肿瘤化疗,中山大学.ppt

单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,*,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 overcome?,(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&extension,Locally advanced,N,Lymphatic spread:,LN,M,Hemangial,(Systemic spread):,Remote metastasis,Cancer Chemotherapy,TNM Staging System,Progression of Cancer,Cancer,Treatment of Choice,Localized Cancer:Surgery,Locally Advanced:,Role of Chemotherapy in Cancer Treatment,(,1),Metastatic,Cancer:,Palliative 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,Localized or Regional,Cancer Cases,Micro-Metastasis,May occur(Sub Clinical Metastasis),Efficacy of Chemotherapy to Cancers,Chemotherapy Curable Cancers,Childhood:,ALL 70%,NHL,50%,Burkitt,s Lymphoma,50%,Wilm,s Tumor 50%,Ewings Sarcoma 50%,Embrynal,50%,Rhabdomyosarcoma,Chemo-Resistant(Insensitive)Cancers,Non-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 depolarization,(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 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 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.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,Lobaplatin,New,Theraputic,Targets,e.g.Anti-,angioclonal,(,Angiostatin,Endostatin,),Monoclonal Antibody:,Herceptin,For Breast Cancer,(Her 2,neu,over expression),Gene therapy,