晚期肝细胞癌的靶向治疗进展

目前,原发性肝细胞癌（HCC）是居全球第5位的常见肿瘤,并且在肿瘤相关性死亡中排第3位。大部分肝细胞癌患者诊断时已无法手术切除并且中位生存期很短,由于传统的细胞毒药物对晚期肝细胞癌疗效有限,本文总结目前靶向治疗领域的一些进展,希望将来在肝细胞癌系统治疗方面能够获得实质性突破。     

结直肠癌肝转移瘤局部介入治疗应用进展

结直肠癌是世界上死亡率排名前5位的恶性肿瘤,其主要死因是肝转移。结直肠癌发生肝转移多是晚期,其治疗效果较差,生存期较短,严重影响结直肠癌的预后。目前,根治性手术切除是结直肠癌肝转移(Colorectal liver metastasis,CRLM)的一线治疗方法,然而,绝大多数病人在被确诊时已失去手术治疗的机会。国家综合癌症网络(National Comprehensive Cancer Network,NCCN)建议将局部治疗(Locoregional therapy,LRT)用于无法行根治性手术切除且对化疗不敏感或无效的CRLM患者,它主要包括经导管动脉内治疗和消融治疗。本文就局部介入治疗CRLM的应用进展做一综述。     

晚期原发性肝癌治疗的研究进展

原发性肝癌位居全球最常见恶性肿瘤的第五位,在癌症相关死亡原因中排名第三位.原发性肝癌治疗方法的选择很大程度上取决于肝脏功能,肿瘤大小,是否存在转移灶和血管侵犯.目前,原发性肝癌的根治方法包括肝切除术和肝移植手术,但是很多患者确诊时已进入晚期,失去了治愈的机会.全身系统性治疗对于晚期原发性肝癌的患者变得尤为重要,其中包括:分子靶向治疗、全身系统性化疗和免疫治疗.本文就近年来晚期原发性肝癌治疗的研究进展作一综述.     

原发性肺类癌的治疗进展与展望

原发性肺类癌(pulmonary carcinoid,PC)是一种较为少见的肺部肿瘤。在2015年世界卫生组织(WHO)最新的肿瘤分类中,PC包括典型类癌(typical carcinoid,TC)和非典型类癌(atypical carcinoid,AC)。PC与大细胞神经内分泌癌(large cell neuroendo? crine carcinoma,LCNEC)和小细胞肺癌(small cell lung carcinoma,SCLC)均属于肺部神经内分泌肿瘤(neuroendocrine tumor,NET)。由于发病率较低,且缺乏特异性的临床表现,PC的诊断和管理相对较复杂。对于整体健康状况和肺储备可以耐受手术的早期局限型PC患者,外科手术切除是首选的治疗方法。而晚期或不可切除PC患者,目前各种指南推荐的标准系统治疗缺乏统一的共识。本文拟对PC最新的诊断及多学科治疗进展进行综述。      

晚期胰腺癌的内科治疗

化疗是目前晚期胰腺癌内科治疗的重要手段,吉西他滨为标准用药,以其为基础的综合治疗方案在不断探索中,并取得一定进展.放疗同期化疗的应用存在一定争议,尚待进一步的研究证实.新辅助治疗的出现.使部分进展期胰腺癌患者获得了肿瘤切除的可能,对延长生存期意义重大.靶向治疗的出现为转移性胰腺癌患者带来了希望,提高了生存获益.     

厄洛替尼一线治疗晚期非小细胞肺癌的研究进展

世界范围内,肺癌是导致癌症患者死亡的第1位病因,其中非小细胞肺癌（NSLCLC）占新诊断肺癌的80％以上。大多数患者在诊断时即为不可切除,根治性治疗后复发的患者也很常见。目前标准的两药含铂化疗方案治疗晚期非小细胞肺癌的疗效不尽人意,随机临床试验显示中位生存期不到10个月,很少有患者能活过2年。尽管许多临床研究试图将不同的化疗方案联合运用到治疗中,     

进展期结直肠癌的内科治疗进展

结直肠癌在我国发病率及病死率近来逐年升高,已上升至恶性肿瘤的第4位,目前对于进展期结直肠癌患者仍需采用以化疗为主的综合治疗手段.与仅接受最佳支持治疗相比,化疗能够延长患者的生存期,并改善生活质量.近年来由于新一代化疗药物和分子靶向药物相继涌现,中位生存期不断得到延长.因此,在转移性结直肠癌mCRC中施行化疗已经达成共识,标准的化疗方案也基本得到公认,必要时联合分子靶向治疗的新观点逐步得到接受.本文就国内外近年来对于晚期结直肠癌的内科治疗进展作一综述.     

