化疗治疗进展期胃癌的临床研究

目的:探讨新辅助化疗中应用术前区域性动脉灌注化疗治疗进展期胃癌的临床疗效.方法:35例临床诊断Ⅱ期以上胃癌病人在手术前接受新辅助化疗,方案为:丝裂霉素C 15 mg/m2,顺铂60 mg/m25-氟尿嘧啶1 000 mg/m2,经股动脉插管区域冲击化疗一次,6～9 d后接受手术.同期收治的41例Ⅱ期以上进展期胃癌病人行常规手术治疗.比较观察新辅助化疗后肿瘤原发病灶的缓解情况、毒副反应及两组间的远期生存率变化.结果:新辅助化疗组35例全部完成术前区域性动脉化疗,毒性反应主要为胃肠道反应和骨髓抑制,均属可控范嗣内1～2级,其中29例(82.9%)病人获得根治性切除(R0切除),中位生存期26.6个月,1、3和5年生存率分别为68.6%、37.1%和14.3%.常规手术组41例中有28例(68.3%)获得R0切除,中位生存期为15.3个月,1、3和5年生存率分别为63.4%、19.5%和7.3%.结论:术前区域性动脉化疗耐受性良好;新辅助化疗有望提高进展期胃癌病人的远期疗效.     

新辅助区域动脉化疗在进展期胃癌中的临床疗效

目的 观察新辅助区域动脉化疗对进展期胃癌的临床疗效及毒性反应.方法 回顾性分析2000年2月至2005年5月上海交通大学医学院附属仁济医院收治的158例相同临床分期的进展期胃癌患者的临床资料.其中76例(研究组)给予术前区域动脉化疗,方案为表阿霉素50 mg/m2+顺铂60 mg/m2+5-氟尿嘧啶1000 mg/m2,2003年起方案改为奥沙利铂130 mg/m2+5-氟尿嘧啶1000mg/m2,一次性动脉灌注,6～11 d后手术治疗.另82例(对照组)术前未行化疗,直接手术治疗.两组患者术后均接受静脉辅助化疗.对两种治疗方式的临床效果、根治性(R0)切除率、手术并发症和远期预后进行评估.采用x2检验,Kaplan-Meier法行生存分析.结果 研究组和对照组的R0切除率分别为86%(65/76)和71%(58/82),两组比较,差异有统计学意义(x2=5.01,P<0.05).研究组的化疗毒副反应轻微.研究组和对照组的术后并发症发生率分别为20%(15/76)和16%(13/82),两组比较,差异无统计学意义(x2=0.41,P＞0.05).研究组和对照组的中位生存时间分别为41个月和23个月,5年总体生存率分别为44.6%和29.1%,两组比较,差异有统计学意义(x2=3.95,P<0.05).结论 进展期胃癌患者采用新辅助区域动脉化疗耐受性良好,有助于提高R0切除率,并延长其生存时间.     

动脉内灌注新辅助化疗治疗晚期乳腺癌

目的探讨动脉内灌注新辅助化疗对晚期乳腺癌疗效及病理特征的影响。方法36例晚期乳腺癌术前超选择动脉置泵灌注化疗。化疗方案为CEF方案:5氟尿嘧啶(5Fu)500mg/m2,环磷酰胺(CTX)400mg/m2,表阿霉素(EPI)60mg/m2。每周1～2次,2～3次为一个疗程,休息2周后可重复灌注化疗,2～3个疗程后进行手术。结果动脉内灌注新辅助化疗后,术前肿瘤病灶临床完全缓解(CR)6例。部分缓解(PR)25例,稳定(MR)5例,有效率(CR PR)86.1%。术后病理学检查发现:癌细胞均有不同程度的核固缩,碎裂,胞浆凝固,变性;细胞间质水肿,纤维增生,炎细胞浸润;血管内膜增厚,血栓形成。结论动脉内灌注新辅助化疗可以明显改变晚期乳腺癌的组织学形态,改善临床症状,提高生存率。     

