Application of Regional Arterial Infusion Chemotherapy in Advanced Gastric Cancer

Gastric cancer ranks as the fifth most common malignant tumor worldwide and is the third most common cause of cancer-related death. For advanced gastric cancer (AGC), neoadjuvant chemotherapy (NAC) can reduce its stage, increase the rate of radical resection, improve response to treatment, reduce the risk of local recurrence and improve survival rate. Regional arterial infusion chemotherapy (RAIC) is a form of NAC that involves directly injecting chemotherapeutic drugs into the tumor site through the tumor-feeding artery. RAIC increases the local drug concentration around the tumor, thereby improving the therapeutic responses and reducing the adverse effects of the drugs. In recent years, RAIC has attracted increasing attention. This article summarizes the basic principles, procedure, chemotherapy regimens, adverse drug reactions and complications, clinical applications and response evaluation of RAIC in the treatment of AGC.

A Totally Absorbable Multilayer PLGA Implant Device Containing Doxorubicin Inhibited Tumor Growth and Metastasis without Systemic Toxicity in Murine Breast Cancer and an Ideal Pharmacological Paradigm for Regional Chemotherapy

We hypothesize that a cylinder implant made of multilayer Poly-lactic-co-glycolic-acid (PLGA) membrane can be a method for controlled and extended drug release. We fashioned a multilayer cylindrical implant termed STID100 that released doxorubicin for 3 weeks in an orthotopic 4T1 breast cancer model in Balb/C mice. This implant starts as a thin doxorubicin-embedded PLGA membrane, and is then rolled into a cylinder containing an air gap between the membrane layers. Its controlled sustained release delivered 2× the amount of the intravenous (IV) equivalent of doxorubicin, inhibited the primary tumor, and prevented lung metastasis. Importantly it did not cause weight loss, splenomegaly, or cardiac toxicity vs systemically administrated doxorubicin. This favorable safety profile is further substantiated by the finding of no detectable plasma doxorubicin in multiple time points during the 3-week period, and low tumor doxorubicin concentration. The implant system delivered to the specification of an ideal pharmacological paradigm might offer a better coverage of the local tumor, significantly preventing metastatic spread with less drug toxicity to many vital organs, compared to the traditional pharmacology of IV route. The profile of STID made it an attractive therapeutic alternative in metastatic tumor prevention, pain management and many other diverse clinical scenarios.

Effect of systemic intravenous chemotherapy combined with regional arterial perfusion chemoembolization on the malignancy of locally advanced gastric cancer

Objective:To study the effect of systemic intravenous chemotherapy combined with regional arterial perfusion chemoembolization on the malignancy of locally advanced gastric cancer. Methods:A total of 90 patients with primary gastric cancer who received treatment in Tianyou Hospital Affiliated to Wuhan University of Science & Technology between January 2014 and May 2016 were collected and divided into control group and observation group according to the random number table method, 45 cases in each group. The control group of patients received routine systemic intravenous chemotherapy + surgical treatment, and the observation group of patients received systemic intravenous chemotherapy combined with local arterial perfusion chemoembolization + surgical treatment. Levels of tumor markers and angiogenesis factors in serum as well as the expression of oncogenes and tumor suppressor genes in gastric cancer tissue were compared between the two groups of patients before and after chemotherapy.Results:Before chemotherapy, the levels of tumor markers and angiogenesis factors in serum as well as the expression of oncogenes and tumor suppressor genes in gastric cancer tissue were not significantly different between the two groups of patients;after chemotherapy, serum CEA, CA724, CA242, AFP, VEGF, Ang-2, COX2 and PD-ECGF levels of observation group were lower than those of control group, andiASPP, p130Cas, ERBB2 and C-myc mRNA expression in gastric cancer tissue were lower than those of control group while GKN1, p16, PTEN, TSPYL5 and merlin mRNA expression in gastric cancer tissue were higher than those of control group.Conclusions: Preoperative systemic intravenous chemotherapy combined with regional arterial perfusion chemoembolization can effectively reduce the malignancy of locally advanced gastric cancer and provide favorable conditions for the operation.

