肿瘤化疗,中山大学.ppt

1、CANCER CHEMOTHERAPY(Lecture Outline For Medical Students),管 忠 震,Cancer Chemotherapy,(1) The role of chemotherapy in cancer treatment (2) Current status of cancer chemotherapy: How effective it is? (3) Mechanism of cancer chemotherapy: a brief review (4) Difficulties in cancer chemotherapy: How to ov

2、ercome? (5) New developments,A Brief Review of Natural History of Cancer,Normal somatic cell mutation Malignant change Cancer cell Proliferate (Mitosis),Cell mitosis:,DNA Synthesis Mitosis RNA S phase M phase,Cancer cell: Number Increasing,Cancer in situ T Local tumor mass Local infiltration & exten

3、sion Locally advanced N Lymphatic spread: LN M Hemangial (Systemic spread): Remote metastasis,Cancer ChemotherapyTNM Staging System Progression of Cancer,Cancer, Treatment of Choice,Localized Cancer: Surgery Locally Advanced:,Role of Chemotherapy in Cancer Treatment,(1) Metastatic Cancer: Palliative

4、 or Curative Chemotherapy (2) Adjuvant Chemotherapy: to erradicate or control micro-metastasis (3) Neo-adjuvant Chemotherapy (Induction Chemotherapy) to make Surgery of RT possible to alleviate surgical damage to eradicate micro-metastasis (4) Hematological Malignancies: Primary Treatment,In Localiz

5、ed or Regional Cancer CasesMicro-Metastasis May occur(Sub Clinical Metastasis),Efficacy of Chemotherapy to Cancers,Chemotherapy Curable Cancers,Childhood: ALL 70% NHL 50% Burkitts Lymphoma 50% Wilms Tumor 50% Ewings Sarcoma 50% Embrynal 50% Rhabdomyosarcoma,Chemo-Resistant (Insensitive) Cancers,Non-

6、Small Cell Lung Cancer G.I. Cancers Pancreatic Cancer Melanoma,Mechanism of Cancer Chemotherapy(Cytostatic Drugs),Anti-proliferation (1) Blockage DNA Synthesis Blockage purined pyramidine synthesis Inhibit DNA polymerase (2) Direct Damage to DNA Breakage of DNA chain Cross-linkage, inhibit depolariz

7、ation (3) Inhibit Transduction (DNA RNA) (4) Spindle toxin Mitosis damage (5) Inhibit topoisomerase,Difficulties in Cancer Chemotherapy,(1) Non-dividing Cancer Cells (Go cells),Growth Fraction (GF) and sensitivty Insensitive Cancers: Non-small Cell Lung Cancer G-I Cancers Liver Cancer, etc Go Cells

8、in Sensitive Cancer: Recurrence,(2) Proliferating Normal Cell: Damage,Myelo Suppression: Granulocytopenia Infection Thrombocytopenia Hemorrhage RBC anemia Lymphocytopenia Immune Suppression Mucous Epith Cells Stomatitis G-I reactions Germ Cells Inferlity Foetus Teratogenic, Abortion,(3) Other Organ

9、Toxicity Cardiac, Hepatic, Renal, etc. Pulmonary (4) Drug Resistance,Methods of Improvement:,Component Transfusion Protected Environment (life Island, Lamina Air Flow Unit), Hematopoietic Growth Factore (G-CSF, GM-CSF, Stem Cell Transplants),肿瘤化学治疗中值 得 注 意 的 事 项,Precaution in Cancer Chemotherapy,1.

10、全面评估患者的病情 有机结合各种治疗手段 (Multi-Modality treatment) 2. 每一患者均有具体的治疗目标: 根治性化疗 (Curative chemotherapy) 姑息性化疗: 延长寿命 (Palliative chemotherapy) 缓解症状 Palliative Care?,3. 权衡利弊 Toxicity Benefit vs Risk Cost 4. 尽量使用标准治疗方案: ( Standard Protocol) 经Clinical Study 证实 密切观察,防止及处理不良反应 (Adverse effects),Cancer Chemotherapy: New Advances,1. Hi Dose CT/Stem Cell Transplantation 2. New Anticancer Drugs Taxanes: TAXOL, TAXOTERE Topoisomerase I Inhibitor: CPT-10, CPT-11, TOPOTECAN Gemcitabine Oxaliplatin, Loba