肝动脉化疗栓塞联合微波消融治疗中晚期肝癌的疗效观察

目的:观察肝动脉化疗栓塞（TACE）联合微波消融（PMCT）治疗原发性中晚期肝癌的临床疗效。方法:选取不能手术切除的原发性中晚期肝癌患者150例,行TACE治疗的80例作为对照组,行TACE联合PMCT治疗的70例患者作为联合组,比较两组甲胎蛋白平均下降率、总有效率、生存率及毒副反应。结果:对照组和联合组甲胎蛋白（AFP）下降率分别为46.3%和76.8%;总有效率分别为58.8%和78.6%;0.5、1、1.5、2年的生存率分别为91.3% 、77.5%、45.0%、11.3%和97.1%、82.9%、61.4%、31.4%;两组均未发生严重毒副反应。结论:TACE 联合PMCT治疗中晚期肝癌安全、有效、可行,临床疗效优于单纯TACE治疗,可提高患者生存期,改善患者的生活质量。     

TACE联合PMCT治疗中晚期肝癌的临床观察

目的:观察TACE联合PMCT治疗中晚期肝癌的治疗效果.方法:61例原发性中晚期肝癌患者随机分为两组,单纯TACE组30例,TACE联合PMCT组31例,所有患者先行肝动脉化疗栓塞术(TACE),TACE联合PMCT组于二周后再施行PMCT手术,治疗三周期后,对疗效进行评价.结果:TACE组的完全坏死率、1年生存率分别为43.3%、63.3%;而联合治疗组分别为83.9%、80.6%.两组间完全坏死率、1年生存率差异均有统计学意义(P＜0.05).结论:原发性中晚期肝癌患者采用TACE+PMCT疗效优于单纯TACE治疗.     

TACE联合冷循环PMCT治疗原发性肝癌的临床应用

目的：评价肝动脉化疗栓塞（TACE）联合冷循环经皮微波凝固治疗（PMCT）原发性肝癌的临床疗效。方法：71例确诊为原发性肝癌的患者,分期是Ⅰa～Ⅲa,随机分为治疗组（PMCT和TACE联合治疗组）33例,对照组（TACE组）38例。治疗组患者先行TACE治疗,2～4周后根据复查的AFP和CT/MR等的影像学检查决定再次行TACE或者PMCT。随访时间5～48个月（平均25.5个月）,随访内容包括AFP、肝功能、影像学资料、并发症等。根据随访的生存时间、复发情况作统计学分析。结果：治疗组和对照组治疗的肝癌患者的1、2、3年累积生存率分别是84.23%、72.29%、61.96%和55.84%、22.79%、11.40%,治疗组和对照组治疗的肝癌患者的6个月、12个月、24个月累积复发率分别6.06%、9.09%、24.24%和7.89%、31.57%、60.52%。TACE联合PMCT治疗肝癌没有严重并发症,对肝功能的损害轻。治疗组33例有5例合并动静脉瘘（AVF）,经动脉栓塞治疗后2例AVF消失,3例治疗后效果不理想的患者行PMCT后AVF消失。结论：本组研究初步显示,TACE联合PMCT治疗原发性肝癌是安全、有效、可行的方法,在治疗原发性肝癌的临床应用近、中期的效果好。PMCT提供了治疗肝癌合并AVF新的方法。     

斑蝥酸钠维生素B6注射液联合TACE治疗中晚期肝癌疗效观察

目的 观察斑蝥酸钠维生素B6注射液联合肝动脉化疗栓塞(TACE)治疗中晚期肝癌的疗效及不良反应.方法 将72例中晚期肝癌随机分成治疗组(36例)和对照组(36例),治疗组斑蝥酸钠维生素B6注射液0.5 mg/d,静滴,d1～14,于第3天行TACE治疗,术中动脉注射斑蝥酸钠0.5 mg;对照组单纯行TACE治疗.2～3周期为一疗程,观察疗效和不良反应.结果 治疗组和对照组总有效率比较,差异无显著性(P＞0.05),两组进展率、生活质量提高率、毒副反应发生率、18和24个月生存率比较,差异有显著性(P＜0.05) .结论 斑蝥酸钠维生素B6注射液联合肝动脉化疗栓塞(TACE)治疗中晚期肝癌,不仅可降低进展率和毒副反应发生率,而且可提高生活质量,延长中位生存期,提高长期生存率,值得推广应用.     

