“水来了，路在何方？”恶性胸腹水处理系列
恶性胸腹水是指由于恶性肿瘤或癌性病变引起胸腔、腹腔脏壁层胸腹膜发生弥漫性病变而导致体腔液体异常增多的现象。恶性凶腹水严重地影响着肿瘤患者的生存质量和预后，了解恶性胸腔积液和恶性腹腔积液的临床表现并进行诊断和规范化的治疗尤为重要。中国医学论坛报·壹生特邀国内知名学者，细致讲解如何处理恶性胸腹水。
共6节课 查看课程详情-
妇科恶性肿瘤引起的腹水处理（下）
内容提要：1. 卵巢癌的手术治疗2. 卵巢癌的辅助化疗3. 卵巢癌的维持治疗(最下方有课程中涉及的文献信息）更多精彩内容，可下载壹生APP观看，或添加小助手微信号（13269296986，注明“恶性胸腹水”）咨询。文献资料：1. Bristow, R.E., et al., Survival effect of maximal cytoreductive surgery for advanced ovarian carcinoma during the platinum era: a meta-analysis. J Clin Oncol, 2002. 20(5): p. 1248-59.2. Burger, R.A., et al., Incorporation of bevacizumab in the primary treatment of ovarian cancer. N Engl J Med, 2011. 365(26): p. 2473-83.3. du Bois, A., et al., Incorporation of pazopanib in maintenance therapy of ovarian cancer. J Clin Oncol, 2014. 32(30): p. 3374-82.4. Harter, P., et al., A Randomized Trial of Lymphadenectomy in Patients with Advanced Ovarian Neoplasms. N Engl J Med, 2019. 380(9): p. 822-832.5. Kim, M.K., et al., Management of Endometrial Hyperplasia: A Survey of Members of the Korean Gynecologic Oncology Group. Int J Gynecol Cancer, 2015. 25(7): p. 1277-84.6. Konstantinopoulos, P.A., et al., Homologous Recombination Deficiency: Exploiting the Fundamental Vulnerability of Ovarian Cancer. Cancer Discov, 2015. 5(11): p. 1137-54.7. Moore, K., et al., Maintenance Olaparib in Patients with Newly Diagnosed Advanced Ovarian Cancer. N Engl J Med, 2018. 379(26): p. 2495-2505.8. Perren, T.J., et al., A phase 3 trial of bevacizumab in ovarian cancer. N Engl J Med, 2011. 365(26): p. 2484-96.9. van Driel, W.J., et al., Hyperthermic Intraperitoneal Chemotherapy in Ovarian Cancer. N Engl J Med, 2018. 378(3): p. 230-240.
2019-06-13 62056 看过 免费 -
妇科恶性肿瘤引起的腹水处理（上）
内容提要：1. 卵巢上皮癌的诊断2. 妇科恶性肿瘤新辅助化疗（NACT）的进展3. 腹腔镜探查评估确定是否需要NACT(最下方有课程中涉及的文献信息）更多精彩内容，可下载壹生APP观看，或添加小助手微信号（13269296986，注明“恶性胸腹水”）咨询。 文献资料：1. Kehoe, S., et al., Primary chemotherapy versus primary surgery for newly diagnosed advanced ovarian cancer (CHORUS): an open-label, randomised, controlled, non-inferiority trial. Lancet, 2015. 386(9990): 249-57.2. Vergote, I., et al., Neoadjuvant chemotherapy or primary surgery in stage IIIC or IV ovarian cancer. N Engl J Med, 2010. 363(10): 943-53.3.Onda, T., et al., Comparison of treatment invasiveness between upfront debulking surgery versus interval debulking surgery following neoadjuvant chemotherapy for stage III/IV ovarian, tubal, and peritoneal cancers in a phase III randomised trial: Japan Clinical Oncology Group Study JCOG0602. Eur J Cancer, 2016. 64: 22-31.4.Y.A. Lyons, et al. 2019 SGO;2301 - Poster Session