Effects of cytoreductive surgery combined with hyperthermic perfusion chemotherapy on prognosis of patients with advanced gallbladder cancer

BACKGROUND Gallbladder cancer(GC)is a common malignant tumor and one of the leading causes of cancer-related death worldwide.It is typically highly invasive,difficult to detect in the early stages,and has poor treatment outcomes,resulting in high mortality rates.The available treatment options for GC are relatively limited.One emerging treatment modality is hyperthermic intraperitoneal chemotherapy(HIPEC).HIPEC involves delivering heated chemotherapy directly into the abdominal cavity.It combines the strategies of surgical tumor resection and localized chemotherapy administration under hyperthermic conditions,aiming to enhance the concentration and effectiveness of drugs within the local tumor site while minimizing systemic toxicity.AIM To determine the effects of cytoreductive surgery(CRS)combined with HIPEC on the short-term prognosis of patients with advanced GC.METHODS Data from 80 patients treated at the Punan Branch of Renji Hospital,Shanghai Jiao Tong University School of Medicine between January 2018 and January 2020 were retrospectively analyzed.The control group comprised 44 patients treated with CRS,and the research group comprised 36 patients treated with CRS combined RESULTS The baseline data of the research and control groups were similar(P>0.05).Six days after surgery,the alanine aminotransferase,aspartate aminotransferase,total bilirubin,and direct bilirubin levels significantly decreased compared to the preoperative levels in both groups(P<0.05).However,the values did not differ between the two groups six days postoperatively(P>0.05).Similarly,the postoperative creatinine and blood urea nitrogen levels were significantly lower than the preoperative levels in both groups(P<0.05),but they did not differ between the groups six days postoperatively(P>0.05).Furthermore,the research group had fewer postoperative adverse reactions than the control group(P=0.027).Finally,a multivariate Cox analysis identified the tumor stage,distant metastasis,and the treatment plan as independent factors affecting prognosis(P<0.05).The three-year survival rate in the study group was higher than that in the control group(P=0.002).CONCLUSION CRS combined with HIPEC lowers the incidence of adverse reactions and improves survival in patients with advanced GC.

Regional but fatal: Intraperitoneal metastasis in gastric cancer

Peritoneal carcinomatosis appears to be the most common pattern of metastasis or recurrence and is associated with poor prognosis in gastric cancer patients. Many efforts have been made to improve the survival in patients with peritoneal metastasis. Hyperthermic intraperitoneal chemotherapy remains a widely accepted strategy in the treatment of peritoneal dissemination. Several phase Ⅱ-Ⅲ studies confirmed that the combined cytoreducitve surgery and hyperthermic intraperitoneal chemotherapy resulted in longer survival in patients with peritoneal carcinomatosis. In addition,proper selection and effective regional treatment in patients with high risk of peritoneal recurrence after resection will further improve prognosis in local advanced gastric cancer patients.

Comparison of regional arterial chemotherapy and systemic intravenous chemotherapy for advanced pancreatic cancer:a systematic review and meta-analysis

Chemotherapy is the mainstay of treatment for advanced pancreatic cancer(stageⅢ/Ⅳ).However,conventional systemic intravenous chemotherapy(SIC)has been unsatisfactory for pancreatic cancer.In recent years,regional arterial infusion chemotherapy(RAIC)has been clinically used as a new chemotherapy regimen for the treatment of advanced pancreatic cancer,but its efficacy is controversial.The purpose of this study was to evaluate the clinical efficacy and safety of RAIC.We searched literatures in databases such as PubMed,EMBASE,Cochrane Library,Web of Science,and CNKI.After screening,this meta-analysis finally included 9 randomized controlled trials(RCTs)with 444 patients(230 RAIC and 214 SIC).We used the Cochrane Risk of Bias 2.0 tool to assess risk of bias for included RCTs.Outcomes were overall survival(OS),overall response rate(ORR),adverse events rate(AER),and pain remission rate.Outcome indicators used relative risk(RR)and its 95%confidence interval(CI)as effect analysis statistics.The results showed that RAIC had some advantages over SIC in terms of ORR,OS,incidence of leukopenia,and pain remission.In conclusion,compared with SIC,RAIC has better clinical efficacy and lower toxicity in the treatment of advanced pancreatic cancer.