肝动脉化疗栓塞分别联合经皮微波凝固治疗与^125I放射性粒子植入治疗原发性大肝癌的疗效观察

目的评价和比较肝动脉化疗栓塞（TACE）联合经皮微波凝固治疗（PMCT）与TACE联合^125I放射性粒子植入治疗原发性大肝癌的效果。方法46例原发性大肝癌患者接受TACE联合PMCT治疗,20例接受TACE联合^125I放射性粒子植入治疗。术后2个月、3个月分别行动态增强CT复查。观察并比较两组疗效、毒副反应及并发症发生的情况。结果综合治疗后3个月,TACE联合PMCT组的有效率为82．61％,明显高于TACE联合^125I放射性粒子植入组的有效率55．00％（P〈0．05）。两组的临床总控制率分别为93．47％、85．00％（P〉0．05）。两组发生的毒副反应无明显差异,均未出现严重并发症。结论TACE联合PMCT及TACE联合^125I放射性粒子植入均为原发性大肝癌安全、有效的治疗方法,两组毒副反应及并发症的发生率相当,前者治疗效果较为理想,值得临床应用。     

CDFI引导下经皮微波热凝固联合血管介入法治疗肝癌的综合应用

目的:探讨应用彩色多普勒超声显像(CDFI)引导经皮微波热凝固(PMCT)联合血管介入法治疗肝癌的可行性与治疗效果。方法:56例肝癌患者,应用PMCT治疗26例,30个结节;PMCT联合TACE30例,42个结节,先行肝动脉化疗栓塞(TACE),3d后行PMCT治疗,其中8例合并门静脉癌栓的病例,在TACE治疗2周后行经皮门静脉化疗(PVC)。结果:肿瘤<5cm的肝癌结节53个,PMCT与联合治疗组均获较好疗效。肿瘤≥5.0cm的19个结节中,联合治疗组在肿瘤缩小、血流信号消失、生存期方面均优于PMCT组。结论:PMCT联合TACE治疗肝癌具有协同作用,是中晚期肝癌有效的综合治疗方法。     

鸦胆子油乳肝动脉灌注联合碘油栓塞治疗原发性肝癌的临床观察

目的 探讨鸦胆子油乳肝动脉灌注联合碘油栓塞治疗原发性肝癌的疗效和毒副反应.方法 163例原发性肝癌被分为2组,治疗组66例采用鸦胆子油乳肝动脉灌注联合碘油栓塞治疗,对照组97例采用肝动脉灌注化疗栓塞(TACE).治疗结束后评价两组的疗效和毒副反应.结果 治疗组和对照组有效率分别为33.33%和32.99%,差异无统计学意义(P>0.05);两组中位疾病进展时间分别为4.8、4.1个月,差异无统计学意义(P>0.05);两组0.5、1、2年生存率分别为86.36%、37.88%、15.15%和82.47%、35.05%、7.22%.差异均无统计学意义(P>0.05).治疗组未见明显的毒副反应,生活质量明显提高(P<0.05),而对照组毒副反应较大,且出现4例治疗相关性死亡.结论 鸦胆子油乳肝动脉灌注联合碘油栓塞治疗原发性肝癌疗效与TACE相似,但其能提高生活质量,且毒副反应较轻.     

肝动脉化疗栓塞术治疗中晚期肝癌120例疗效分析

目的 观察经导管肝动脉化疗栓塞术(TACE)治疗中晚期原发性肝癌的疗效、毒副反应.方法 采用 Seldinger技术,经股动脉穿剌,选择性肝动脉插管灌注化疗药物联合碘油栓塞或加用明胶海绵治疗中晚期原发性肝癌患者120例,共行 280次介入治疗.结果 全组120例患者中,完全缓解60.0%(72/120),部分缓解31.7%(38/120),稳定8.3%(10 /120),12个月以上生存率达63.3%(76/120).结论 TACE治疗中晚期原发性肝癌疗效确切,能够显著延长患者的生存期,提高其生存质量.     