肝癌免疫治疗的现状及进展

肝癌是一种高度恶性肿瘤，目前首选治疗仍然是手术切除，但切除率低，且术后复发率高，因此肝癌的综合治疗尤为重要。近几年来生物治疗在肝癌的综合治疗中取得了较大进展，特别在预防术后复发和治疗不可手术切除的肝癌方面．因此生物治疗成了继手术、放疗、化疗后肿瘤治疗的第四模式，其中免疫治疗更是肝癌生物治疗的最重要的组成部分。现将目前肝癌免疫治疗的基础研究和临床应用进行综述。     

肝外胆道系统肿瘤放化综合治疗进展

肝外胆道系统肿瘤是一种少见且预后差的疾病,诊断时多为晚期,丧失了根治手术切除的机会,放化综合治疗成为其主要治疗手段.近年来,放化综合治疗在可切除和不可切除的肝外胆道系统肿瘤治疗上取得了一定进展.     

伊马替尼治疗晚期胃肠间质瘤的疗效分析及不良反应

目的 评价靶向药物伊马替尼治疗晚期(不可切除或复发转移)胃肠间质瘤(GIST)患者的临床疗效并总结所有胃肠间质瘤患者服用伊马替尼后的不良反应.方法 回顾分析我院自2004年6月至2009年12月接受伊马替尼治疗的GIST患者154例,其中晚期患者96例.完全切除术后辅助治疗58例.对晚期患者的治疗疗效进行分析,并统计所有患者服药后的不良反应.结果 资料完整的晚期患者73例,接受伊马替尼治疗中位时间23个月,其中完全缓解0例,部分缓解53例(72.6%),疾病稳定15例(20.5%),原发耐药疾病进展5例(6.8%),客观有效率为72.6%,疾病控制率为93.2%.中位无进展生存期45.0个月,患者1、3、5年无进展生存率分别为86%、61%和34%,患者1、3、5年总体生存率分别为98%、88%和72%.154例患者接受过至少一次伊马替尼治疗,起始剂量400 mg/d,绝大多数患者不良反应为1～2级,耐受良好.最常见的不良反应分别为水肿(75.3%)、消化道反应(37.7%)和贫血(22.7%).3级或以上不良反应发生率15.6%(24/154).结论 伊马替尼治疗晚期GIST疗效肯定;患者对于400 mg/d的治疗剂量耐受良好.     

Neoadjuvant chemotherapy with a combination of docetaxel,cisplatin, fluorouracil,and leucovorin in nonresectable advanced gastric cancer: a short communication

The aim of this study was to evaluate the efficacy and toxicity of docetaxel (TAX), cisplatin (CDDP), and fluorouracil (5-FU) plus leucovorin (CF) as the neoadjuvant chemotherapy (NACT) regimens in the treatment of nonresectable advanced gastric cancer. Twelve patients with nonresectable advanced gastric cancer were treated with NACT regimens consisted of docetaxel, cisplatin, fluorouracil, plus leucovorin before operation. Nine of the 12 patients were downstaged and 8 were radically operated after the end of the NACT. The overall response rate was 75% with 8.3% complete response and 66.7% partial response, and the ascites disappeared in 63.6%. The most common toxicities were bone marrow suppression, nausea, vomiting, alopecia, and heptoses. The toxicities were recoverable after symptomatic treatment. The results confirmed that the combination of docetaxel, cisplatin, fluorouracil plus leucovorin (CF) is a very effective and well-tolerated regimen as NACT for the patients with nonresectable advanced gastric cancer.     

Current perspectives in the treatment of advanced prostate cancer

Prostate cancer (PC) continues to be an important world health problem for men. Patients with locally confined PC are treated with either radiotherapy or surgery. However, treatment of more advanced stages of the disease is problematic. Initially, androgen deprivation offers a period of clinical stability, which is however invariably followed by progression to non-responsiveness to hormonal manipulation. Current management of patients with androgen-independent prostate cancer (AIPC) displays modest response rates and achieves only short-term benefit. Recently, knowledge in the complex pathophysiology of advanced PC has led to the identification of mechanisms and target molecules permitting the introduction of new therapies. Consequently, many investigational treatments are ongoing for AIPC in Phase-II and Phase-III trials aiming at the combination of chemotherapeutic regimens along with immunotherapy targeting PC-associated antigens. Other attractive options are gene therapy, as well as the targeting of survival signaling, differentiation, and apoptosis of the malignant PC cells. Further treatment modalities are directed against the tumor microenvironment, bone metastasis, or both. Collectively, the aforementioned efforts introduce a new era in the management of advanced PC. Novel pharmaceutical compounds and innovative approaches, integrated into the concept of individualized therapy will hopefully, during the next decade, improve the outcome and survival for hundreds of thousands of men worldwide.     

