Targeted therapy is the treatment of established cancer sites at the cellular level. The corresponding therapeutic drug can be designed, and the drug enters the body to specifically select the carcinogenic site to combine and act to cause the tumor cell to specifically die without affecting the normal tissue cells surrounding the tumor, so the molecular targeted therapy is also called "Biological missiles."
In addition to conventional surgery, radiotherapy, chemotherapy, biotherapy and traditional Chinese medicine treatment, different target treatment techniques can be used for target treatment for tumors at different organ and molecular level targets. Localized lesion targets can be treated with local targeted ablation therapy, targeted radiation therapy, radioactive particle implantation targeted internal irradiation therapy, high energy focused ultrasound therapy, endovascular intervention, and topical drug injection therapy. Molecular targeted therapy targets malignant phenotypic molecules of tumor cells, acting on specific cell receptors, signaling pathways that promote tumor growth, survival, regulation of neovascularization and cell cycle, and inhibition of tumor cell growth. Or promote the anti-tumor effect of apoptosis. Different from traditional cytotoxic chemotherapy, tumor molecular targeted therapy has specific anti-tumor effect, and the toxicity is significantly reduced, which has opened up a new field of tumor chemotherapy.
Treatment
Argon-helium superconducting surgery system
Argon arborectomy is a widely used ablation treatment technology. Since 1998, there have been more than 100 hospitals in the United States. More than 80 units in China are equipped with argon-helium equipment, which can accurately freeze a variety of tumors. Excision, and made breakthroughs in the treatment of liver cancer, lung cancer, pancreatic cancer, prostate cancer, kidney cancer, breast cancer and other fields. Intraoperative cryopreservation is suitable for almost all solid tumors. Unlike other ablation methods such as radiofrequency, argon-helium cryoablation can treat small tumors as well as large-volume (larger than 5cm in diameter) tumors. The release of heat from the internal blood flow, freezing is not easy to cause damage to the large blood vessels, so that it is also possible to treat tumors that cannot be surgically removed near the large blood vessels. According to the statistics of the 14th World Congress of Cryotherapy in November 2007, the number of tumors treated with cryocareTM cryoablation in the United States has reached 11,000, of which more than 10 have completed more than 500 units, and some hospitals have reached 4,000 cases. More than 30 kinds of diseases, China is the world's largest country for the treatment of liver cancer and lung cancer.
Due to the different characteristics of various targeted ablation techniques, the choice of treatment technology for a particular case may vary. Dr. Zhang Keqin [4] compared argon-helium cryoablation with radiofrequency (RFA) and microwave (MCT) thermocoagulation for the treatment of rabbit VX2 liver cancer. Three minimally invasive treatments in ablated rabbit VX2 liver cancer, whether in ablation target Regarding the area and transverse diameter, the complete ablation rate of the tumor in the ablation target area, the argon-helium cryopreservation is superior to RFA and MCT in terms of the tumor cell residual rate in the ablation target area and the complete necrosis rate of the tumor cells in the ablation target area. RFA and MCT are equally effective. In addition, the tumor-borne dissemination caused by the "boiling effect" of RFA and MCT is a clinically insurmountable problem. All of these aspects suggest that the clinical efficacy of argon-helium cryoablation in the treatment of rabbit VX2 liver cancer may be better than RFA and MCT.