Conversion of Unresectable to Resectable Liver Metastases from Colorectal Carcinoma Using Hepatic Arterial Chronomodulated Chemotherapy: A Case Report and Short Literature Review

Background: The regional chronomodulated hepatic arterial infusion chemotherapy (HAIC) is an effective regimen for the treatment of patients with unresectable liver metastases from colorectal cancer, especially for the conversion into resectability. Aim: To demonstrate that chronomodulated HAI triplet chemotherapy according to OPTILIV protocol is well tolerated and displayed high antitumor activity in this heavily-pretreated patient. Case Presentation: A 54 years old patient from Russia was treated for a tumor in the ascending colon presented with 13 hepatic metastases ranging from 0.3 to 2.7 cm in diameter. He underwent a laparoscopic right hemicolectomy, 12 cycles of FOLFIRINOX combined to bevacizumab for the last 5 cycles, resulting in a partial response according to CT scan. It was decided to perform a two-stage hepatectomy at Paul Brousse hospital: left partial hepatectomy allowed the excision of 9 lesions. Radio frequency ablation was performed in 2 nodular lesions. Afterwards, the patient received 5 cycles of chronomodulated triplet chemotherapy into the hepatic artery, according to the OPTILIV protocol design, yet without cetuximab, because of the KRAS mutation in the liver metastases, with a partial re-sponse. The patient could then undergo the second stage of the planned right hepatectomy, which turned out to be an R0 resection followed by receiving three courses of chronomodulated HAIC. Disease progression was documented after 3 months. Chronomodulated FOLFIRI chemotherapy was re-started intravenously, in combination with Aflibercept and it was associated with further disease progression. The genetic analysis of our patient’s cancer revealed a high level of MSI. The patient was included in the Phase 2 CheckMate-142 trial and received nivolumab 3 mg/kg every 2 weeks within 3 months. Treatment was discontinued due to ineffectiveness. Then the patient underwent radiotherapy geared towards reduction of pain. Afterwards, the patient died from the disease progression 2 years after the beginning of treatment. Conclusion: In this article, the authors report a clinical case with chronomodulated HAIC as rescue therapy in a heavily pretreated patient with metastatic colorectal cancer, allowing to achieve an objective response despite prior progression on FOLFIRINOX (the same triplet chemo by IV route). This strategy permitted to overcome drug resistance and to perform further complete resection of the liver me-tastases with prolonged patient survival. Thus, chronomodulated HAI is useful in patients with liver metastases from colorectal cancer and de-serves to be further assessed prospectively in clinical trials chemotherapy.

Performance of the Multiprofessional Team in Cytoreductive Surgeries with Intraperitoneal Hyperthermic Chemotherapy:Experience Reporting

Purpose:This study aims at reporting the experience of a cancer hospital’s multiprofessional team with surgery patients in performing cytoreductive surgeries associated with hyperthermic intraperitoneal chemotherapy.Methods:It is a reporting about the experience of the multiprofessional team at AC Camargo Cancer Center’s surgery center,which operates in cytoreductive surgeries with hyperthermic intraperitoneal chemotherapy,thus guaranteeing the surgery patient’s safety.Results:No safety report for the surgery patient subjected to intraperitoneal hypothermic chemotherapy was found in the literature.Therefore,the surgery center’s multiprofessional team’s practice was based on standards for manipulating chemotherapeutic agents and for safely administering medication.A checklist was elaborated for cytoreductive surgeries with hyperthermic intraperitoneal chemotherapy based on the surgery patient safety protocol and the institution’s multiprofessional team’s experience.Conclusions:From the multiprofessional team’s experiences in cytoreductive surgeries with hyperthermic intraperitoneal chemotherapy,the importance of elaborating a checklist to promote the quality of assistance and guarantee patient safety during the entire intraoperative phase became evident.