奥沙利铂联合5-FU术前动脉化疗对进展期胃癌的临床疗效

目的：探讨进展期胃癌患者术前用奥沙利铂（OXA）联合5-氟尿嘧啶（5-FU）行区域性动脉灌注化疗的临床效果。
方法：48例Ⅱ期以上胃癌患者,术前行区域性动脉灌注化疗（A组）,方案为OXA 130 mg/m+ 5-FU 750 mg/m,经股动脉插管行区域冲击化疗1次,8～12 d后接受手术。同期另48例相同临床分期的胃癌患者直接行手术治疗（B组）。两组术后均接受OXA /甲酰四氢叶酸钙/5- FU方案化疗6个周期,观察两组的毒副反应、手术并发症和临床疗效。
结果：A组有38例（79.2%）获得根治性切除;镜检32例（66.7%）出现组织病理学改变,如肿瘤组织坏死、淋巴细胞炎性浸润、癌细胞凋亡、以及间质水肿纤维组织增生等。B组有30例（62.5%）行根治性切除,根治切除率显著低于A组,两组间差异有统计学意义（P<0.05）,且B组病理检查未出现上述变化。A组术前化疗的毒性反应均限于Ⅰ～Ⅱ级;两组的术后并发症无统计学差异。A组患者的中位生存期为36.0个月;1,2,3年总生存率分别为79.2%,62.5%和52.1%。B组中位生存期为21.5个月;1,2,3年总生存率分别为66.7%,45.8%和35.4%。A,B组比较,2年和3年总生存率差异有统计学意义（P<0.05）。
结论：术前应用OXA/5-FU方案行区域性动脉灌注化疗可使肿瘤组织产生显著的组织病理学改变,有利于提高进展期胃癌根治性手术切除率及2,3年生存率。     

术前区域性动脉灌注化疗对进展期胃癌预后的影响

目的　探讨术前区域性动脉灌注化疗对进展期胃癌预后的影响。方法　对 80例行根治性手术切除的进展期胃癌患者 (其中 3 3例术前行介入化疗 )的临床资料进行分析 ,并应用Cox比例风险模型对可能影响胃癌患者预后的临床病理、治疗措施及分子生物学等 11项指标进行多因素回归分析。结果　术前介入化疗组患者 5年生存率为 59.3 % ,显著高于对照组术后 5年生存率的 47.6% (P<0 .0 5)。Cox多因素回归分析显示 ,术前动脉插管介入化疗为影响进展期胃癌患者术后长期存活的独立预后因素之一。结论　术前区域性动脉灌注化疗对改善胃癌患者预后具有重要价值     

多西紫杉醇/顺铂/5-氟脲嘧啶新辅助化疗方案治疗局部进展期胃癌的临床研究

目的　了解多西紫杉醇加顺铂及 5 氟脲嘧啶的联合新辅助化疗方案治疗局部进展期胃癌的疗效和毒副作用。方法　自 2 0 0 1年 10月～ 2 0 0 3年 9月 ,有 37例局部进展期胃癌病人入组本次临床研究。入组病例术前接受的新辅助化疗方案为 :多西紫杉醇 75mg m2 ,第 1天 ;顺铂 75mg m2 ,第1天 ;5 氟脲嘧啶 50 0mg m2 ,第 1- 5天 ,每三周为一周期 ,共三个周期。观察新辅助化疗后肿瘤原发病灶的缓解情况 ,并观察新辅助化疗的毒副反应。结果　新辅助化疗后所有病人进行了根治性手术治疗 ,临床有效率为 51.4 % ,其中完全缓解 (CR)占 8.1% ( 3例 ) ,部分缓解 (PR)占 4 3.2 % ( 16例 ) ,疾病稳定 (SD)占 2 7.0 % ( 10例 ) ,疾病进展 (PD)占 2 1.6 % ( 8例 ) ,术后病理水平缓解率为 10 .8% ( 4 37) ,其中 2例达到完全缓解。毒副反应主要为白细胞减少症、腹泻、恶心 呕吐、脱发 ,共有 8例病人发生了Ⅲ～Ⅳ级的白细胞减少症 ,但未有因此而发生的败血症和死亡病例。结论　多西紫杉醇加顺铂及5 氟脲嘧啶的新辅助化疗方案在进展期胃癌的治疗中近期疗效显著 ,耐受性良好     

