重组溶瘤单纯疱疹病毒oHSV2 治疗结直肠癌的实验研究

  目的  评估重组溶瘤单纯疱疹病毒oHSV2在CT26结肠癌荷瘤小鼠中的抗肿瘤效果,初步探讨其治疗机制。  方法  构建CT26细胞荷瘤小鼠肿瘤模型。1）小鼠瘤内注射oHSV2,ELISA法测定血清中粒细胞-巨噬细胞集落刺激因子（granulocyte-macro-phage colony-stimulating factor,GM-CSF）浓度;2）荷瘤小鼠分为oHSV2组、5-氟尿嘧啶（5-FU）组（阳性对照组）、磷酸盐缓冲液（PBS）组（阴性对照组）。给药后,记录小鼠体质量、肿瘤体积、生存期及生活状态等变化,评估病毒抗肿瘤效果;3）流式细胞术定量检测肿瘤引流淋巴结（tumor-draining lymphnode,TDLN）内树突状细胞（dendritic cell,DC）及瘤体内CD4+T与CD8+T的比例。  结果  1）瘤内注射oHSV2后,血清中的GM-CSF浓度不断升高。首次给药后第8 天出现高峰（3150±327.1）pg/mL,后缓慢下降;2）相比PBS组,oHSV2和5-FU组均表现出显著的抗肿瘤效果,小鼠生存期显著延长（50 d vs. 36 d,P＜0.01;51 d vs. 36 d,P＜0.01）,但oHSV2治疗未引起小鼠体质量下降。治疗起始第28天,5-FU组平均体质量较PBS组有显著性差异（16.61 g vs. 22.07 g,P＜0.01）,oHSV2组与PBS组差异无统计学意义（P>0.05）,且小鼠病毒注射区皮肤无坏死、溃疡;3）流式分析结果显示相比PBS组,oHSV2治疗组的DC（6.49% vs. 3.73%,P＜0.01）,CD4+T（15% vs. 8.57%,P＜0.01）与CD8+T（8.19% vs. 5.15%,P＜0.01）比例升高。而5-FU组各细胞比例较PBS组明显降低（P＜0.05）。  结论  瘤内注射oHSV2有效抑制结直肠癌细胞生长,病毒治疗与化疗药物相比不伴有明显的毒副反应。病毒在荷瘤小鼠体内复制产生具有生物活性的GM-CSF,可增强抗肿瘤免疫。      

结直肠癌可切除肝转移灶的术前化疗文献复习

结直肠癌是常见的肿瘤之一,近一半的患者最终会发生肝转移,肝转移灶切除是唯一的治愈方法。对于评估为可切除的肝转移灶,由于其术后复发率高,患者生存时间并未有显著延长,术前影像学难以发现的肝内微小转移灶成为局部复发的重要因素之一。术前化疗可以减少微小转移灶,增加R0切除（完整切除）率,减少术后复发风险。但是,是否所有术前评估为可切除肝转移灶的结直肠癌患者均可以从术前化疗中获益仍存在争议。     

结直肠癌肝转移免疫治疗研究进展

肝转移是评估结直肠癌（colorectal cancer,CRC）患者治疗效果和生存预后的关键影响因素。近年来,免疫疗法通过强化宿主的抗肿瘤免疫反应,已经在多种实体瘤的治疗中展现出良好的潜力,成为转移性或复发性实体瘤治疗的主流选择。基于免疫检查点抑制剂的免疫疗法在CRC治疗中显示出了安全性和有效性的积极进展,尤其是在错配修复缺陷（deficient mismatch repair,dMMR）型CRC中表现突出。然而,对于肝转移患者而言,其生存预后的改善尚不明显。本文回顾了免疫治疗在CRC肝转移治疗中的应用策略和疗效,并对其未来的发展方向进行探讨和展望。     

结直肠癌肝转移治疗进展

结直肠癌肝转移是影响结直肠癌患者生存率的主要原因,目前对其治疗尚无最佳方案。肝叶切除术是治疗肝转移癌的“金标准”,对于3个以下的肝脏转移灶,行肝叶切除术是最佳选择。而对于无手术指征的肝转移患者,使用去氧氟尿苷的肝动脉化疗可获得较高的缓解率。随着生理周期化疗、基因治疗、射频消融治疗、肝血流阻断灌注治疗等方法的发展,结直肠癌肝转移患者的治愈率有望获得提高。     

腹腔镜下同期治疗结直肠癌并肝转移的临床观察

目的 探讨腹腔镜下行结直肠癌切除术同时处理合并肝转移癌的疗效。方法 对32例结直肠癌合并肝转移患者行腹腔镜下结直肠癌切除手术,同时利用腹腔镜直视下切除或射频消融等方法治疗肝转移癌。结果 32例患者手术过程顺利,手术时间为220～384min,平均280min,出血量为240～1300ml,无严重并发症发生。随访6～32月,18例存活,7例死于肺、脑或腹腔转移,3例死于复发,2例死于脑出血,2例死于心肌梗塞。结论 利用腹腔镜直视下治疗结直肠癌并肝转移安全有效,可避免二期手术的创伤。     

