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1.
Onco Targets Ther ; 9: 5897-5902, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27713643

RESUMO

BACKGROUND: Radical resection is the main treatment for colorectal cancer (CRC), but metastasis or recurrence is common in which liver metastasis accounted for 83% of the cases. Therefore, the prognosis of patients with advanced CRC may be improved if liver metastasis is prevented. This study aims to investigate the efficacy of hepatic arterial infusion chemotherapy (HAIC) on liver metastases of stage III CRC patients after curative resection. METHODS: Between 2002 and 2008, 287 stage III CRC patients who had undergone radical resection were included in this study. According to postoperative adjuvant chemotherapy modality, these patients were divided into two groups. Patients in the combined therapy group received two cycles of HAIC plus four cycles of systemic chemotherapy, while patients in the monotherapy group received six cycles of systemic chemotherapy alone. The HAIC regimen consisted of hepatic arterial infusion of oxaliplatin (OXA, 85 mg/m2) on day 1 and 5-fluorouracil (5-FU, 2,400 mg/m2) on days 2 and 3 followed by a vein infusion of folinic acid (FA, 200 mg/m2) as a 2-hour infusion on days 2 and 3. The systemic chemotherapy regimen consisted of a 2-hour infusion of OXA (85 mg/m2) on day 1 followed by FA (200 mg/m2) as a 2-hour infusion on days 2 and 3, and by 5-FU (2,400 mg/m2) as a 48-hour infusion. This was repeated every 4 weeks. All cases were followed up for 5 years or until death. The 5-year overall survival, disease-free survival, liver metastases-free survival, and the overall liver metastases rates were retrospectively compared. RESULTS: Significant differences were found in the 5-year overall survival (combined therapy, 70.71%; monotherapy, 57.14%; P=0.014), disease-free survival (combined therapy, 69.29%; monotherapy, 55.78%; P=0.021), and liver metastases-free survival rates (combined therapy, 70%; monotherapy, 56.46%; P=0.019). CONCLUSION: Prophylactic adjuvant HAIC can prevent metachronous liver metastases and improve the prognosis of patients with stage III CRC after curative resection.

2.
Drug Des Devel Ther ; 10: 2461-6, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27536066

RESUMO

OBJECTIVE: This study aimed to investigate the efficacy of Jianpi Ligan decoction (JLD) as an adjuvant therapy for patients with unresectable hepatocellular carcinoma (HCC) treated by transarterial chemoembolization (TACE). METHODS: From March 2007 to March 2013, 103 patients with unresectable HCC who underwent TACE in our center were included in this retrospective study. Among the 103 patients, 53 patients accepted JLD along with TACE (JLD group) and 50 patients accepted TACE alone (control group). Indices including complication, toxicity, treatment success rate, and long-term survival were obtained for analysis and comparison. RESULTS: There was no significant difference in patient characteristics between the two groups. No procedure-related deaths or encephalopathy occurred. Fewer patients from the JLD group experienced constipation (7/53 vs 15/50, P=0.0377), abdominal bloating (5/53 vs 12/50, P=0.0466), and lack of appetite (35/53 vs 42/50, P=0.0360). The JLD group had lesser and lighter hepatic toxicity (P=0.0265) and gastrointestinal toxicity (P=0.0445) such as nausea and vomiting. The JLD group had a significantly higher treatment success rate than the control group (51/53 vs 40/50, P=0.0103). Three-year overall survival probability was significantly higher in the JLD group than in the control group (37.74% vs 26.00%; hazard ratio [HR] 0.6171; 95% confidence interval [CI], 0.3832-0.9938; P=0.0365 by log-rank test). No significant difference was found in 3-year overall survival probability (39.22% vs 32.50%; HR, 0.7449; 95% CI, 0.4398-1.2614; P=0.2491 by log-rank test) or 3-year intrahepatic recurrence-free survival probability in patients who achieved treatment success (37.25% vs 30.00%; HR, 0.7280; 95% CI, 0.4332-1.2233; P=0.2087 by log-rank test) between the two groups. CONCLUSION: Application of JLD was effective for reduction of side effects and improvement of long-term survival for patients with unresectable HCC treated by TACE.