Multidisciplinary management of nonresectable hepatocellular carcinoma

This article summarizes the consensus of an early morning workshop on the multidisciplinary management of nonresectable hepatocellular carcinoma (HCC) held on July 4, 2010, under the auspices of the 1st Asia-Pacific Primary Liver Cancer Expert Meeting (APPLE) Scientific Advisory Committee. Important points are as follows: (1) nonresectable HCC consists of locally advanced HCC and HCC with extrahepatic spread. The grouping system for locally advanced HCC comprises the following categories: nodular, massive with intrahepatic metastases, diffuse, and disease with vascular invasion. (2) In actual clinical practice, the orchestration of multimodality treatment options is keenly needed for successful treatment of individual patients with nonresectable HCC. Physicians in charge tend to prefer maximal cytoreductive measures as long as the condition of the individual patient allows. (3) There are a few studies on the combined use of radiation therapy and transcatheter arterial chemoembolization or hepatic arterial infusion chemotherapy in the form of phase I and II trials. (4) At this stage, scientific evidence on multidisciplinary management of nonresectable HCC is lacking. Further studies on multidisciplinary management should focus on the subcategory of locally advanced HCC. (5) Further discussion is needed in the upcoming APPLE meeting to clarify the guidelines as well as to determine a practical multidisciplinary approach for nonresectable HCC patients.     

Arterial infusion chemotherapy for patients with advanced pancreatic cancer

Although various therapies have been tried to improve advanced nonresectable pancreatic cancer, a sufficient consensus has not yet been obtained about the treatment. We have performed arterial infusion chemotherapy for pancreatic cancer in order to maintain QOL. The response rate was 17.3%, the mean survival time 282.1+/-204.7 days, median survival time 243.0+/-84.7 days, and many patients were continuously treated on an outpatient basis. It is thus expected that survival time and maintenance of QOL can be extended by self-sustaining arterial infusion chemotherapy.     

胰腺癌的早期诊断和治疗进展

胰腺癌(pancreatic cancer,PC)是恶性程度很高的肿瘤,5年生存率低于5%。由于其发病隐匿,确诊时已到晚期,仅有约10%-20%的患者能行手术根治。CT是PC诊断和分期的影像学依据。近年来随着磁共振成像和超声内镜技术的发展,为PC的诊断提供了更精确的影像学资料,尤其对局部浸润和淋巴结转移的患者。手术切除是仅有的根治手段。近十年来,吉西他滨已成为晚期PC的标准化疗法,以吉西他滨为基础的联合化疗,尤其是同分子靶向因子的联合治疗是有前途的。辅助放射治疗仍有争论,但随着放射运载技术的发展,放射治疗将会被越来越多的用于临床。姑息治疗的目的是为了缓解疼痛和改善恶性肿瘤所造成的恶液质。本文就PC早期诊断及治疗进展作一综述。     

Sequential Therapy in the Treatment of Locally Advanced Noninflammatory Breast Cancer

Optimal care of patients with locally advanced breast cancer requires the use and thoughtful integration of all effective modalities of treatment. A number of alternative combinations of surgery, chemotherapy, and radiation have been promoted, each with its own particular advantages and shortcomings. The advantages of sequenced, multimodality therapy of locally advanced, noninflammatory breast cancer include (1) the ability to convert nonresectable tumors to resectable ones, (2) early institution of systemic therapy, (3) in vivo evaluation of tumor response with the potential for optimization of therapy, and (4) relatively low morbidity rates with the ability to render most patients disease-free at their primary site. The results of this treatment strategy are discussed.     