肝动脉灌注化疗联合仑伐替尼治疗巴塞罗那临床肝癌B或C期肝细胞癌

目的观察肝动脉灌注化疗(HAIC)联合仑伐替尼治疗巴塞罗那临床肝癌(BCLC)B或C期肝细胞癌(HCC)效果,分析影响患者生存时间的因素。方法 回顾性分析104例BCLC B或C期HCC患者资料,根据治疗方案将其归入观察组(46例,接受HAIC联合仑伐替尼治疗)及对照组(58例,仅接受HAIC);比较2组疗效、不良反应及患者总生存期(OS)和无进展生存期(PFS),以Cox回归分析评估OS影响因素。结果 治疗后3、6个月,观察组改良实体瘤疗效评价标准(mRECIST)评估结果均优于对照组(P均<0.05);治疗后1年,组间mRECIST评估结果差异无统计学意义(P>0.05)。观察组患者总生存率高于对照组(P<0.05),而组间无进展生存率差异无统计学意义(P>0.05)。观察组皮疹发生率高于对照组(P<0.05)。多因素Cox回归分析结果显示,相比单一HAIC,HAIC联合仑伐替尼[风险比(HR)=0.425,95%CI(0.255,0.791)]可延长患者OS;相比治疗前美国东部肿瘤协作组(ECOG)评分1、AFP≥400μg/ml、瘤灶数目≥3及BCLC C期,治疗前ECOG评分0、AFP<400μg/ml、瘤灶数目≤2及BCLC B期均为HCC患者OS独立保护因素(P均<0.05)。结论 HAIC联合仑伐替尼治疗BCLC B期或C期HCC安全、有效;治疗前ECOG评分、血清AFP水平、瘤灶数目及BCLC分期均为OS影响因素。

球囊阻断肝动脉灌注化疗用于不可切除肝细胞癌合并肝动脉-门静脉瘘

目的观察球囊阻断肝动脉灌注化疗(b-HAIC)用于不可切除肝细胞癌(HCC)合并肝动脉-门静脉瘘(HAPF)的有效性及安全性。方法回顾性分析8例接受FOLFOX b-HAIC的不可切除HCC合并HAPF患者,记录技术成功率及治疗相关不良事件并评价疗效。结果对8例成功完成17次b-HAIC,技术成功率100%。首次b-HAIC后1个月,8例HAPF瘘口分流量降低或完全闭合,治疗有效率100%。2~3次b-HAIC后,HCC客观缓解率(ORR)和疾病控制率(DCR)分别为87.50%(7/8)及100%(8/8)。8例治疗后均出现1~3级不良事件,以腹痛(7/8,87.50%)及转氨酶一过性升高(5/8,62.50%)为主,经休息或对症治疗后均好转;未见4~5级不良事件。结论b-HAIC治疗不可切除HCC合并HAPF有效且相对安全。