Assuntos
Carcinoma Hepatocelular/tratamento farmacológico , Medicamentos de Ervas Chinesas/farmacologia , Medicamentos de Ervas Chinesas/uso terapêutico , Neoplasias Hepáticas/tratamento farmacológico , Quimioembolização Terapêutica , Humanos , Prognóstico , Modelos de Riscos Proporcionais , Estudos Retrospectivos , Taxa de Sobrevida , Resultado do Tratamento
3.
Hepatogastroenterology ; 62(137): 122-5, 2015.
Artigo em Inglês | MEDLINE | ID: mdl-25911881

RESUMO

BACKGROUND/AIMS: To explore the effect of prophylactic hepatic artery infusion chemotherapy (HAIC) on survival probability after curative resection in patients with hepatocellular carcinoma (HCC). METHODOLOGY: 85 patients with HCC were randomly assigned to HAIC group (42 cases) and control group (43 patients), all the database of two groups had no significant difference. Patients in HAIC groups underwent hepatic artery infusion chemotherapy (5-FU 1000 mg/m2 on day 1, Oxaliplatin 85 mg/m2 on day 1 and Gemcitabine 1000 mg/m2 on day 1 and 8) starting 3 weeks after operation with intervals of 4 weeks. All patients were followed up for 3 years and intrahepatic recurrence-free survival, disease-free survival rate and overall survival rate were recorded. RESULTS: Intrahepatic recurrence rate of HAIC group and the control group was respectively 19.05% and 39.53%, P < 0.05. Disease-free survival rate was respectively 57.14% and 44.19%, P < 0.05. Overall survival rate was 66.67% and 46.51%, P < 0.05. All patients in HAIC group tolerated the therapy. No adverse effect above grade 3 was reported in HAIC group. CONCLUSION: HAIC effectively and safely prevents intrahepatic recurrence and improves the prognosis of patients with HCC after curative resection.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma Hepatocelular/terapia , Hepatectomia , Artéria Hepática , Neoplasias Hepáticas/terapia , Terapia Neoadjuvante , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Carcinoma Hepatocelular/mortalidade , Carcinoma Hepatocelular/patologia , Quimioterapia Adjuvante , China , Desoxicitidina/administração & dosagem , Desoxicitidina/análogos & derivados , Progressão da Doença , Intervalo Livre de Doença , Esquema de Medicação , Feminino , Hepatectomia/efeitos adversos , Hepatectomia/mortalidade , Humanos , Infusões Intra-Arteriais , Estimativa de Kaplan-Meier , Neoplasias Hepáticas/mortalidade , Neoplasias Hepáticas/patologia , Masculino , Pessoa de Meia-Idade , Terapia Neoadjuvante/efeitos adversos , Terapia Neoadjuvante/mortalidade , Recidiva Local de Neoplasia , Compostos Organoplatínicos/administração & dosagem , Oxaliplatina , Estudos Prospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
4.
Hepatogastroenterology ; 61(133): 1415-20, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25436319

RESUMO

BACKGROUND/AIMS: This study aims to investigate the safety and efficacy of hepatic arterial infusion chemotherapy (HAIC) on liver metastases from pancreatic cancer after pancreatectomy. METHODOLOGY: We randomly assigned 106 patients with pancreatic cancer after pancreatectomy between 2005 and 2010 to receive 2 cycles of HAIC plus 4 cycles of systemic chemotherapy (Combined Therapy) or 6 cycles of systemic chemotherapy alone (Monotherapy). Both the HAIC and systemic chemotherapy regimen consisted of a 5-hour infusion of 5-fluorouracil 1000 mg/m2 on day 1 followed by gemcitabine 800 mg/m2 as an over 30-min infusion on day 1 and day 8. The treatment was started on an average of 21.2 days after surgery and repeated every 4 weeks. The disease-free survival, overall survival and liver metastases-free survival were compared. RESULTS: There was no significant difference in adverse effects between two groups. Significant differences were found in 3-year overall survival (Combined Therapy, 23.08 %; Monotherapy, 14.81%; P=0.0473) and liver metastases-free survival (Combined Therapy, 80.77%; Monotherapy, 55.56%; P=0.0014). CONCLUSIONS: HAIC effectively and safely prevents liver metastases and improves the prognosis of patients with pancreatic cancer after pancreatectomy.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinoma Ductal Pancreático/secundário , Carcinoma Ductal Pancreático/terapia , Artéria Hepática , Neoplasias Hepáticas/prevenção & controle , Neoplasias Hepáticas/secundário , Pancreatectomia , Neoplasias Pancreáticas/patologia , Neoplasias Pancreáticas/cirurgia , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Carcinoma Ductal Pancreático/mortalidade , Quimioterapia Adjuvante , China , Desoxicitidina/administração & dosagem , Desoxicitidina/análogos & derivados , Intervalo Livre de Doença , Esquema de Medicação , Estudos de Viabilidade , Feminino , Fluoruracila/administração & dosagem , Humanos , Infusões Intra-Arteriais , Estimativa de Kaplan-Meier , Neoplasias Hepáticas/mortalidade , Masculino , Pancreatectomia/efeitos adversos , Pancreatectomia/mortalidade , Neoplasias Pancreáticas/mortalidade , Fatores de Tempo , Resultado do Tratamento
5.
Hepatogastroenterology ; 61(131): 563-6, 2014 May.
Artigo em Inglês | MEDLINE | ID: mdl-26176036