TACE联合瘤内注药治疗中晚期肝癌的疗效观察

目的评价瘤内注射碘化油混悬液和无水乙醇联合肝动脉化疗栓塞术(TACE)治疗中晚期肝癌的疗效。方法 61例中晚期肝癌随机分为联合介入组(实验组)与TACE组(对照组),组间比例是1∶1,实验组采取瘤内注射碘化油混悬液和无水乙醇联合TACE术,对照组则单纯采取TACE术,比较两组之间的总有效率,无进展生存期,总生存率和不良反应。结果实验组的总有效率明显优于对照组(64.5%vs 40.0%,P=0.049);治疗和对照组中位无进展生存期(PFS)分别为10月和7月(χ2=4.821,P=0.028),中位生存时间(MST)分别为17月和14月(P=0.061)。两组均未出现严重的不良反应。结论瘤内注射碘化油混悬液和无水乙醇联合肝动脉化疗栓塞术(TACE)治疗可增加肿瘤有效率,延缓肿瘤进展时间,不良反应可耐受。     

TACE联合三氧化二砷治疗原发性肝癌的临床研究

目的:探讨三氧化二砷(As2O3)联合经导管肝动脉化疗栓塞术(TACE)对中晚期原发性肝癌的治疗效果.方法:经病理、影像学诊断及AFP值证实的原发性肝癌符合筛选条件的患者共53例,28例和25例分别采用TACE联合As2O3和单纯TACE治疗,分别评价近期疗效、远期疗效、AFP变化、毒副反应和生活质量.结果:试验组与对照组疾病控制率分别为64.3％和52.0％,P=0.365.两组1年生存率分别为67.86％和40.00％,P=0.042,1年半生存率分别为57.14％和28.00％,P=0.033.AFP变化分别为28.57％和24.00％,P =0.706;两组毒副反应基本可以耐受,生活质量有一定改善.结论:As2 O3联合TACE治疗原发性肝癌能提高一年及一年半生存率,不良反应较小.     

Experience with Impedance Phlebography Compared with Venography

Venography is a particularly reliable method for the diagnosis of deep venous thrombosis but is not suitable as a screening test. Impedance phlebography represents another attempt to discover a simple, non-invasive and reliable method of detecting deep venous thrombosis. It does not, however, meet these criteria.     

Compliance with guidelines and correlation with outcome in patients with advanced germ-cell tumours

PurposeTo evaluate prior compliance with guidelines in patients treated with salvage chemotherapy for advanced germ-cell tumours (GCT).Patients and methodsData concerning the initial management of patients requiring salvage chemotherapy for GCT at Institut Gustave Roussy between 2000 and 2010 were obtained and correlated with recommendations for treatment. Criteria of non-compliance were defined based on guidelines. Compliance with guidelines, predictive factors for non-compliance and the impact on outcome were analysed.ResultsAmong 82 patients treated in the salvage setting, guidelines to initial treatment were followed in only 41 cases (50%). The most common non-compliance criteria were non-adherence to the planned dose (16%), an inappropriate interval between first-line chemotherapy cycles (16%), the lack of post-chemotherapy surgery (16%) and a long interval to post-chemotherapy surgery (48%). Compliance with standard care was better in cancer centres than in other hospitals (private or public) (Odd Ratio (OR): 6.9, P = 0.001). A poor-risk status according to the International Germ Cell Cancer Collaborative Group (IGCCCG) was also predictive of compliance in univariate but not in multivariate analysis. No significant difference in outcome after salvage chemotherapy was observed. Patients relapsing after non-compliant first-line therapy tended to be more easily salvaged, which is consistent with the fact that their initial treatment was inadequate. Some of these relapses were therefore probably not due to true biologically refractory disease.ConclusionGuidelines for first-line treatment are adhered to in only half the patients requiring salvage chemotherapy. As the only predictive factor for non-compliance was the treating centre, centralisation of patients with GCT in well-trained hospitals should be recommended.     