肝动脉灌注化疗栓塞术联合信迪利单抗治疗晚期原发性肝癌近期疗效及远期生存率

目的 探讨肝动脉灌注化疗栓塞术(TACE)联合信迪利单抗治疗晚期原发性肝癌(PLC)的近期疗效及远期生存率。方法2018年4月至2019年4月在资阳市人民医院82个随机双盲实验中,对符合AASLD指南,巴塞罗那(BCLC)分期为B/C期者;肝功能Child-Pugh分级A/B级的PLC进行研究。经计算机生成的随机列表随机分配,对照组仅行TACE治疗,研究组则采用TACE联合信迪利单抗治疗,连续治疗4周期比较两组临床疗效、肿瘤标志物水平T淋巴细胞亚群指标变化,随访观察远期生存情况。结果 对照组和研究组病人各41例,治疗后1个月时对照组肿瘤控制率(DCR)为80.49%,研究组DCR为92.68%,组间差异无统计学意义(χ^(2)=2.63,P=0.105);治疗后3个月时研究组DCR为87.80%,明显高于对照组的73.17%,组间差异有统计学意义(χ^(2)=4.00,P=0.046)。治疗前,研究组甲胎蛋白(AFP)、高尔基体蛋白73(GP-73)及甲胎蛋白异质体3(AFP-L3)水平分别为(82.74±5.77)μg/L、(90.27±4.67)μg/L及(148.74±62.15)mg/L,对照组3项指标水平依次为(84.28±6.02)μg/L、(89.74±5.32)μg/L、(156.20±41.03)mg/L,组间数据差异无统计学意义(t=1.18,t=0.48,t=0.64,P>0.05);治疗后研究组AFP、GP-73及AFP-L水平分别为(14.22±2.60)μg/L、(49.39±5.63)μg/L、(82.41±21.75)mg/L,均显著低于对照组的(57.13±6.21)μg/L、(65.28±3.74)μg/L、(117.20±35.62)mg/L,组间差异有统计学意义(t=40.81,t=15.05,t=5.34,P<0.05)。治疗前,研究组CD4+、CD8+及CD4+/CD8+水平分别为(29.17±6.33)%、(27.86±3.92)%、(1.04±0.25),对照组依次为(28.63±5.41)%、(28.53±4.63)%及(1.01±0.20),组间差异无统计学意义(t=0.42,t=0.73,t=0.60,P>0.05);治疗后研究组CD4+、CD4+/CD8+水平分别为(36.28±4.11)%、(1.33±0.40),显著高于对照组的(30.52±5.01)%及(1.09±0.32),组间差异有统计学意义(t=5.69,t=3.00,P<0.05)。治疗前,研究组CD151、CD168、CD9及CD63分别为(94.18±18.33)%、(96.27±16.08)%、(98.52±16.33)%、(94.57±10.96)%,对照组4项数据水平依次为(96.31±21.05)%、(97.24±14.20)%、(99.36±17.41)%、(93.64±12.60)%,组间差异无统计学意义(t=0.49,t=0.29,t=0.23,t=0.36,P>0.05);治疗后研究组CD151、CD168指标水平分别为(32.06±6.34)%、(31.28±4.78)%,显著低于对照组的(87.36±15.03)%、(76.34±11.52)%,而CD9及CD63水平分别为(210.54±27.12)%、(247.02±30.21)%,显著高于对照组的(104.52±12.94)%、(110.32±16.30)%,组间差异有统计学意义(t=21.71,t=23.13,t=22.59,t=25.50,P<0.05)。治疗后随访36~48个月,研究组失访3例,总生存率为47.37%,对照组失访1例,总生存率为25.0%,组间差异有统计学意义(χ^(2)=4.24,P=0.040)。研究组≥3级毒副反应总发生率为13.16%,与对照组27.5%差异无统计学意义(χ^(2)=2.46,P=0.117)。结论 TACE联合PD-1治疗晚期PLC可降低机体肿瘤标志物水平、提升病人的免疫功能及近期疗效,同时可延长病人远期生存率,严重毒副反应发生率较低。