观察FOLFOX新辅助化疗方案治疗不能切除的进展期胃癌的疗效

目的 研究奥沙利铂联合氟尿嘧啶和亚叶酸钙(FOLFOX)方案术前进行新辅助化疗对术前评估难以进行根治性手术的进展期胃癌患者的临床疗效及不良反应.方法 入组患者均为兰州军区兰州总医院2008年4月-2009年10月收治的16例晚期胃癌而无法行根治手术.新辅助化疗方案为:奥沙利铂130 mg/m~2第1天;氟尿嘧啶500 mg/m~2、亚叶酸200 mg/m~2第1～5天,每3周为1个周期,共2个周期.观察新辅助化疗后原发病灶的变化情况及用药后的不良反应.结果 新辅助化疗后13例患者获得肿瘤减期,疗程结束后4～6周11例进行根治性手术切除.临床完全缓解(CR)2例,部分缓解(PR)10例,疾病稳定(SD)3例,进展(PD)1例,总有效率为75.0%(12/16).不良反应主要为骨髓抑制、腹泻、恶心呕吐、外周神经感觉异常,经对症治疗后均能缓解.结论 奥沙利铂联合氟尿嘧啶及亚叶酸钙的新辅助化疗方案在不能手术切除的进展期胃癌的治疗中,显著提高手术切除率,耐受性良好,值得推广.     

浸润性膀胱癌术前动脉化疗的疗效分析

目的　评价术前动脉化疗对浸润性膀胱癌预后的影响。　方法　回顾性总结经手术、病理证实并获随访的 6 0例浸润性膀胱癌患者资料。 6 0例分为术前动脉化疗组 (30例 )和单纯手术组(30例 )。术前动脉化疗组经髂内动脉灌注化疗药物后 1～ 2周内接受手术。分析比较两组膀胱保留率、术后复发率、转移率和生存率的差异。　结果　术前动脉化疗组膀胱保留率达 80 % ,单纯手术组4 3% ;动脉化疗组术后肿瘤复发率 2 5 % (6 / 2 4 ) ,单纯手术组 6 1% (8/ 13) ,差异有显著性意义 (P <0 .0 5 )。术前动脉化疗组 1、2、3、4和 5年生存率分别为 93%、82 %、6 7%、5 8%、4 8% ,高于单纯手术组的86 %、6 8%、5 6 %、4 6 %、35 % ,差异均有显著性意义 (P <0 .0 5 )。但两组间术后转移率差异无显著性意义 (P >0 .0 5 )。　结论　术前动脉化疗安全有效 ,可以显著提高浸润性膀胱癌的治疗效果。     

肝动脉灌注化疗联合XELOX方案治疗胃肠道恶性肿瘤肝转移的疗效及安全性分析

目的探讨肝动脉灌注化疗(hepatic artery infusion chemotherapy,HAIC)联合XELOX方案对胃肠道恶性肿瘤肝转移的疗效和安全性。方法回顾性分析我院2002年1月~2008年12月不可切除的胃肠道恶性肿瘤肝转移41例资料,肝动脉灌注氟尿嘧啶脱氧核苷(fluorodeoxyuridine,FUDR)500 mg,第1~5天,静脉给予奥沙利铂130 mg/m2,第1天,口服卡培他滨1000 mg/m2,每天2次,第1~14天。18例为一线化疗,17例为二线化疗,6例为三/四线化疗。观察无进展生存期(progression-free survival,PFS)、有效率(response rate RR)及总生存期(overall survival,OS),并评估药物不良反应。结果一线化疗18例RR 44.4%(8/18),肝脏转移灶RR 50.0%(9/18);二线化疗17例RR 23.5%(4/17),肝脏转移灶RR 29.4%(5/17)。一线、二线及三/四线治疗的总体中位PFS分别为8、4、2.5月,肝转移灶中位PFS分别为10.5、5、4月。Ⅲ/Ⅳ度不良反应主要以白细胞减少(4例)、手足综合征(4例)、感觉神经障碍(3例)、腹泻(4例)为主,均对症治疗治愈。结论 HAIC联合XELOX方案治疗合并肝转移的晚期胃肠道恶性肿瘤有一定疗效,一线治疗生存获益更明显,不良反应可耐受。     