2019-06-06 81007 看过 免费 -
胃肠肿瘤引起的恶性腹水处理（下）
内容提要：1. 腹腔灌注化疗（IP）的药物选择2. 紫杉醇IP的注意事项3. VEGF抗体治疗恶性浆膜腔积液的进展腹腔灌注化疗（IP）是一种腹腔恶性肿瘤辅助治疗手段。IP可以提高局部药物浓度，降低全身副反应。但腹腔灌注化疗的药物选择的考虑因素与化疗不同，除了药物的抑癌性，还需要考虑在腹腔的药物动力学和安全性。现临床较为常用的药物是紫杉醇类药物，同时，贝伐珠单抗和catumaxomab也是在探索中的腹腔灌注药物。(最下方有课程中涉及的文献信息）更多精彩内容，可下载壹生APP观看，或添加小助手微信号（13269296986，注明“恶性胸腹水”）咨询。文献资料：1. 李燕. 腹腔联合全身化疗治疗胃肠道恶性肿瘤并发腹腔积液81例[J]. 肿瘤研究与临床, 2009, 21(1):52-53.2. Chen, D., et al., Greater efficacy of intracavitary infusion of bevacizumab compared to traditional local treatments for patients with malignant cavity serous effusion. Oncotarget, 2017. 8(21): p. 35262-35271.3. Ferrara, N. and W.J. Henzel, Pituitary follicular cells secrete a novel heparin-binding growth factor specific for vascular endothelial cells. Biochem Biophys Res Commun, 1989. 161(2): p. 851-8.4. Hamilton, C.A., et al., Intraperitoneal bevacizumab for the palliation of malignant ascites in refractory ovarian cancer. Gynecol Oncol, 2008. 111(3): p. 530-2.5. Ishigami, H., et al., Phase III Trial Comparing Intraperitoneal and Intravenous Paclitaxel Plus S-1 Versus Cisplatin Plus S-1 in Patients With Gastric Cancer With Peritoneal Metastasis: PHOENIX-GC Trial. J Clin Oncol, 2018. 36(19): p. 1922-1929.6. Kesterson, J.P., P. Mhawech-Fauceglia, and S. Lele, The use of bevacizumab in refractory ovarian granulosa-cell carcinoma with symptomatic relief of ascites: a case report. Gynecol Oncol, 2008. 111(3): p. 527-9.7. Kobold, S., et al., Intraperitoneal VEGF inhibition using bevacizumab: a potential approach for the symptomatic treatment of malignant ascites? Oncologist, 2009. 14(12): p. 1242-51.8. Miyamoto, K., et al., Disposition kinetics of taxanes in peritoneal dissemination. Gastroenterol Res Pract, 2012. 2012: p. 963403.9. Numnum, T.M., et al., The use of bevacizumab to palliate symptomatic ascites in patients with refractory ovarian carcinoma. Gynecol Oncol, 2006. 102(3): p. 425-8.10. Pichelmayer, O., et al., Bevacizumab is active in malignant effusion. Ann Oncol, 2006. 17(12): p. 1853.11. Senger, D.R., et al., A highly conserved vascular permeability factor secreted by a variety of human and rodent tumor cell lines. Cancer Res, 1986. 46(11): p. 5629-32.12. Sugarbaker, P.H., et al., Update on chemotherapeutic agents utilized for perioperative intraperitoneal chemotherapy. Oncologist, 2005. 10(2): p. 112-22.13. Yamaguchi, H., et al., Breakthrough therapy for peritoneal carcinomatosis of gastric cancer: Intraperitoneal chemotherapy with taxanes. World J Gastrointest Oncol, 2015. 7(11): p. 285-91.