Genetic testing in prostate cancer management: Considerations informing primary care

Inherited genetic mutations can significantly increase the risk for prostate cancer (PC), may be associated with aggressive disease and poorer outcomes, and can have hereditary cancer implications for men and their families. Germline genetic testing (hereditary cancer genetic testing) is now strongly recommended for patients with advanced/metastatic PC, particularly given the impact on targeted therapy selection or clinical trial options, with expanded National Comprehensive Cancer Network guidelines and endorsement from multiple professional societies. Furthermore, National Comprehensive Cancer Network guidelines recommend genetic testing for men with PC across the stage and risk spectrum and for unaffected men at high risk for PC based on family history to identify hereditary cancer risk. Primary care is a critical field in which providers evaluate men at an elevated risk for PC, men living with PC, and PC survivors for whom germline testing may be indicated. Therefore, there is a critical need to engage and educate primary care providers regarding the role of genetic testing and the impact of results on PC screening, treatment, and cascade testing for family members of affected men. This review highlights key aspects of genetic testing in PC, the role of clinicians, with a focus on primary care, the importance of obtaining a comprehensive family history, current germline testing guidelines, and the impact on precision PC care. With emerging evidence and guidelines, clinical pathways are needed to facilitate integrated genetic education, testing, and counseling services in appropriately selected patients. There is also a need for providers to understand the field of genetic counseling and how best to collaborate to enhance multidisciplinary patient care.     

鸦胆子油乳瘤内注射辅助化疗治疗局部晚期非小细胞肺癌疗效观察

目的 探讨鸦胆子油乳瘤内注射辅助化疗治疗不可手术切除局部晚期非小细胞肺癌(LANSCLC)的临床疗效.方法 将568例不可切除LANSCLC患者随机分为治疗组和对照组,每组284例.治疗组采取鸦胆子油乳瘤内注射辅助多西他赛+顺铂化疗方案治疗,对照组单纯采取多西他赛+顺铂方案化疗.治疗后比较分析2组患者的疗效和毒副反应.结果 治疗组和对照组总有效率分别为51.4％、41.2％,差异有统计学意义(P＜0.05);治疗组治疗后Karnofsky评分改善情况优于对照组,差异有统计学意义(P＜0.05).治疗组和对照组的毒副反应均主要为骨髓抑制、恶心呕吐和静脉炎.结论 鸦胆子油乳瘤内注射辅助多西他赛+顺铂化疗方案治疗不可切除LANSCLC可提高疗效,而不增加化疗的毒副反应.     

原发性肝癌的综合治疗--附607例报告

背景与目的：虽然原发性肝癌(简称肝癌)的早期诊断和早期治疗取得了很大进步,但大多数为合并有肝硬化的中晚期肝癌患者,手术切除并非适合所有肝癌患者,即使能切除,术后复发率也高达60％以上,因而,肝癌的整体治疗效果较差。本研究探讨肝癌的综合治疗方法,以进一步提高肝癌的整体治疗效果。方法：回顾性分析我科以外科为主综合治疗的607例肝癌患者的病例资料,其中,手术切除共423例,行不规则性肝叶切除134例,局部切除95例,肝叶或肝段切除123例,半肝或半肝以上切除共54例,联合脏器切除17例;手术不能切除184例,行肝固有动脉结扎联合肝动脉及门静脉双插管化疗或瘤体内注射无水乙醇或冷冻、射频治疗、微波固化、腹腔化疗等。结果：总的手术切除率69．7％(423／607),手术死亡率1．2％(5／423);全组3、5、10年生存率分别为42．7％(218／511)、37．5％(123／328)和26．5％(26／98);切除组3、5、10年生存率分别为57．2％(203／355)、51．3％(118／230)和35．3％(24／68);不能切除组3、5、10年生存率分别为9．6％(15／156)、5．1％(5／98)和6．7％(2／30)。结论：以外科为主的综合治疗是目前可切除肝癌较好的治疗方法。术后个体化综合治疗可提高肝癌的手术治疗效果。     

Assessment of efficacy of arterial infusion chemotherapy with gemcitabine for four cases of advanced pancreatic cancer

We treated 4 cases of advanced pancreatic cancer: 2 cases were nonresectable and the other 2 cases did not choose an operation but arterial infusion chemotherapy with gemcitabine after the transcatheter peripancreatic arterial embolizaiton. One case resulted in a tumor decrease but the other 3 cases observed a tumor progress. Although we confirmed cancer pain suppression in all cases and a disappearance of tumor fever in one case, the survival period was 7 months in spite of the treatment. As for the complication of arterial infusion chemotherapy with gemcitabine, we recognized bone marrow suppression (grade 1) in 3 cases. This therapy seemed to be effective for suppression of pain and tumor fever caused from the advanced pancreatic cancer. However, we need to improve in survival period from this therapy.