儿童胃间质瘤肝转移一例并文献复习

目的 提高对胃间质瘤病理特点、临床诊疗的认识。 方法 结合文献复习对1例儿童胃交界性间质瘤恶变转移的临床资料进行分析。 结果 本例患者儿童期起病,以腹部包块、腹痛、腹泻、呕血、黑便为主要表现,通过剖腹探查、免疫组织化学等明确诊断为胃交界性间质瘤,未接受手术及分子靶向治疗,随访至2016年3月已达6年之久,其日常生活及学习尚能自理,但病灶出现逐年增大并远处转移。 结论 不经治疗的胃交界性间质瘤有恶变及转移趋势,应积极采取治疗措施,减少恶变及转移,提高患者生命质量。     

结直肠癌肝转移的治疗进展

结直肠癌肝转移是影响结直肠癌预后的重要因素，治疗方案包括手术治疗、化疗（全身静脉化疗和介入治疗）、基因治疗和局部治疗（射频消融、激光消融、无水酒精注射和冷冻切除术）等，其中手术是目前唯一有效的治愈手段，手术死亡率1％～2．8％，术后5年生存率34％-38％，但仅有10％．25％结直肠癌肝转移患者确诊时适合于手术切除，因此各种非手术治疗的作用正日益受到关注。本文对结直肠癌肝转移的综合治疗作一综述。     

结直肠癌肝转移的治疗

结直肠癌是常见的恶性肿瘤之一 ,肝脏是结直肠癌常见的远处转移器官 ,结直肠癌患者最终约有 5 0 %发生肝转移[1] 。如何处理结直肠癌肝转移 ,是改善结直肠癌预后的 1个重要研究课题 ,我们对此作一综述。1　手术治疗结直肠癌肝转移患者行肝切除术是获得治愈的首选治疗手段 ,术后 5年生存率达 2 5 %～ 40 % [2～ 4 ] 。Ｎｏｒｄｌｉｎｇｅｒ等[3] 报道80例 ,其中 44例为单发性 ,36例为多发性 ;局限于 1叶者 76例 ,2叶者 4例 ;43例为同时性肝转移癌 (ｓｙｎｃｈｒｏｎｏｕｓｌｉｖｅｒｍｅｔａｓｔａｓｅｓ) ,37例为异时性肝转移癌 (ｍｅｔａｃ…     

结直肠癌肝转移的治疗现状及进展

对于结直肠癌肝转移病人,肝切除术彻底清除转移病灶被认为是目前的首选疗法.随着技术的进步,手术的适应证得到了很大拓展,主要决定于手术切除的可行性.化疗、消融治疗作为传统的辅助疗法,近年亦得到不断完善.而新出现的许多分子生物学疗法正得到迅速发展,部分已进入临床研究阶段,显示出较好的耐受性,并在部分患者的治疗中取得了良好效果.联合应用这些疗法以获得更佳的疗效,有着远大的前景.     

结直肠癌肝转移的治疗进展

结直肠癌是威胁人类健康的重要疾病之一,世界范围每年有超过1百万的新发病例,将近50万的患者死于该病。其发病率位于欧美发达国家恶性肿瘤第3位,死亡率位于第2位[1]。我国结直肠癌发病率呈上升趋势,发病率位于恶性肿瘤的第3位,而病死率位于第5位[2]。约有25%的患者在确诊结直肠癌时发现肝转移,另有25%在疾病进展过程中出现肝转移,最终约2/3的患者死于肝转移[3]。以往结直肠癌出现肝转移被认为是晚期的表现,无积极治疗的价     

Anaerobic liver abscess and intrahepatic metastases: a case report and review of the literature.

A patient is described in whom the first recurrence of a cloacogenic carcinoma of the rectum was an intrahepatic metastasis associated with an hepatic abscess caused by the anaerobic bacterium Peptococcus prevotii. Three previously reported cases of infection associated with hepatic tumor nodules have been found in which bacteriologic data were provided, and in all three cases anaerobic bacteria were the primary or only infection organisms. Experimental data exist which document the ability of certain anaerobic bacteria to grow selectively in tumor nodules, but not in the normal tissues of a tumor-bearing host. Since 23% of patients with liver metastases have fever and offer a clinical picture compatible with infection, occult anaerobic infection associated with liver metastases may be more common than previously recognized.     

Rectal neurogenic sarcoma: case report and review of the literature

A neurogenic sarcoma without NF-1 was discovered in a 73-year-old woman in the anorectal region, an unusual site for these tumors. The tumor was of high-grade malignancy and deeply located with mesorectal infiltration; it did not originate from a major nerve. We presume an origin from less differentiated neural crest cells and present a review of the literature on the best treatment for these neoplasms.     

Rectal small cell carcinoma: a case report and review of the literature

We present a rare case of small cell carcinoma of the rectum presenting with rectal bleeding and discomfort in a fit 51-year-old gentleman. Our patient was treated with a combination of chemotherapy and radiotherapy and remains alive and free of disease 6 years after diagnosis. Our patient experience and review of the literature is presented highlighting the uncertainties regarding the biological behaviour and management.     