2019-05-30 65912 看过 免费 -
胃肠肿瘤引起的恶性腹水处理（上）
内容提要：1. 腹膜转移的分期标准2. 腹膜转移的综合治疗策略3. 癌性腹水的对症治疗与系统化疗大约10%的胃癌患者存在腹水，检出腹水大于50ml 的胃癌患者，腹膜转移的发生率高达75%以上，并且常伴有多种并发症，处理难度大。日本的一项回顾性研究证明有腹膜转移的胃癌患者预后显著降低。而针对癌性腹水，现在尚无基于循证证据的治疗指南。腹水是影响患者生存预后的核心因素之一。根据患者的情况，应选择合适的治疗方案，包括对症治疗、全身系统化疗及腹腔灌注化疗。(最下方有课程中涉及的文献信息）更多精彩内容，可下载壹生APP观看，或添加小助手微信号（13269296986，注明“恶性胸腹水”）咨询。文献资料：1. 中国抗癌协会胃癌专业委员会.胃癌腹膜转移防治中国专家共识[J].中国医学前沿杂志,2017,9(5):p. 29-40.2. Barnett, T.D. and J. Rubins, Placement of a permanent tunneled peritoneal drainage catheter for palliation of malignant ascites: a simplified percutaneous approach. J Vasc Interv Radiol, 2002. 13(4): p. 379-83.3. Boku, N., et al., Fluorouracil versus combination of irinotecan plus cisplatin versus S-1 in metastatic gastric cancer: a randomised phase 3 study. Lancet Oncol, 2009. 10(11): p. 1063-9.4. Chang, D.K., et al., Clinical significance of CT-defined minimal ascites in patients with gastric cancer. World J Gastroenterol, 2005. 11(42): p. 6587-92.5. Iwasa, S., et al., Multicenter feasibility study of combination therapy with fluorouracil, leucovorin and paclitaxel (FLTAX) for peritoneal disseminated gastric cancer with massive ascites or inadequate oral intake. Jpn J Clin Oncol, 2012. 42(9): p. 787-93.6. Koizumi, W., et al., S-1 plus cisplatin versus S-1 alone for first-line treatment of advanced gastric cancer (SPIRITS trial): a phase III trial. Lancet Oncol, 2008. 9(3): p. 215-21.7. Maeda, H., M. Kobayashi, and J. Sakamoto, Evaluation and treatment of malignant ascites secondary to gastric cancer. World J Gastroenterol, 2015. 21(39): p. 10936-47.8. Nashimoto, A., et al., Gastric cancer treated in 2002 in Japan: 2009 annual report of the JGCA nationwide registry. Gastric Cancer, 2013. 16(1): p. 1-27.9. Nishina, T., et al., Randomized phase II study of second-line chemotherapy with the best available 5-fluorouracil regimen versus weekly administration of paclitaxel in far advanced gastric cancer with severe peritoneal metastases refractory to 5-fluorouracil-containing regimens (JCOG0407). Gastric Cancer, 2016. 19(3): p. 902-10.10. O'Neill, M.J., et al., Tunneled peritoneal catheter placement under sonographic and fluoroscopic guidance in the palliative treatment of malignant ascites. AJR Am J Roentgenol, 2001. 177(3): p. 615-8.11. Smith, E.M. and G.C. Jayson, The current and future management of malignant ascites. Clin Oncol (R Coll Radiol), 2003. 15(2): p. 59-72.12. Yamada, Y., et al., Phase III study comparing oxaliplatin plus S-1 with cisplatin plus S-1 in chemotherapy-naïve patients with advanced gastric cancer. Ann Oncol, 2015. 26(1): p. 141-8.13. Yonemura, Y., et al., A comprehensive treatment for peritoneal metastases from gastric cancer with curative intent. Eur J Surg Oncol, 2016. 42(8): p. 1123-31.