基于FOLFOX方案球囊阻断肝动脉灌注化疗治疗不可切除肝细胞癌

目的观察基于FOLFOX方案球囊阻断肝动脉灌注化疗(b-HAIC)治疗不可切除肝细胞癌(uHCC)的有效性和安全性。方法回顾性分析20例接受FOLFOX方案b-HAIC治疗的uHCC患者资料,根据氟尿嘧啶剂量分为低(600 mg/m^(2)·22 h,8例)、中(1200 mg/m^(2)·44 h,6例)及高剂量组(2400 mg/m^(2)·44 h,6例);记录b-HAIC治疗周期,评估临床疗效,计算客观反应率(ORR)和疾病控制率(DCR),并通过甲胎蛋白(AFP)变化评估治疗有效性。记录治疗相关不良事件。结果20例接受1~4个(中位数为2个)周期b-HAIC治疗。随访7~31周、中位随访时间15周,期间完全缓解4例(4/20,20.00%),部分缓解12例(12/20,60.00%),疾病稳定4例(4/20,20.00%),ORR达80.00%(16/20),DCR 100%(20/20);最佳疗效出现于开始治疗4~16周后,中位时间为6周。低、中、高剂量组ORR分别为75.00%(6/8)、83.33%(5/6)、83.33%(5/6),各组DCR均为100%;17例b-HAIC前AFP升高,治疗后均不同程度降低。治疗相关不良事件包括灌注期间上腹部疼痛、恶心和呕吐,以及b-HAIC后转氨酶及总胆红素升高、中性粒细胞百分比升高、骨髓抑制等,均经对症处理后改善。结论基于FOLFOX方案的b-HAIC用于uHCC近期疗效佳且不良反应可控。

FOLFOX-肝动脉灌注化疗联合程序性死亡受体-1抑制剂和靶向药物治疗中国肝癌分期Ⅲa期肝细胞癌

目的观察FOLFOX-肝动脉灌注化疗(HAIC)联合程序性死亡受体-1(PD-1)抑制剂和靶向药物治疗中国肝癌分期(CNLC)Ⅲa期肝细胞癌(HCC)的价值。方法回顾性分析61例接受PD-1抑制剂+靶向药物治疗的CNLCⅢa期HCC患者,根据是否接受联合FOLFOX-HAIC治疗将其归入观察组(n=30)及对照组(n=31);比较组间一般资料、治疗方案、不良反应及疗效,分析观察组方案的治疗价值。结果组间患者一般资料及PD-1抑制剂+靶向药物方案差异均无统计学意义(P均>0.05);1~2级不良反应中,观察组恶心、呕吐及腹痛发生率均高于对照组(P均<0.05),而其余1~2级及3级不良反应组间发生率差异均无统计学意义(P均>0.05)。观察组客观缓解率(ORR)、无进展生存期(PFS)及总生存期(OS)均高于对照组(P均<0.05)。结论FOLFOX-HAIC联合PD-1抑制剂+靶向药物治疗CNLCⅢa期HCC疗效较佳而安全性尚可。

HIPEC、PRAC联合腹腔镜手术在中晚期结直肠癌中的应用效果及对血清肿瘤标志物水平的影响

目的分析腹腔热灌注化疗(HIPEC)、术前区域动脉灌注化疗(PRAC)联合腹腔镜手术在中晚期结直肠癌中的应用效果及对血清肿瘤标志物水平的影响。方法选择2018年1月至2020年12月收治的60例中晚期结直肠癌患者,以编号的奇偶性将其分为观察组和对照组,各30例。两组均实施腹腔镜手术治疗,对照组实施PRAC,观察组在对照组基础上术后给予HIPEC。比较两组的治疗效果。结果观察组的治疗总有效率高于对照组(P<0.05)。治疗后,观察组的糖链抗原19-9(CA19-9)、糖链抗原125(CA125)、糖链抗原242(CA242)及癌胚抗原(CEA)水平低于对照组,差异具有统计学意义(P<0.05)。治疗后,两组的CD4^(+)、CD8^(+)、CD4^(+)CD25^(+)、CD4^(+)/CD8^(+)及自然杀伤(NK)细胞比较,差异无统计学意义(P>0.05)。两组的不良反应总发生率比较,差异无统计学意义(P>0.05)。结论HIPEC、PRAC联合腹腔镜手术可提升中晚期结直肠癌患者的治疗效果,降低血清肿瘤标志物水平,改善预后,且安全性理想。

