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1.
胃癌在全国范围内是发病率最高的恶性肿瘤之一,在癌症相关死亡原因中排名第三。目前外科手术仍然是胃癌获得根治性治疗的主要手段,但是其中有30%~40%的进展期胃癌患者在初诊时就失去了根治手术的机会,因此不可切除胃癌转化为可切除胃癌是患者获得"治愈"的最佳选择。随着近些年来新型药物的出现、治疗手段的多样化及多学科诊治模式的发展,"转化治疗"的理念应运而生,从而延长患者生存时间并提高其生活质量。本文就不可切除胃癌的治疗现状与进展、"转化治疗"的应用等进行综述。 相似文献
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M. Langenberg C.H.J. Terhaard G.J. Hordijk R.J.J. van Es E.E. Voest A. de Graeff 《Clinical otolaryngology》2004,29(6):729-734
Several randomized studies and meta‐analyses have shown that simultaneous radio‐ and chemotherapy prolongs survival in patients with unresectable squamous cell carcinoma of the head and neck as compared with conventional radiotherapy. We assessed the feasibility and effectiveness of simultaneous radiotherapy (35 × 2 Gy) and chemotherapy [cisplatinum 100 mg/m2 or carboplatin (AUC 6) on days 1, 22 and 43] in daily clinical practice in a cohort of 87 patients treated at our institute between 1998 and 2002. Eighty patients completed radiotherapy according to schedule. Eighty patients received two courses of chemotherapy and 50 patients three courses. Nephrotoxity, bone marrow suppression and ototoxicity were the most frequent side‐effects. Median weight loss was 8.5%. Median survival was 15 months and 44% of the patients were alive at 2 years. Patients receiving three courses of chemotherapy had a better survival than patients receiving two or less courses. Treatment with simultaneous radio‐ and chemotherapy for advanced head and neck cancer is a demanding, but feasible treatment in daily clinical practice. Survival seems to be comparable with the results achieved in patients selected for clinical trials. 相似文献
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Lyons JM Karkar A Correa-Gallego CC D'Angelica MI DeMatteo RP Fong Y Kingham TP Jarnagin WR Brennan MF Allen PJ 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2012,14(7):469-475
Background
The optimal surgical management of patients found to have unresectable pancreatic cancer at open exploration remains unknown.Methods
Records of patients who underwent non-therapeutic laparotomy for pancreatic cancer during 2000–2009 and were followed until death at Memorial Sloan–Kettering Cancer Center, New York, were reviewed.Results
Over the 10-year study period, 157 patients underwent non-therapeutic laparotomy. Laparotomy alone was performed in 21% of patients; duodenal bypass, biliary bypass and double bypass were performed in 11%, 30% and 38% of patients, respectively. Complications occurred in 44 (28%) patients. Three (2%) patients died perioperatively. Postoperative interventions were required in 72 (46%) patients following exploration. The median number of inpatient days prior to death was 16 (interquartile range: 8–32 days). Proportions of patients requiring interventions were similar regardless of the procedure performed at the initial operation, as were the total number of inpatient days prior to death. Patients undergoing gastrojejunostomy required fewer postoperative duodenal stents and those undergoing operative biliary drainage required fewer postoperative biliary stents.Conclusions
In this study, duodenal, biliary and double bypasses in unresectable patients were not associated with fewer invasive procedures following non-therapeutic laparotomy and did not appear to reduce the total number of inpatient hospital days prior to death. Continued effort to identify unresectability prior to operation is justified. 相似文献6.