2019-05-23 74127 看过 免费 -
恶性胸腔积液的处理——细胞因子药物治疗进展
上一节课程，刘红兵老师为我们介绍了MPE的诊断和传统治疗方法，本次课程将继续同一讲题，介绍MPE的细胞因子药物治疗进展。近年来生物免疫制剂发展较为迅速，临床中应用较为广泛。它既能参与免疫调节，也能起到抗肿瘤的作用。此类药物一般患者可以耐受，毒副作用较小，减少了骨髓抑制及消化道反应的发生。肿瘤坏死因子、血管内皮生长因子等药物都展现出不错的临床结果，多个研究已证实其在MPE中的应用价值。然而，未来仍有许多有待继续研究的课题在等待着我们。本节课程，刘红兵老师深入讲解这些潜力药物的机制和临床进展，并且在课程的最后还有ATS/STS/STF临床实践指南的重点解读，一起来学习吧。内容提要：1. 肿瘤坏死因子（TNF）治疗MPE2. VEGF抗体治疗MPE3. ATS/STS/STR 恶性胸腔积液临床实践指南重点解读(最下方有课程中涉及的文献信息）更多精彩内容，可下载壹生APP观看，或添加小助手微信号（13269296986，注明“恶性胸腹水”）咨询。文献信息：1. 恶性胸腔积液诊断与治疗专家共识，中华内科杂志，2014，53(3):252-2562. 张玉, 等. 恶性胸腔积液综合治疗进展[J]. 现代生物医学进展, 2012,12(17):3358-3361.3.注射用重组改构人肿瘤坏死因子治疗国人恶性胸、腹腔积液的前瞻性多中心临床研究[J]. 临床肿瘤学杂志, 2016, 21(7).4. 晚期非小细胞肺癌抗血管生成药物治疗中国呼吸领域专家共识，中华结核和呼吸杂志.2016,39(11):839-849.5. 秦叔逵,等.腔内应用重组人血管内皮抑制素和/或顺铂治疗恶性胸腹腔积液的前瞻性、随机对照、全国多中心Ⅲ期临床研究[J].临床肿瘤学杂志,2017,22(3):193-202.6. Frances Balkwill. Tumour necrosis factor and cancer. Nature reviews cancer, 9, 2009:361-3717. Balkwill, F., Tumour necrosis factor and cancer. Nat Rev Cancer 2009, 9 (5), 361-71.8. Du, N, et al. Intrapleural combination therapy with bevacizumab and cisplatin for non-small cell lung cancer‑mediated malignant pleural effusion. Oncol Rep 2013, 29 (6), 2332-40.9. Feller-Kopman, D. J, et al. A. A., Management of Malignant Pleural Effusions. An Official ATS/STS/STR Clinical Practice Guideline. Am J Respir Crit Care Med 2018, 198 (7), 839-849.10. Ishii, H, et al. Enhancement of pleural dissemination and lymph node metastasis of intrathoracic lung cancer cells by vascular endothelial growth factors (VEGFs). Lung Cancer 2004, 45 (3), 325-37.5. Kitamura, K, et al. Yoshimura, A.; Gemma, A., Bevacizumab plus chemotherapy for advanced non-squamous non-small-cell lung cancer with malignant pleural effusion. Cancer Chemother Pharmacol 2013, 71 (2), 457-61.6. Lejeune, F. J, Clinical use of TNF revisited: improving penetration of anti-cancer agents by increasing vascular permeability. J Clin Invest 2002, 110 (4), 433-5.7. Limaverde-Sousa, G, et al. Antiangiogenesis beyond VEGF inhibition: a journey from antiangiogenic single-target to broad-spectrum agents. Cancer Treat Rev 2014, 40 (4), 548-57.8. Ma, X, et al. Recombinant human endostatin endostar suppresses angiogenesis and lymphangiogenesis of malignant pleural effusion in mice. PLoS One 2012, 7 (12), e53449.9. Spella, M, et al. Switching off malignant pleural effusion formation-fantasy or future? J Thorac Dis 2015, 7 (6), 1009-20.10. Tamiya, M, et al. Phase2 study of bevacizumab with carboplatin-paclitaxel for non-small cell lung cancer with malignant pleural effusion. Med Oncol 2013, 30 (3), 676.11. Yano, S, et al. Production of experimental malignant pleural effusions is dependent on invasion of the pleura and expression of vascular endothelial growth factor/vascular permeability factor by human lung cancer cells. Am J Pathol 2000, 157 (6), 1893-903.