进展期胃癌术后奥沙利铂早期循环式腹腔热灌注化疗联合全身化疗的临床观察

目的观察进展期胃癌术后奥沙利铂早期循环式腹腔热灌注化疗联合全身化疗的临床疗效。方法选择2006年3月—2009年3月我院收治的可根治性切除的进展期胃癌患者86例,采用随机数字表法将患者随机分为两组:对照组43例和治疗组43例。对照组患者胃癌术后2～3周行全身化疗。治疗组患者根据胃癌术后恢复状况第1～2天开始行循环式腹腔热灌注化疗,1次/d,90 min/次,连续4 d,术后1个月行全身化疗。观察两组毒副作用及并发症,术后2年复发率及术后1、3年生存率。结果两组患者均无手术死亡。两组患者Ⅰ～Ⅱ度骨髓抑制、Ⅲ～Ⅳ度骨髓抑制、Ⅰ～Ⅱ度恶心呕吐、Ⅲ～Ⅳ度恶心呕吐、切口感染、吻合口漏、粘连性肠梗阻发生率比较,差异均无统计学意义(P>0.05)。治疗组43例患者胃癌术后早期腹腔热灌注化疗均顺利完成,术后1年时失访1例,对照组患者2年内复发率〔27.9%(12/43)〕较治疗组〔7.1%(3/42)〕升高、术后3年生存率〔37.2%(16/43)〕较治疗组〔73.8%(31/42)〕降低,差异均有统计学意义(P<0.05);两组术后1年生存率〔90.7%(39/43)与95.2%(40/42)〕比较,差异无统计学意义(P>0.05)。结论进展期胃癌术后早期循环式腹腔热灌注化疗联合全身化疗可明显降低腹腔复发率,无明显毒副作用,不增加术后并发症的发生率,能提高患者中远期生存率。

恩度肝动脉灌注联合肝动脉化疗栓塞治疗中晚期原发性肝癌的生存分析

目的探讨恩度肝动脉灌注联合经导管肝动脉化疗栓塞治疗中晚期肝癌的疗效。方法选取2009年9月-2011年6月天津医科大学附属石油医院收治的76例中晚期肝癌患者。其中44例给予恩度肝动脉灌注联合经导管肝动脉化疗栓塞治疗,其余32例作为对照组,仅行经导管肝动脉化疗栓塞治疗。治疗后,所有患者不定期行CT或磁共振成像(MRI)检查,观察肿瘤复发或转移情况以及有无肿瘤新生血管形成。计数资料组间比较采用χ2检验,Kaplan-Meier法绘制生存曲线,Log-rank法分析两组术后生存差异。结果恩度治疗组的治疗有效率(RR)高于对照组(70.45%vs 43.75%),差异有统计学意义(χ2=5.47,P<0.05);疾病控制率(DCR)高于对照组(84.09%vs 56.25%),差异有统计学意义(χ2=7.18,P<0.01);两组中位无进展生存时间(m PFS)分别为9.00个月和5.00个月,差异有统计学意义(P=0.044)。中位生存期(m OS)分别为10.64个月和8.11个月,差异无统计学意义(P=0.448)。结论采用恩度肝动脉灌注联合经导管肝动脉化疗栓塞治疗中晚期肝癌,可明显改善患者近期疗效及PFS,但对总生存期的改善不明显。

选择性区域灌注化疗对胃癌根治术后患者预后的影响

目的评价选择性区域灌注化疗对根治性胃癌切除术后患者预后的影响。方法 2003年1月-2005年12月解放军309医院普外科收治的胃癌患者共127例,入院后完善辅助检查除外远处转移,随机分为术中置泵(置泵组)和术中不置泵(对照组)两组。置泵组共63例,其中男51例,女12例,年龄50.7±6.2岁;对照组共64例,其中男54例,女10例,年龄53.3±7.5岁。两组在性别、年龄、TNM分期、病变部位、病理类型等方面的构成无统计学差异(P>0.05)。所有患者均行胃癌根治术,置泵组术中放置胃网膜右动、静脉和腹腔化疗泵,术后全身化疗联合区域灌注化疗,对照组术后仅行静脉化疗。比较两组并发症、局部复发率、肝脏转移率、腹腔转移率、1年生存率、3年生存率、5年生存率等指标。结果所有患者均成功实施手术,手术并发症主要为胃瘫和切口感染,多数患者完成6周期术后化疗,主要不良反应为轻到中度的恶心呕吐和白细胞减少,无手术和化疗相关死亡。置泵组和对照组分别有6例和9例患者未能完成化疗,原因包括不能耐受及化疗泵堵塞等。置泵组随访11.7～60个月,失访2例,对照组随访10.5～60个月,失访4例。置泵组和对照组间比较,局部复发率(17.5%,32.8%),肝脏转移率(27.0%,43.8%),腹腔转移率(14.3%,29.7%),3年生存率(71.4%,53.1%)和5年生存率的差异均有统计学意义(46.0%,28.1%,P均<0.05),但1年生存率间差异无统计学意义(92.1%,87.5%,P>0.05)。结论胃癌根治术后的选择性区域灌注化疗是对现有治疗模式的一种有益补充,值得临床推广应用。