Cody M. Lebeck Lee MD Ioannis A. Ziogas MD Rajiv Agarwal MD Sophoclis P. Alexopoulos MD Kristen K. Ciombor MD Lea K. Matsuoka MD Daniel B. Brown MD Cathy Eng MD 《Cancer》2022,128(12):2243-2257
The 5-year overall survival rate of a patient with unresectable metastatic colorectal cancer is poor at approximately 14%. Similarly, historical data on liver transplantation (LT) in those with colorectal liver metastases (CRLM) showed poor outcomes, with 5-year survival rates between 12% and 21%. More recently, limited data have shown improved outcomes in select patients with 5-year overall survival rates of approximately 60%. Despite these reported survival improvements, there is no significant improvement in disease-free survival. Given the uncertain benefit with this therapeutic approach and a renewed investigational interest, we aimed to conduct a contemporary systematic review on LT for CRLM. A systematic review of the literature was performed according to the preferred reporting items for systematic reviews and meta-analysis statement. English articles reporting on data regarding LT for CRLM were identified through the MEDLINE (via PubMed), Cochrane Library, and ClinicalTrials.gov databases (last search date: December 16th, 2021) by 2 researchers independently. A total of 58 studies (45 published and 13 ongoing) were included. Although early retrospective studies suggest the possibility that some carefully selected patients may benefit from LT, there is minimal prospective data on the topic and LT remains exploratory in the setting of CRLM. Additionally, several other challenges, such as the limited availability of deceased donor organs and defining appropriate selection criteria, remain when considering the implementation of LT for these patients. Further evidence from ongoing prospective trials is needed to determine if and to what extent there is a role for LT in patients with surgically unresectable CRLM. 相似文献
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Localized unresectable neuroblastoma: results of treatment based on clinical prognostic factors. 总被引:1,自引:0,他引:1
A Garaventa L Boni M S Lo Piccolo G P Tonini C Gambini A Mancini L Tonegatti M Carli L C di Montezemolo A Di Cataldo F Casale K Mazzocco G Cecchetto A Rizzo B Bernardi 《Annals of oncology》2002,13(6):956-964
BACKGROUND: We previously reported that stage 3 neuroblastoma comprises (i) a low-risk group including all infants (age 0-11 months) as well as older children with non-abdominal primaries, and (ii) a high-risk group made up of children >1 year of age with abdominal primaries. Aggressive chemotherapy was effective only in the latter group. PATIENTS AND TREATMENT: On this basis, in 1990 we designed a new protocol by which all low-risk patients received standard-dose chemotherapy, while the high-risk ones received very aggressive chemotherapy. RESULTS: Between November 1990 and December 1997 a total of 95 eligible and evaluable children were enrolled: 47 were low-risk (35 infants and 12>1 year of age at diagnosis and having non-abdominal primaries), and 48 were high-risk (being >1 year of age and having abdominal primaries). Of the 47 low-risk patients, five relapsed and four subsequently died. The 5-year overall survival (OS) was 91%. Of the 48 patients in the high-risk group, 22 relapsed or progressed, 18 of whom died from their disease and two from toxicity, and one was lost to follow-up. The 5-year OS was 60%. Univariate analysis showed that age, site of primary, risk-group, urine vanillylmandelic excretion, plasma levels of lactate dehydrogenase, ferritin and neurone-specific enolase, and MYCN status correlated with outcome. However, multivariate analysis showed that only MYCN status retained prognostic value. CONCLUSIONS: In low-risk stage 3 neuroblastoma, standard-dose chemotherapy is associated with an excellent chance of being cured. Aggressive chemotherapy is effective for high-risk patients, but results are still unsatisfactory. MYCN gene amplification is a prognostic indicator for most, but not all, treatment failures. 相似文献
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Hadjicostas P Malakounides N Varianos C Kitiris E Lerni F Symeonides P 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2006,8(1):61-64
Introduction and aim. Radiofrequency ablation (RFA) is effective in the treatment of unresectable hepatic tumors and promising results have also been described in tumors of kidney, lung, brain, prostate, and breast. The radiofrequency destruction of solid pancreatic tumors sounds logical but also seems risky due to the friable pancreatic parenchyma, the fear of pancreatitis and the prejudiced myth of ‘the pancreas is not your friend’. Patients and methods. We present our initial experience and we describe our technique during intraoperative RFA in four patients with locally advanced and unresectable pancreatic adenocarcinoma (head of pancreas, three; body-tail, one; diameter, 3–12 cm). In all the patients, the RFA was followed by bypass palliative procedures (cholecystojejunostomy and Brown''s anastomosis and/or gastrojejunostomy). A drainage tube was left close to the ablated area. Serum amylase and fluid amylase (drain) were measured for 5–7 days postoperatively. Sandostatin was also administered prophylactically for 3–5 days. Results. The postoperative period was uneventful in all the patients, without complications or evidence of pancreatitis. The post RFA CT scan showed remarkable changes in the density and the characteristics of the tumors in all the patients. All the patients are alive, at 12, 8, 5 and 3 months postoperatively, respectively. In one patient (with cancer of the body of the pancreas) who was receiving morphine because of intolerable pain, significant pain relief has been observed. Conclusions. From our initial results, RFA seems to be a feasible, potentially safe and promising option in patients with locally advanced and unresectable pancreatic cancer. Nevertheless, larger series of cases are needed to secure our encouraging results. 相似文献