RESUMO

BACKGROUND/AIMS: This study aims to compare the clinical outcomes and costs between endoscopic biliary stenting (EBS) and percutaneous transhepatic biliary stenting (PTBS). METHODOLOGY: We randomly assigned 112 patients with unresectable malignant biliary obstruction 2006 and 2011 to receive EBS or PTBS with self-expandable metal stent (SEMS) as palliative treatment. PTBS was successfully performed in 55 patients who formed the PTBS group (failed in 2 patients). EBS was successfully performed in 52 patients who formed the EBS group (failed in 3 patients). The effectiveness of biliary drainage, hospital stay, complications, cost, survival time and mortality were compared. RESULTS: Patients in PTBS group had shorter hospital stay and lower initial and overall expense than the BBS group (P < 0.05). There was no significant difference in effectiveness of biliary drainage (P = 0.9357) or survival time between two groups (P = 0.6733). Early complications occurred in PTBS group was significantly lower than in EBS group (3/55 vs 11/52, P = 0.0343). Late complications in the EBS group did not differ significantly from PTBS group (7/55 vs 9/52, P = 0.6922). The survival curves in the two groups showed no significant difference (P = 0.5294). Conclusions: 3.


Assuntos
Colangiopancreatografia Retrógrada Endoscópica/economia , Colestase/economia , Colestase/terapia , Neoplasias do Sistema Digestório/complicações , Drenagem/economia , Custos de Cuidados de Saúde , Stents/economia , Adulto , Idoso , China , Colangiopancreatografia Retrógrada Endoscópica/efeitos adversos , Colangiopancreatografia Retrógrada Endoscópica/instrumentação , Colangiopancreatografia Retrógrada Endoscópica/mortalidade , Colestase/diagnóstico , Colestase/etiologia , Colestase/mortalidade , Análise Custo-Benefício , Neoplasias do Sistema Digestório/economia , Neoplasias do Sistema Digestório/mortalidade , Drenagem/efeitos adversos , Drenagem/instrumentação , Drenagem/mortalidade , Feminino , Humanos , Estimativa de Kaplan-Meier , Tempo de Internação/economia , Masculino , Metais/economia , Pessoa de Meia-Idade , Complicações Pós-Operatórias/economia , Desenho de Prótese , Fatores de Tempo , Resultado do Tratamento
6.
Hepatogastroenterology ; 60(121): 42-5, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-22641110

RESUMO

BACKGROUND/AIMS: This study aims to compare the clinical outcomes and costs between percutaneous transhepatic biliary stenting (PTBS) and surgical bypass. METHODOLOGY: We randomly assigned 142 patients with unresectable malignant biliary obstruction between 2005 and 2010 to receive PTBS or surgical bypass as palliative treatment. PTBS was successfully performed in 70 patients who formed the PTBS group (failed in 7 patients). Sixty five patients underwent surgical bypass treatment. Additional gastrojejunostomy was performed in five patients. The effectiveness of biliary drainage, hospital stay, complications, cost, survival time and mortality were compared. RESULTS: Patients in PTBS group had shorter hospital stay and lower initial and overall expense than the surgical group (p<0.05). There was no significant difference in effectiveness of biliary drainage (p=0.9307) or survival time between two groups (p=0.4826). Early complications of PTBS group was significantly lower than surgical group (3/75 vs. 11/65, p=0.0342). Late complication in PTBS group did not differ significantly from surgical group (9/70 vs. 6/65, p=0.6823). The survival curves in the two groups showed no significant difference (p=0.1032). CONCLUSIONS: PTBD is a better palliative treatment than surgical bypass for unresectable malignant biliary obstruction for its high effectiveness of biliary drainage and acceptable expense and complication.


