Locoregional chemotherapy in neoplasms]

Intra-arterial chemotherapy of carcinoma increases drug concentration at the level of the tumour and reduces systemic toxicity. It is being used in the treatment of solid tumours in various parts of the body with increasingly encouraging results. It can also be carried out in an outpatient setting owing to the use of particularly advanced techniques.     

Locoregional chemotherapy of liver tumors

Experiences with different protocols of intraarterial chemotherapy in the treatment of primary or secondary liver malignancies in 38 cases were reported. The follow-up period was two years in all patients. Complications due to chemotherapy were observed only in very few patients. In 15 patients complications during chemotherapy from the implantable infusion system (Port a Cath) like leckage (n = 8), thrombosis of the system (n = 4), thrombosis of the hepatic artery (n = 1) and aneurysma of the hepatic artery (n = 2) occurred. Highest survival rates for the first and second year were achieved in patients with resectable liver metastases from colorectal cancer. A prophylactic implantation of an intraarterial catheter can be considered in patients in which a liver resection was performed because of multilocular uni- or bilateral metastases. CEA- and CA-19-9 levels did not correspond to the tumor progress in many cases.     

Primary chemotherapy in the treatment of breast cancer]

Between 1980 and 1992, 457 consecutive patients with initial breast cancer entered two successive protocols combining neoadjuvant chemotherapy, hormonotherapy (tamoxifen) and locoregional radiotherapy (teleradiotherapy and boost by iridium) as exclusive locoregional treatment. Cytological diagnosis, hormone receptors, cytological grading were provided by fine needle aspiration. Both protocols included velbe, thiotepa, methotrexate, 5FU and adriamycin with some minor differences regarding the schedule of doses and their number during induction and during the consolidation phase. In both studies, over 50% patients had locally advanced breast cancer (IIb, IIIa or IIIb). Chemotherapy induced tumor regression over 50% in 91% patients of the first protocol (30% complete clinical remission CR) and in 94% patients of the 2nd protocol (40% CR): in this protocol 20 poor responders were given a rescue protocol (2 CR; 9 partial remissions). The 5 year actuarial rate of breast preservation is 94% and the 5 year actuarial rate of local relapses is 15%. The cosmetic results according to Danoff are excellent 20%, good 55%, mean 35%. Disease free survival and overall survival compare favorably to published data: they depend on TNM stages, tumor differentiation and chemotherapy induced early tumor regression.     

Intra-arterial chemotherapy in the treatment of liver metastases of colorectal cancer]

AIM: The authors evaluate the value of hepatic intrarterial chemotherapy (HAC) as an alternative treatment for hepatic metastases from colo-rectum cancer unsuited to radical surgery. METHODS: This study evaluates the physiopathological and pharmacodynamic bases for this type of treatment, the correct procedure for patient staging and selection, the surgical technique used to insert the infusional system, surgical complications and those linked to endoarterial treatment, the evaluation of response and the results. Complications correlated to the infusional system were evaluated in a total of 1223 patients in 10 non-randomised studies and 7 randomised studies taken from the literature. Complications correlated to chemotherapy were analysed in a total of 777 patients from 8 randomised studies and 7 randomised using FUDR. Special emphasis was placed on the possible association of locoregional and systemic treatment in order to prevent extrahepatic progression, the main cause of death in patients undergoing a single cycle of HAC. RESULTS: By comparing locoregional and systemic treatment taken from a number of randomised and non-randomised studies, the results were evaluated in terms of objective response and survival. CONCLUSIONS: There was no proportional increase in survival rates compared to systemic treatment only, in spite of the large proportion of objective responses achieved using locoregional treatment alone.     