晚期胰腺癌动脉灌注化疗与癌内注射的临床应用

晚期胰腺癌２１例，采用选择性动脉置管，ＡＤＭ、ＤＤＰ、５－ＦＵ灌注化疗，术中癌内注射５－ＦＵ或纯酒精。结果完全缓解４例，部分缓解７例，胰十二指肠二步切除１例；平均生存期９．１±３．４个月。晚期胰腺癌应用动脉灌注化疗与癌内注射治疗，可望获得再手术二步切除。

区域性动脉灌注化疗并栓塞对不能手术的恶性肠梗阻的临床应用

目的评价区域性动脉灌注化疗并栓塞对不能手术恶性肠梗阻的临床应用价值。方法回顾分析不能手术的恶性肠梗阻患者86例，行区域性动脉灌注化疗或配合栓塞治疗。计算治疗肠梗阻的有效率和显效时间。比较不同肿瘤肠梗阻的无进展生存时间和总生存期。结果肠系膜上动脉置管持续灌注化疗35例，肠系膜下动脉灌注化疗及栓塞51例，并双侧髂内动脉灌注化疗16例。同时行肠系膜上、下动脉灌注化疗7例。灌注化疗及栓塞1～8次，平均3．62次。初次治疗后肠梗阻开始缓解时间4—156h，平均22．5h。有效率为89．5％（77／86）。肠梗阻持续缓解时间2-16个月，平均（7．03±3．02）个月。从发生肠梗阻计算患者生存期为3～32个月，平均（11．57±5．47）个月。胃癌所致肠梗阻疗效及预后均较差。9例肠梗阻无明显缓解者给予对症治疗或手术治疗。结论区域性动脉灌注化疗及栓塞对不能手术恶性肠梗阻具有较高的肠梗阻缓解率。选择性直肠动脉灌注化疗及栓塞对缓解结直肠癌及盆腔转移瘤所致肠梗阻症状安全、可行。

紫杉醇腹腔热灌注治疗晚期卵巢癌临床观察

目的探讨肿瘤细胞减灭术(cytoreductive surgery,CRS)后紫杉醇腹腔热灌注治疗晚期卵巢癌的临床效果。方法选取晚期卵巢癌患者46例,随机分观察组和对照组各23例,观察组CRS后给予紫杉醇腹腔热灌注治疗+奥沙利铂、多西他赛静脉化疗,对照组CRS后给予奥沙利铂、多西他赛静脉化疗。比较2组治疗过程中出现的并发症与不良反应、疗效、肿瘤控制、腹腔积液控制、生活质量、无进展生存期(progression-free survival,PFS)等指标。结果 2组肿瘤控制情况和有效率差异无统计学意义(P>0.05);观察组腹腔积液控制情况和KPS评分情况优于对照组,无进展生存期长于对照组(P<0.05);2组不良反应发生率差异无统计学家意义(P>0.05)。结论晚期卵巢癌患者CRS术后实施紫杉醇腹腔热灌注治疗,可提高患者的腹腔积液控制、KPS评分、PFS,且不明显增加并发症与不良反应发生率。