Liver Transplantation for Biliary Rhabdomyosarcoma With Liver Metastasis: Report of One Case

Background

Liver transplantation in combination with chemotherapy in postoperative biliary rhabdomyosarcoma recurrence of children was evaluated.

新辅助治疗低位局部进展期直肠癌35例结果分析

目的 探讨新辅助治疗对低位局部进展期直肠癌的临床治疗价值。方法 对35例低位局部进展期直肠癌患者，采用新辅助治疗方案。常规分割放疗，放疗总剂量DT：46Gy，每次2Gy，每周5次。全身化疗2个疗程，每次予以奥沙利铂130mg／m^2，第1天静脉点滴；甲酰四氢叶酸钙(CF)200mg／m^3，第1～3天静脉点滴；氟尿嘧啶(5-FU)500mg／m^2，第1～3天静脉点滴。治疗结束后4～6周进行手术。结果 经新辅助治疗后，病理完全缓解7例，肿瘤平均缩小34．4％，65．7％的病例T分期下降，淋巴结阴转率为55．6％。根治切除34例，其中腹会阴联合切除18例，保肛手术16例，保肛率为45．7％。姑息性Hartmann术1例。随访至今，肝转移2例，根治切除术后无1例局部复发。保肛患者肛门功能良好。结论 对低位局部进展期直肠癌患者采用新辅助治疗，可使肿瘤分期降低，提高手术切除率和保肛率。     

自体外周血干细胞移植支持下的大剂量化疗在乳腺癌术前治疗中的应用

目的：观察自体外周血干细胞移植支持下的大剂量化疗（HDC／APBSCT）在乳腺癌术前治疗中应用的可行性。方法：本组3例乳腺癌患者,分别为T3N1M0（Ⅲa期）、T4N1M0（Ⅲb期）、T4N1M1（Ⅳ期）,均给予HDC／APBSCT治疗后,再予以手术。HDC／APBSCT实行过程为：FEC方案诱导化疗2个周期,给后评定疗效;自体外周血干细胞动员、采集、冻存;大剂量化疗及APBSC回输支持治疗。3例患者采用的治疗为：环磷酰胺2．5g/m^2、足叶乙甙600mg/m^2和卡铂600mg/m^2。HDC／APBSCT治疗后重新评定疗效,选择手术方案并实施。例1行乳腺癌根治术、例2行改良根治术,例3行改良根治加大面积植皮术。结果：HDC／APBSCT治疗后4周（例1、例2）以及33d后（例3）给予手术治疗。经观察对手术操作无明显影响,伤口愈合良好,其中例3同时给予一期大面积植皮亦愈合良好。Ⅲa、Ⅲb期2例患者随访时间已起过30个月至今健康生活。Ⅳ期患者术后16个月死于脑部转移。结论：HDC／APBSCT在乳腺癌术前治疗中具有一定可行性。将该方法做为中晚期乳腺癌患者的一种可供选择的抢救性治疗措施是值得偿试的。     

Sequential combination chemotherapy consisting of vincristine, peplomycin, methotrexate, cis-diamminedichloroplatinum (II) and adriamycin in urothelial cancer