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随着肿瘤外科学的发展 ,肿瘤手术病人及术后复发病例的增加 ,癌复发的外科治疗成为研究的重要课题 ,可以称之为“复发外科学”。因为除早期癌可以通过手术达到基本治愈外 ,对进展期癌来说 ,即使是根治手术 ,不免有 40 %～ 5 0 %的病人要出现复发和转移。即使外科技术进一步提高 ,治愈率提高的幅度也不会很大 ,因为术后出现的某些癌复发 (血液、腹膜转移等 )是外科技术不能解决的。　　那么 ,对于术后复发的癌症病人应采取什么态度和治疗措施呢 ?有的根据传统观念、个人经验及失败教训 ,采取消极态度 ;有的强调本学科的优势 ,忽视综合治疗作…     

Neoadjuvant chemotherapy before definitive treatment for stage III carcinoma of the breast

One hundred women with American Joint Committee (AJC) stage III (T2, N2; T3, N0/1/2; T4, N0/1/2) carcinoma of the breast were treated with combination chemotherapy following biopsy to confirm the diagnosis and determine hormone receptor status before any other treatment of the local disease (so-called neoadjuvant chemotherapy). Response was assessed after three cycles of treatment, and responders were treated until the tumor and/or axillary nodes failed to show further regression. Definitive surgery was then performed, usually radical mastectomy. Chemotherapy was resumed following surgery for a total of 12 cycles. Ninety patients are assessable, and 70% have responded to chemotherapy. Outcomes of both responders and nonresponders were analyzed. Radical mastectomy without postoperative radiotherapy seems to be the preferable surgical treatment for the responders. Median follow-up of the assessable patients was 27 months; projected five-year disease-free survival of the responders is greater than 65%, and projected overall five-year survival of this group is greater than 85%. Because the follow-up of these patients suggests a marked improvement in outcome compared with similar patients treated traditionally with mastectomy or radiotherapy followed by adjuvant chemotherapy, we advocate more widespread use of combination chemotherapy before definitive treatment for stage III carcinomas of the breast.     

Solitary metastasis of breast carcinoma in the optic chiasm

Optic chiasmatic compression from suprasellar metastatic lesions is well known, but metastasis intrinsic to the optic chiasm has not been reported. A 45-year-old woman, with treated breast carcinoma, presented with headache and chiasmatic syndrome from a large suprasellar tumour. At surgery, an exophytic chiasmatic tumour was encountered, with an appearance similar to a glioma. The pathological appearance was consistent with the primary neoplasm in the breast.     

新辅助化疗提高不可切除结直肠癌肝转移手术切除率

一、概述 结直肠癌是最常见的恶性肿瘤之一,全世界新发病例约100万／年,每年约50万患者因此而死亡。死亡的主要原因是肝转移。肝脏是结直肠癌最常见的,也常常是唯一的转移部位。而结直肠癌诊断时约有10％～25％发现时已伴有肝转移（同时性肝转移）,还有50％～70％最终发展到肝转移,尸检发现结直肠癌肝转移率高达60％～71％。结直肠癌肝转移完全切除后,5年生存期为21％～48％,甚至治愈。     

Intra-arterial infusion chemotherapy using implantable reservoir for liver metastasis of the lung cancer--an effective case]

A 70-year-old man, who had undergone operation for primary lung adenocarcinoma one and a half year ago, was readmitted to our hospital for back pain. The CT scan revealed liver, vertebrae and lymph nodes metastases. Because of severe back pain, irradiation to the thoracic vertebrae was performed first. Next, a catheter was inserted into the hepatic artery and an implantable reservoir for intra-arterial chemotherapy was also left in the subcutaneous tissue to treat the liver metastasis. Mitomycin C was injected intermittently in the hepatic artery more than 10 times. The liver metastasis became necrotic and almost disappeared. The patient was free from the back pain and there was no evidence of regrowth of the liver metastasis at the time of this report, which was 14 months after the discovery of the liver metastasis.     

乳腺癌肝转移特征及诊疗

乳腺癌发病人数逐年攀升,相较于其他部位转移的患者,乳腺癌肝转移患者通常预后较差.目前国内外尚无针对乳腺癌肝转移诊疗的指南.本文旨在为乳腺癌肝转移的临床诊疗提供一定的思路和依据.本文对乳腺癌肝转移临床特点、发病机制的研究现状与治疗进展进行综述.早期肝转移患者往往没有明显症状或体征,考虑肝转移的患者最好行影像学引导下穿刺确...