奥沙利铂联合羟基喜树碱和氟尿嘧啶及亚叶酸钙治疗晚期胃癌的临床研究

目的：观察以奥沙利铂（LOHP）、羟基喜树碱（HCPT）、氟尿嘧啶（5FU）及亚叶酸钙（LV）组成的HLOF方案和顺铂（DDP）、HCPT、5-FU及LV组成的HLPF方案治疗晚期胃癌的疗效与安全性。方法：61例患者随机分组，试验组32例给予HLOF方案化疗，L-OHP130mg／m^2，静脉滴入2h，d1；HCPT6mg／m^2，静脉滴入，d1～d3；5-FU500mg／m^2，静脉滴入．d1～d3；LV100mg／m^2，静脉滴入，d1～d3。对照组29例给予HLPF方案化疗，除用DDP替代L-OHP外余同对照组。DDP用法：30mg／m^2，静脉滴入，d1～d3。以上方案均每21～28d重复。每例至少完成2个周期化疗方可评价疗效。结果：试验组CR2例．PR17例，SD8例，PD5例，有效率为59．4％（19／32）；对照组PR12例．SD11例，PD6例，有效率为41．4％。两组总有效率差异无统计学意义，P〉0．05。不良反应HLOF组食欲下降、恶心、呕吐的发生率较对照纽低，P〈0．05；神经毒性发生率高于对照组。KPS评分HLOF组升高幅度高于对照，P〈0．05。两组疾病无进展时间（time to progress，TTP）及生存期比较，差异均无统计学意义，P〉0.05。结论：治疗晚期胃癌，两者均为有效、低毒的化疗方案。在改善生活质量和减轻消化道反应方面，HLOF优于HLPF方案。     

癌症的个体化治疗

个体化是肿瘤治疗过程中常常被忽视的问题，肿瘤生物学的个体化特征决定了肿瘤治疗的个体化。癌症的个体化特性包括时间个体化、空间个体化、解剖上的个体化、结构的个体化、基因的个体化、功能的个体化和人为的个体化等七个方面。医学模式整体观念的形成、后基因组时代的到来，为肿瘤个体化治疗提供了必要的契机和工具。因此，传统的肿瘤临床治疗手段正在逐渐被以更为准确的以分子标志物辅助诊断为依据，分子信息指导下的更为安全有效的个体化治疗所取代。     

BREAST CONSERVING THERAPY IN STAGE T_1 & T_2 BREAST CANCER PATIENTS

There have been several well-established multi-centered clinical trails about breast conserving therapy (BCT) published their results and showed that for appropriately selected and staged patients with early invasive carcinoma of the breast, breast conservation therapy has been shown to result in survival rates and local recurrence rates comparable to those achieved with mastectomy while preserving the breast[1,2]. In 1995, our hospital began breast conserving therapy of early stage breast can…     

Role for CD40L in the Therapy of Human Cancer

CD40L-CD40 interaction is central to the control of thymusdependent humoral immunity and cell mediated immune responses. CD40, a member of the tumor necrosis factor receptor （TNF- R） family, has been found on the surface of B lymphocytes, monocytes, hematopoietic progenitors, dendritic cells （DCs）, endothelial cells, epithelial cells and so on. Its natural ligand （CD40 ligand, CD40L）, CD154, a member of the tumor necrosis factor （TNF） family, is mainly expressed on activated CD4^＋ T lymphocytes. A direct growth-inhibitory effect can be found when ligated CD40 is on human breast, ovarian, cervical, bladder, non-small cell lung, and squamous epithelial carcinoma cells. This effect is related to the induction of cell cycle blockage and/or apoptosis. CD40L induces phenotypic and functional maturation of DCs, and can increase tumor immunogenicity through up-regulation of costimulatory molecular expression and cytokine production by epithelial cancer cells. As a result, CD40L can enhance tumor rejection immune responses. Furthermore, by means of a “bystander effect”, even CD40-negative tumor subsets can be eliminated by activated tumor-reactive cytotoxic T lymphocytes（CTL）. This review summarizes recent findings on CD40L recombinant protein and gene therapy-based tumor treatment approaches.     

归芪方合苯那普利对糖尿病大鼠肾组织转化生长因子β_1的影响

目的研究归芪方联合血管紧张素转化酶抑制剂(ACEI)苯那普利对糖尿病大鼠肾功能和肾组织转化生长因子β_1(TGF-β_1)基因表达的影响。方法Wistar大鼠腹腔注射链脲佐菌素(STZ)以建立糖尿病模型,将糖尿病大鼠分为糖尿病模型组、苯那普利治疗组、归芪方治疗组、归芪方合苯那普利治疗组,另设正常对照组。实验第8周时统一处死,观察各组大鼠肾重/体重、血糖、内生肌酐清除率(CCr)及肾组织结构的改变,放免法测定24h尿微量白蛋白排泄率(UAER)、β2-微球蛋白(β_2-MG)、血浆及肾组织血管紧张素Ⅱ(AngⅡ)含量,原位杂交检测肾脏皮质TGF-β_1基因表达的变化。结果与单用苯那普利或归芪方相比,联合用药可明显减少尿白蛋白、β_2-MG,控制肾脏肥大,改善肾功能,使肾皮质TGF-β_1mRNA表达量进一步减少,同时肾脏病理改变亦减轻。结论苯那普利合用归芪方能更有效地抑制TGF-β_1mRNA的表达,减轻肾脏损伤,改善肾功能,延缓糖尿病肾病慢性病理进展。     