2019-05-16 85047 看过 免费 -
恶性胸腔积液的处理——诊断与传统治疗
恶性胸腔积液（MPE）是指原发于胸膜的恶性肿瘤或其他部位的恶性肿瘤转移至胸膜引起的胸腔积液，几乎所有肿瘤均可出现MPE，肺癌最常见，乳腺癌和淋巴瘤等也会导致MPE的出现。了解MPE的临床表现并进行诊断和规范化的治疗尤为重要。本节课刘红兵老师将为大家讲解恶性胸腔积液的诊断和传统治疗，下节课程会继续为大家讲解细胞因子药物治疗MPE的进展。内容提要：① MPE典型病例② MPE的诊断路径③ MPE的传统治疗方案(最下方有课程中涉及的文献信息）更多精彩内容，可下载壹生APP观看，或添加小助手微信号（13269296986，注明“恶性胸腹水”）咨询。文献信息：1. 恶性胸腔积液诊断与治疗专家共识，中华内科杂志，2014，53(3):252-2562. Oldem, Am, et al. Treatment of malignant pleural effusion: PleuRx catheter or talc pleurodesis? A cost-effectiveness analysis. J Palliate Med. 2010,13(1):59-653. Medford AR, et al. A national survey of oncologist and chest physicians' attitudes towards empirical anti-oestrogen therapy, early pleurodesis and preference of sclerosing agent in malignant breast and ovarian pleural disease. J Palliat Med,2005，19(5):430-4314. Rahman NM, et al, Use of lipoteichoic acid-T for pleurodesis in malignant pleural effusion: a phase I toxicity and dose-escalation study. Lancet Oncol, 2008, 9(10):946-9525. Seto T, et al. Intrapleural hypotonic cisplatin treatment for malignant pleural effusion in 80 patients with non-small-cell lung cancer: a multi-institutional phase II trial. Br J Cancer. 2006,95(6):717-7216. Pleuritis carcinomatosa，Miyanaqa A,Gan Tokagaku Ryoho,2011,38(4):524-5277. 张玉, 等. 恶性胸腔积液综合治疗进展[J]. 现代生物医学进展, 2012,12(17):3358-3361.8. Becker G, et al. Malignant ascites: systematic review and guideline for treatment. Eur J Cancer. 2006, 42(5):589-597. 9. Roberts ME, et al. Management of a malignant pleural effusion: British Thoracic Society Pleural Disease Guideline 2010. Thorax. 2010, 65 Suppl 2:ii32-40.
2019-05-09 76883 看过 免费
热门资讯
- Rock Master Dialogue 大师对话：cGVHD 线上诊疗间第十六期精彩来袭！
- Rock Master Dialogue 大师对话：cGVHD 线上诊疗间第十五期精彩来袭！
- Rock Master Dialogue 大师对话：cGVHD 线上诊疗间第十七期精彩来袭！
- Rock Master Dialogue 大师对话：cGVHD 线上诊疗间第十八期精彩来袭！
- Rock Master Dialogue 大师对话：cGVHD 线上诊疗间第十九期精彩来袭！
- 10张图片搞懂肝脏的分段 | 临床干货
- Wiley首席执行官Matt Kissner访问中国：加强中国市场投入，助力中国科研发展
- 评估急性胰腺炎严重程度的7大评分量表 | 诊疗干货
- 以创新为钥，以患者至上——安斯泰来中国区赵萍总裁专访
- 如何判断早期食管癌的浸润深度?目前常用的IPCL分型有哪些?