The VPM-CisA (vincristine (VCR), peplomycin (PLM), methotrexate (MTX), cisplatin (CDDP) and doxorubicin (ADM), regimen was used to treat 33 patients with urothelial tract tumors. Twenty-two patients had bi-dimensionally measurable disease parameters and 11 patients with locally advanced tumors were given postoperative adjuvant chemotherapy. The protocol consisted of 0.6 mg/m2 VCR on days 1 and 3, 3 mg/m2 PLM on days 1 to 4, 3 mg/m2 MTX on days 2 and 4, 35 mg/m2 CDDP on day 4, and 20 mg/m2 ADM on day 5. These doses were adjusted for each case: the above mentioned dose x [(80/(40+Age]2 +[(Karnofsky's performance status/100)2]. Of these patients, 28 (86 percent) were treated adequately, including 8 (36 per cent) who achieved a complete (2) or partial (6) remission. The mean duration of survival was 65.2 weeks for complete and partial responders, and 48.8 weeks for non-responders, which was not a statistically significant difference. Of 11, who were given post-operative adjuvant chemotherapy (mean observation period: 83.5 weeks) 9 were alive without evidence of disease, 1 had a recurrence 8 months after first chemotherapy, 1 died due to pulmonary and liver metastasis 2 years after the chemotherapy. Toxicity included mild myelosupression, moderate anorexia, vomiting, and severe gastric ulcer, pulmonary fibrosis.     

原发性胃恶性淋巴瘤57例诊治探讨

本文报告１９７１～１９９３年收治的５７例原发性胃恶性淋巴瘤，其中ＩＥ期３３例、ⅡＥ期７例、ⅢＥ期３例、Ⅳ期１４例。本组术前确诊仅１２例。误诊主要原因是本病临床表现缺乏特异性，更重要的是其Ｘ线征象与胃癌或溃疡病酷似。本组手术切除率９２．２％（４７／５１）。全组５年生存率６２．７％，１０年生存率４７．６％。在ＩＥ期３３例中，８例单一手术切除，术后５年生存率５９．２％；２５例术后加用化疗和／或放疗，则术后５年生存率达９０．３％。显然切除原发灶，联合术后化疗和／或放疗是合理的。     

新辅助放化疗联合盆腔脏器切除术治疗45例复发性直肠癌

目的：探讨新辅助放化疗联合盆腔脏器切除术在复发性直肠癌治疗中的价值。方法：对45例复发直肠癌患者采用新辅助放化疗方案治疗常规分割放疗,治疗结束后4～6周进行盆腔脏器切除手术。结果：经新辅助放化疗后,病理完全缓解9例,肿瘤平均缩小38.4%,68.9%的病例T期下降。全组R0切除率为82.2%,手术并发症为20.0%,3年生存率为80.0%,5年生存率为44.4%。结论：新辅助放化疗联合盆腔脏器切除术是治疗复发性直肠癌的有效方法,通过降低肿瘤病期,提高手术切除率,从而提高患者生存率。     

Intraarterial COMPA (cis-diammine-dichloroplatinum (II), vincristine, methotrexate, peplomycin, adriamycin) chemotherapy for bladder cancer]

Seventeen patients with bladder cancer were treated with semiselective intraarterial COMPA chemotherapy. One course of COMPA consisted of 20 mg/m2 cis-diammine-dichloroplatinum (CDDP) on days 4 and 5, 0.6 mg/m2 vincristine (VCR) (Oncovin) on days 1 and 2, 5 mg/m2 methotrexate (MTX) on days 2 and 3, 5 mg/body peplomycin (PEP) on days 1, 2 and 3, and 15 mg/m2 adriamycin (ADM) on day 4. These drugs were injected every 2 or 3 weeks through a polyurethane catheter the tip of which was placed just proximal to the aortic bifurcation and during injection both thighs were tied with a pressure of over 250 mmHg. From 2 to 6 courses (mean, 4.4 courses) were administered. Of the 17 patients, 4 achieved complete remission, 10 achieved partial remission and 3 showed no change. After this COMPA chemotherapy eight patients were able to retain their bladders while seven underwent immediate radical cystectomy. The adjuvant COMPA chemotherapy for two patients with pelvic metastasis after radical cystectomy showed good results. Mild degrees of anorexia, nausea, vomiting, hair loss, numbness of fingers and/or toes, leukopenia and intestinal paralysis were observed. Instrumental troubles were seen in two cases; one involved dislocation of the tip of the catheter, the other was infection of the reservoir. Intraarterial COMPA chemotherapy is effective for neoadjuvant therapy of invasive bladder cancer, bladder-preserving treatment and adjuvant therapy of pelvic metastasis.     