Assuntos
Colestase/terapia , Neoplasias/complicações , Stents , Adulto , Idoso , Procedimentos Cirúrgicos do Sistema Biliar/economia , Análise Custo-Benefício , Drenagem , Feminino , Derivação Gástrica/economia , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos
7.
Hepatogastroenterology ; 59(117): 1566-8, 2012.
Artigo em Inglês | MEDLINE | ID: mdl-22456329

RESUMO

BACKGROUND/AIMS: This study aims to investigate the influence of endostatin on angiogenesis in hepatocellular carcinoma (HCC) after transarterial chemoembolization (TACE). METHODOLOGY: Ninety-five patients with HCC were enrolled. Twenty-six patients received initial liver resection without preoperative TACE (non-TACE), 24 received preoperative TACE without endostatin (TACE), 22 received endostatin (15mg/m2) right after TACE intravenously (TACE-V) and 23 received endostatin (15mg/m2) through the hepatic artery during TACE (TACE-A). TACE was performed using Gemcitabine 1000mg/m2 (emulsified with lipiodol, 10-12mL), cisplatin 40 mg/m2 and 5-fluorouracil 500mg/m2 through the hepatic artery feeding the tumor. Patients received liver resection 4 weeks after second course of TACE. RESULTS: The mean microvessel density (MVD) was 32.23±12.71, 57.46±18.38, 44.36±15.13 and 43.48±15.59 in non-TACE, TACE, TACE-V and TACE-A group respectively. The positive rate of vascular endothelial growth factor (VEGF) expression was 46.15%, 91.67%, 77.27% and 73.91% in non-TACE, TACE, TACE-V and TACE-A groups, respectively. Compared to the non-TACE group, MVD and VEGF expression in TACE, TACE-V and TACE-A groups were significantly higher (p<0.05). MVD and VEGF expression in the TACE-V and TACE-A groups were significantly lower than in the TACE group (p<0.05). CONCLUSIONS: Endostatin could significantly repress angiogenesis in HCC after TACE by down-regulating expression of VEGF.


Assuntos
Inibidores da Angiogênese/uso terapêutico , Carcinoma Hepatocelular/terapia , Quimioembolização Terapêutica , Endostatinas/uso terapêutico , Neoplasias Hepáticas/terapia , Neovascularização Patológica/tratamento farmacológico , Adulto , Idoso , Antígenos CD34/metabolismo , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Carcinoma Hepatocelular/irrigação sanguínea , Carcinoma Hepatocelular/metabolismo , Cisplatino/administração & dosagem , Desoxicitidina/administração & dosagem , Desoxicitidina/análogos & derivados , Feminino , Fluoruracila/administração & dosagem , Hepatectomia , Humanos , Neoplasias Hepáticas/irrigação sanguínea , Neoplasias Hepáticas/metabolismo , Masculino , Microvasos/patologia , Pessoa de Meia-Idade , Neovascularização Patológica/metabolismo , Fator A de Crescimento do Endotélio Vascular/metabolismo
8.
Hepatogastroenterology ; 59(116): 1087-90, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22328287

RESUMO

BACKGROUND/AIMS: This study aims to investigate the safety and efficacy of hepatic arterial infusion chemotherapy (HAIC) on liver metastases of Stage III colorectal cancer patients after curative resection. METHODOLOGY: We randomly assigned 287 Stage III colorectal cancer patients after curative resection between 2002 and 2008 to receive 2 cycles of HAIC plus 4 cycles of systemic chemotherapy (combined therapy) or 6 cycles of systemic chemotherapy alone (monotherapy). Both the HAIC and systemic chemotherapy regimen consisted of a 2-hour infusion of Oxaliplatin (85mg/m2) on day 1 followed by folinic acid 200mg/m2 as a 2-hour infusion on days 2 and 3 and by 5-fluorouracil 2400mg/m2 as a 48-hour infusion on days 2 and 3. The treatment repeated every 4 weeks. The disease-free survival, overall survival and liver metastases-free survival were compared. RESULTS: There was no significant difference in adverse effects between two groups. Significant differences were found in 3-year disease-free survival (Combined therapy, 75.00%; Monotherapy, 63.27%; p=0.0035), overall survival (Combined therapy, 84.29%; Monotherapy, 65.31%; p=0.0006) and liver metastases-free survival (Combined therapy, 80.00%; Monotherapy, 69.39%; p=0.0451). CONCLUSIONS: HAIC effectively and safely prevents metachronous liver metastases and improves the prognosis of patients with Stage III colorectal cancer after curative resection.


Assuntos
Neoplasias Colorretais/patologia , Neoplasias Hepáticas/prevenção & controle , Neoplasias Hepáticas/secundário , Adulto , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimioterapia Adjuvante , Neoplasias Colorretais/mortalidade , Neoplasias Colorretais/cirurgia , Feminino , Fluoruracila/administração & dosagem , Artéria Hepática , Humanos , Infusões Intra-Arteriais , Leucovorina/administração & dosagem , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Compostos Organoplatínicos/administração & dosagem , Oxaliplatina
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