生化止血饮对药流后出血动物模型粘附蛋白的影响

目的：探讨生化止血饮改善药物流产后阴道出血的作用机制。方法：建立正常组，药物流产模型组，流产后缩宫素组，益母草组，生化止血饮高剂量组，生化止血饮低剂量组，采用免疫组化法检测大鼠子宫内膜（包括蜕膜）中纤维粘连蛋白（FN），层粘连蛋白（LN），孕激素受体（PR）的变化。结果：生化止血饮可显著降低PR，LN，FN的表达水平（P〈0．05），而益母草组和缩宫素组与药流模型组没有显著性差异（P〉0．05），生化止血饮的疗效优于益母草组及缩宫素组。结论：生化止血饮能通过降低子宫内膜中PR，FN，LN的水平促进蜕膜剥脱，缩短药流后阴道出血的时间，达到减少阴道出血量的目的。     

晚期胃腺癌放疗联合化疗与单纯化疗的疗效比较

胃癌的术后5年生存率很低,大约有2/3的全胃切除术后患者局部复发[1-2].由于胃癌起病隐匿,早期症状不典型,确诊时许多患者已属晚期,失去手术机会,需要采用以全身化疗为主的综合治疗[3].我们对2003年1月至2006年12月收治的、不能手术的晚期胃癌患者分别行三维适形放疗联合紫杉醇、奥沙利铂化疗和单纯化疗,并进行疗效比较,现将结果报告如下.     

多西紫杉醇二线治疗紫杉醇耐药的晚期非小细胞肺癌15例

目的 观察紫杉醇(泰素)耐药的晚期非小细胞肺癌(NSCLC)患者接受多西紫杉醇(泰素帝)二线治疗后的疗效及毒副反应.方法 回顾性分析2005年1月至2008年5月在上海市胸科医院接受多西紫杉醇二线化学治疗的15例NSCLC患者.评价其疗效及不良反应,并随访无疾病进展时间(PFS)及总生存期(OS).结果 15例患者的疾病控制率为66.7%,中位无疾病进展时间为6个月,中位生存期为17.3个月,1年生存率达到63.3%.主要不良反应包括白细胞减少8例(53.3%),胃肠道反应8例(53.3%),呃逆6例(40%),均属可耐受范围.结论 多西紫杉醇二线治疗在紫杉醇耐药的晚期NSCLC患者中显示了良好疗效,且毒副反应可以耐受.     

Radiologically placed temporary hepatic artery catheter for treatment of liver cancer

Hepatic artery infusion (HAI) chemotherapy is associated with higher response rates compared to systemic chemotherapy in those patients with unresectable liver malignancies. Operative hepatic artery catheter (HAC) insertion has significant morbidity and mortality, especially in patients with high‐volume disease, some of whom may not respond to HAI chemotherapy. We report our experience in 45 patients with high‐volume liver disease who were initially treated with HAI chemotherapy via a radiologically placed temporary HAC to try to select the responders who then went on to have an operative HAC. In these 45 patients who had 62 radiologically placed HAC, we found very few major complications, and certainly no complications such as cholecystitis, vascular or malperfusion problems.     

Synthesis of 2‐[(2‐chloro‐2′‐[18F]fluoroethyl)amino]‐2H‐1,3,2‐oxazaphosphorinane‐2‐oxide (18F‐fluorocyclophosphamide), a potential tracer for breast tumor prognostic imaging with PET

A fluorine‐18 labeled analog of the widely used chemotherapeutic agent cyclophosphamide was synthesized as a tracer for prognostic imaging with positron emission tomography. 2‐[(2‐Chloro‐2′‐[¹⁸F]fluoroethyl)amino]‐2H‐1,3,2‐oxazaphosphorinane‐2‐oxide (¹⁸F‐fluorocyclophosphamide), was prepared by direct halogen exchange reaction from the parent cyclophosphamide. In small‐scale syntheses, radiochemical yields of up to 4.9% and specific activities of 960 Ci/mmol were achieved in a total synthesis time of 60–75 min. The [¹⁸F]‐labeled cyclophosphamide analog with radioactive purity >99% and chemical purity >96% was suitable for in vivo (microPET imaging) and ex vivo studies of a murine model of human breast tumors. Copyright © 2005 John Wiley & Sons, Ltd.