The role of neoadjuvant radiochemotherapy using low-dose fraction cisplatin and 5-fluorouracil in patients with carcinoma of the esophagus

OBJECTIVE: We clarified the role of neoadjuvant radiochemotherapy in patients with carcinoma of the esophagus and compared it to neoadjuvant chemotherapy. METHODS: We retrospectively examined 40 patients diagnosed with advanced thoracic esophageal carcinoma who underwent neoadjuvant therapy followed by esophagectomy between 1993 and 1999. We divided them into 2 groups: radiochemotherapy (17) and chemotherapy (23). Radiochemotherapy patients underwent 40 Gy radiation and low-dose fraction cisplatin (7 mg/body/day, 5 days a week x 4 weeks) and 5-fluorouracil (350 mg/body/day x 28 days). Chemotherapy patients received high-dose fraction cisplatin/5-fluorouracil involving 2 courses of cisplatin (70 mg/m2/day on day 1) and 5-fluorouracil (700 mg/m2/day on days 1-5). RESULTS: Complete pathological response was 17.6% in the radiochemotherapy group and 0% in the chemotherapy group respectively. No hospital mortality occurred in the radiochemotherapy group, and 1 of the 23 chemotherapy patients died in the hospital due to postoperative complications. The incidence of residual tumors was significantly higher in the chemotherapy group (34.8%) than in the radiochemotherapy group (0%). Actuarial survival in the radiochemotherapy group at 1 year was 80.2% and at 3 years 53.5%. Actuarial survival in the chemotherapy group at 1 year was 56.5% and at 3 years 30.4%. CONCLUSIONS: Histological effectiveness was greater in patients treated with preoperative radiochemotherapy than those treated with preoperative chemotherapy. The combination of radiation and low-dose fraction CDDP/5-FU thus is first choice in neoadjuvant radiochemotherapy for the advanced esophageal carcinoma.     

Esophageal carcinoma: esophageal ultrasound assessment of preoperative chemotherapy.

The effect of preoperative chemotherapy in the treatment of esophageal carcinoma is difficult to assess because of the inadequacies of clinical staging. Endoscopic esophageal ultrasound (EUS) has been shown to be accurate in the clinical determination of depth of tumor invasion (T) and regional lymph node status (N). Therefore, EUS may be useful in assessing the effect of preoperative chemotherapy in the treatment of esophageal carcinoma. Eleven patients with operable adenocarcinoma of the esophagus or esophagogastric junction underwent staging by EUS before treatment. This was followed by two courses (10 patients) or one course (1 patient) of chemotherapy: etoposide, 120 mg/m2 for 3 days; doxorubicin hydrochloride, 20 mg/m2; and cisplatin, 100 mg/m2. Restaging by EUS was done after treatment. Ten patients then underwent resection of the tumor with lymphadenectomy. One patient was found to have metastatic disease at thoracotomy and did not undergo resection. However, tissue sampling was adequate for the determination of pathological stage. Independent pathological determinations of T and N were then obtained. On completion of chemotherapy, 9 patients (82%) had relief or reduction of preoperative symptoms, and 9 patients (82%) had either no evidence of tumor or reduction of tumor size by endoscopy. Despite this clinical and endoscopic response, no patient had EUS-documented and pathology-confirmed reduction of T. However, 2 patients had EUS-documented and pathology-confirmed progression of N. The accuracy of EUS in the determination of T was 82% and of N, 73%.(ABSTRACT TRUNCATED AT 250 WORDS)