Clinical treatment confirmed that local ablation of argon-helium cryoablation combined with radiotherapy, chemotherapy, biological therapy, interventional therapy and other comprehensive treatments is superior to single treatment, and the survival rate is significantly improved in 1 to 2 years. The long-term efficacy depends on comprehensive treatment measures. select. When the mass is ≥ 4cm, especially greater than 6cm, the treatment effect is poor, and the tumor is easy to relapse or even increase. Therefore, the application of comprehensive treatment measures before and after treatment combined with other treatment methods is particularly important, for example, the treatment of lung cancer: argon-helium knife combined with interventional chemotherapy, combined with radiotherapy, combined with traditional Chinese medicine treatment, compared with radiotherapy, chemotherapy, interventional embolization, 1 year The 2-year survival rate has been significantly improved, and a satisfactory clinical effect has been achieved. The above results indicate that the argon-helium knife will become a necessary technology for clinical treatment of lung cancer. For tumors close to the mediastinum, local argon-helium cryoablation is difficult. Complete treatment with argon-helium knife can also be combined with other local treatment methods. Combined with radiotherapy, the radiation dose can be greatly reduced. Combined drug implantation and radiation particle implantation can be used. Improving the efficacy and reducing the dose of implanted particles, combined with other local treatments and systemic treatment techniques, can change the current concept of comprehensive treatment and improve long-term treatment. At present, the treatment of argon-helium in China is in the ascendant, but there is no prospective, multi-center, randomized controlled clinical trial results to observe its long-term efficacy in the treatment of lung cancer.
The argon-helium targeted therapy technology collaboration group has carried out more work, such as the preparation of the world's first standardized treatment books, including animal and human solid tumor lesions to ablate the size of the target area, and the imaging changes after freezing. Other targeted ablation techniques are recommended to follow.
Radiofrequency ablation
Both MWA and RFA technologies began in the early 1990s. In 1996, LeVeen umbrella-shaped multi-electrodes were certified by the US FDA, which greatly expanded the application range of RFA. Compared with other thermal ablation techniques, RFA is used worldwide. With more than one technique, more than 500 review articles can be retrieved. MWA is mainly carried out in Japan and China, and the majority of RFA reports are from European and American countries. It can be considered that the therapeutic effects of MWA and RFA technologies are basically the same. The RF electrode has evolved from the initial unipolar to multipolar, and cold-circulating RF therapy systems. The disadvantage is that the range of disposable lesions is limited, the maximum lesion volume is 3.5 cm, and the residual lesions are more likely to be more than 3 cm in diameter. American RITA has developed a series of radiofrequency needles for tumors of different sizes. Tumors with a diameter of 3 cm or less can be selected as the first generation of umbrella-shaped multi-polar needles or monopolar needles; tumors with a diameter of 3 cm to 5 cm should be selected as second-generation anchor-like multi-polar needles. Tumors with a diameter of 5cm to 7cm or more should be selected from the latest third-generation cluster electrode needles, and special injection pumps are used to make heat conduction faster and more uniform, and the treatment time is greatly shortened. The treatment of large tumor targeting is more effective and the patient is more relaxed.
Some scholars have proposed how to combine radiofrequency therapy with chemotherapy and local radiotherapy to improve the efficacy of advanced non-small cell lung cancer. For advanced non-small cell lung cancer, especially peripheral lung cancer, radiofrequency ablation is first used to inactivate tumor cells in the tumor area, reduce tumor burden, and then treat residual cancer cells with chemotherapy. For patients with hilar, mediastinal lymph nodes or other metastatic lesions, chemotherapy and other treatments can be combined with chemotherapy. In this way, on the basis of local control, the tumor further improves the quality of life and survival time of patients. With the continuous improvement of RFA technology, RFA combined with interventional chemotherapy, stereotactic radiotherapy, external irradiation, etc., will greatly improve the local control rate of tumors, improve the quality of life, and prolong the survival of patients.
The development and application of molecular targeted therapeutic drugs will have a huge impact on the original concept and model of tumor therapy, but despite the certain effects, there are still many problems to be solved, such as: prediction of efficacy, if Predictive use of patients who are likely to be effective can avoid unnecessary financial investment; how to cooperate with traditional treatment methods to achieve the purpose of improving efficacy; the drug resistance of molecularly targeted drugs and so on. It is believed that with the deepening of research on tumor molecular biology, the mechanism of drug action will further clarify that the individualization of drug application will become possible, and more cancer patients will benefit from it.
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