Late brain metastases from colorectal cancer a case report and review of the literature

Metastatic brain tumors from colorectal cancer are relatively rare. In previous reports the incidence ranged from 1.9 to 3.5 percent of all metastatic brain tumors. In another recent article the cumulative incidence of brain metastasis was estimated at 1.2%. The prognosis for patients with even a single resectable brain metastasis is poor. This paper presents the case report of a 72-year-old woman with a solitary brain metastasis 16 years after a diagnosis of colorectal cancer. She remained asymptomatic for 16 years. The first sign of a secondary tumor was diplopia. Brain scan demonstrated a space-occupying lesion in the occipital area. A solitary tumor was removed by craniotomy. Histological examination showed that it was a metastasis from the intestinal primary tumor. The patient subsequently underwent whole brain radiotherapy for a total dose of 30 Gy in 10 fractions.     

Total vertebral body breast cancer metastases: one case report and literature review

Introduction
Breast cancer is one of the most commonly seen malignant tumors in the female population, and it ranks the first in the incidence of malignancies among women. The skeleton is a common metastatic site for advanced breast cancer and is where spinal metastasis is most frequently seen. The incidence rate of spinal metastasis in descending order is as follows： thoracic vertebrae, lumbar vertebrae, sacrococcygeal vertebrae and cervical vertebrae.     

Multiple liver metastases of breast cancer: report of a case successfully treated with hormone-cytokine-chemotherapy.

The prognosis of patients with hepatic metastasis from breast cancer is usually extremely poor. We present the case of a 39-year-old Japanese woman diagnosed with multiple liver metastasis from breast cancer. A novel approach consisting of hormone-cytokine-chemotherapy with an arterial infusion therapy was carried out. Computed tomography and ultrasonography revealed that the multiple liver metastases were reduced with remaining calcification. Tumor markers decreased rapidly. Complete regression was achieved after these treatments. To date, there has been no relapse during the 8-year follow-up period. These results suggest that the hormone-cytokine-chemotherapy might be a rational modality of treatment against multiple metastatic breast cancer.     

Malignant thymoma with metastases to the gastrointestinal tract and ovary: a case report and literature review

This is the first clinical case report of a thoracic invasive thymoma metastatic to the ovary with disease noted in the entire abdomen including the pelvis 5 1/2 years after initial diagnosis. The involved areas of metastases include the distal ileum, peritoneal and serosal surfaces (including the surface of the distal colon, bladder, and pelvis), and the surface of the right ovary. The patient survived 13 years after her initial diagnosis and 7 1/2 years after discovery of her metastases. Thymomas are rare tumors but comprise the most common primary tumor of the anterior mediastinum. Extrathoracic metastases of malignant thymomas are also rare, and the literature reports that the most common sites for metastases are the liver, lung, lymph nodes, and bone. Extrathoracic disease is associated with a poor prognosis. The average time of survival after the diagnosis of metastases is 1.5 years.     

Gliosarcoma with multiple extracranial metastases: case report and review of the literature

Gliosarcoma is a rare malignant neoplasm of the central nervous system with a propensity for metastasis. There are fewer than 20 reported cases of extracranial metastases of gliosarcoma with the majority of cases reflecting a tendency for hematogenous dissemination. Here we describe the case of a 47-year-old man who developed pervasive extracranial metastases from a temporal gliosarcoma following radio- and chemotherapy for a primary glioblastoma. The patient initially presented with progressively worsening headaches, left-sided weakness and numbness associated with right temporo-parietal mass for which he underwent craniotomy with stereotactic gross-total excision. Two months postoperatively, interstitial brachytherapy and external beam radiotherapy were initiated. The patient initially declined chemotherapy. The tumor recurred twice and the patient underwent re-operation and multiple courses of chemotherapy; histopathological diagnosis remained glioblastoma multiforme. Nineteen months following initial resection the patient’s clinical status deteriorated and CT scan demonstrated multiple intrathoracic, hepatic and splenic lesions. Postmortem examination revealed widespread, infiltrating gliosarcoma with intravascular gliomatosis and extensive visceral metastases. This is the first report of pervasive extracranial metastases to numersous sites, several of which have not been previously reported. The histogenesis and the potential role of therapeutic irradiation in the development of gliosarcoma are briefly reviewed.     

Rectal metastases from lobular carcinoma of the breast: Report of a case and literature review

Metastatic involvement of the gastrointestinal (GI) tract secondary to breast cancer is rare. Reported herein is the case of a 74-year-old woman with metastatic lobular breast carcinoma to the rectum presenting with obstruction. The breast tumour was diagnosed nine years prior to the presentation of rectal metastases. Endoscopy was repeated twice until a diagnosis was established. Examination of endoscopy material revealed infiltration of the rectum by malignant signet ring cells identical to those of the primary breast tumour. The patient did not respond to chemotherapy and underwent laparotomy with a defunctioning colostomy. Literature review revealed only a few more cases of metastatic breast carcinoma to the rectum.Awareness of this condition may lead to accurate diagnosis and early initiation of systemic treatment, thus avoiding surgical intervention.