Treatment with methylnaltrexone is associated with increased survival in patients with advanced cancer

BackgroundMethylnaltrexone (MNTX), a peripherally acting μ-opioid receptor (MOR) antagonist, is FDA-approved for treatment of opioid-induced constipation (OIC). Preclinical data suggest that MOR activation can play a role in cancer progression and can be a target for anticancer therapy.Patients and methodsPooled data from advanced end-stage cancer patients with OIC, despite laxatives, treated in two randomized (phase III and IV), placebo-controlled trials with MNTX were analyzed for overall survival (OS) in an unplanned post hoc analysis. MNTX or placebo was given subcutaneously during the double-blinded phase, which was followed by the open-label phase, allowing MNTX treatment irrespective of initial randomization.ResultsIn two randomized, controlled trials, 229 cancer patients were randomized to MNTX (117, 51%) or placebo (112, 49%). Distribution of patients' characteristics and major tumor types did not significantly differ between arms. Treatment with MNTX compared with placebo [76 days, 95% confidence interval (CI) 43–109 versus 56 days, 95% CI 43–69; P = 0.033] and response (laxation) to treatment compared with no response (118 days, 95% CI 59–177 versus 55 days, 95% CI 40–70; P < 0.001) had a longer median OS, despite 56 (50%) of 112 patients ultimately crossing over from placebo to MNTX. Multivariable analysis demonstrated that response to therapy [hazard ratio (HR) 0.47, 95% CI 0.29–0.76; P = 0.002) and albumin ≥3.5 (HR 0.46, 95% CI 0.30–0.69; P < 0.001) were independent prognostic factors for increased OS. Of interest, there was no difference in OS between MNTX and placebo in 134 patients with advanced illness other than cancer treated in these randomized studies (P = 0.88).ConclusionThis unplanned post hoc analysis of two randomized trials demonstrates that treatment with MNTX and, even more so, response to MNTX are associated with increased OS, which supports the preclinical hypothesis that MOR can play a role in cancer progression. Targeting MOR with MNTX warrants further investigation in cancer therapy.Clinical trials numberNCT00401362, NCT00672477.     

Sarcopenia is associated with survival in patients with urothelial carcinoma treated with systemic chemotherapy

International Journal of Clinical Oncology - Sarcopenia impacts perioperative outcomes and prognosis in various carcinomas. We aimed to investigate whether sarcopenia at the time of chemotherapy...     

Costs associated with complications are lower with capecitabine than with 5‐fluorouracil in patients with colorectal cancer

BACKGROUND:

Capecitabine, an oral alternative to 5‐fluorouracil (5‐FU) in patients with colorectal cancer (CRC), has equal clinical efficacy and a favorable safety profile; however, its use may be limited because of unit cost concerns. In this study, the authors measured the cost of chemotherapy‐related complications during treatment with capecitabine‐ and 5‐FU–based regimens.

METHODS:

Patients with CRC who received at least 1 administration of capecitabine or 5‐FU during 2004 and 2005 were identified from the Thomson MarketScan research databases. Monthly frequency and cost for 23 complications were recorded. Logistic regression was used to predict complication probability. General linear models were used to predict monthly complication cost and total monthly expenditure.

RESULTS:

In total, 4973 patients with CRC met the inclusion criteria for this analysis. Although the most frequently observed complications were the same between capecitabine and 5‐FU (nausea and vomiting, infection, anemia, neutropenia, diarrhea), each was observed with greater frequency in 5‐FU–based regimens. The mean predicted monthly complication cost was significantly higher (by 136%) with 5‐FU monotherapy than with capecitabine monotherapy (difference, $601; 95% confidence interval [95% CI], $469‐$737). In addition, the mean predicted monthly complication cost for 5‐FU+oxaliplatin was higher than the cost with capecitabine plus oxaliplatin (difference, $1165; 95% CI, $892‐$1595). When acquisition, administration, and complication costs were taken into consideration, there were no significant differences in the total cost between capecitabine regimens and 5‐FU regimens.

CONCLUSIONS:

Capecitabine compared well with 5‐FU–based therapy in patients with CRC and was associated with lower complication rates and associated costs. Cancer 2009. © 2009 American Cancer Society.     

超声心动图诊断26例心脏黏液瘤

应用经胸二维超声心动图（2DE）、彩色血流显像（CDFI）及频谱多普勒显像（Doppler）诊断26例心脏黏液瘤（27个瘤体）,对团块的位置、数目、大小、形状、瘤蒂附着点和活动度、心腔内及瓣膜口血流等进行探查及分析．认为心脏超声检查是心脏黏液瘤的首选检查方法,具有实时、经济、简便易行等优点。     

Living with secondary breast cancer: coping with an uncertain future with unmet needs

JOHNSTON S.R.D. (2010) European Journal of Cancer Care 19 , 561–563 Living with secondary breast cancer: coping with an uncertain future with unmet needs