【文章內(nèi)容簡介】 激素， T，B， NK細胞及各種免疫反應(yīng) (fǎny236。ng) 。 癌瘤時辰特點第四十七 頁 ，共一百一十二 頁 。 第四十八 頁 ，共一百一十二 頁 。 癌瘤血流時辰性，實驗表明皮下癌瘤活躍時相與非活躍時相供血相差一倍，但不伴瘤體積變化，此時給藥化療療效增強(zēngqi225。ng)。 時辰治療對療效與毒性的影響第四十九 頁 ，共一百一十二 頁 。第五十 頁 ，共一百一十二 頁 。第五十一 頁 ，共一百一十二 頁 。第五十二 頁 ，共一百一十二 頁 。 如何 (rh233。) 預(yù)防繼發(fā)癌n Define the risk of recurrence and tailor the intensity of cancer therapy: Lowering the dose of treatment for low risk groups is probably the important way to prevent secondary cancer 第五十三 頁 ，共一百一十二 頁 。 Avoid radiation therapyn This has been successful in childhood ALL where intrathecal chemotherapy has been substituted for radiationn Hodgkin`s disease and nonHodgkin`s lymphoma:where certain groups of patients have been found to survive just as well with chemotherapy alone as with chemotherapy plus radiation therapy第五十四 頁 ，共一百一十二 頁 。 Avoid drugs with high carcinogenic potentialn This is difficult to do since all chemotherapy drugs are carcinogenic n Etoposide is associated with a relatively high incidence of myelodysplasia and acute myeloid leukemia and in some instances other drugs could be used instead第五十五 頁 ，共一百一十二 頁 。 /放療 (f224。nɡ li225。o) 心血管并發(fā)癥n Edward . etc。 Cardiovascular plications of Cancer Therapy Diagonsis, Pathogenesis, and Management (Circulation. 2024。 109 : 3112 3131.)第五十六 頁 ，共一百一十二 頁 。 Cardiotoxic Syndromes Associated With Chemotherapeutic Agents（ 1） Agents associated with myocardial depression Anthracyclines Mitoxantrone(Novantrone) Cyclophosphamide(Cytoxan)—high dose Trastuzumab(Herceptin) Ifosfamide(Ifex) Alltrans retinoic acid(Tretinoin)第五十七 頁 ，共一百一十二 頁 。（ 2） Agents associated with ischemia 5FU (adrucil) Cisplatin (platinol) Capecitabine (Xeloda ) IL2第五十八 頁 ，共一百一十二 頁 。（ 3） Agents associated with hypotension Etoposide(Vepesid) Paclitaxel(Taxol) Alemtuzumab (Campath) 阿侖單抗 抗 CD52 Cetuximab (Erbitux) 愛必妥抗表皮生長因子受體（ HER1) Rituximab (Rituxan) 美羅華 抗 CD20 IL2 Denileukin(Ontak) IL2/白喉毒素融合 (r243。ngh233。) 蛋白 Interferonα Alltrans retinoic acid(tretinoin) Homoharringtonine 高三尖杉酯堿（ 4） Agents associated with hypertension Bevacizumab(Avastin) 抗 VEGF Cisplatinin(Platinol)第五十九 頁 ，共一百一十二 頁 。（ 5） Agents associated with other toxic effects Cardiac tamponade or endomyocardial fibrosis : busulfan(Myleran) Hemorrhagic myocarditil : cyclophosphamide(Cytoxan) Bradyarrhythmias: paclitaxel(Taxol),thalidomide(Thalomid) Raynaud phenomenon: vinblastine(Velban) Autonomic neuropathy: vincristine(Oncovin) QT prolongation or torsades de Pointes : arsenic trioxide(Trisenox) Pulmonary fibrosis : bleomycin(Blenoxane)第六十 頁 ，共一百一十二 頁 。 Risk Factor for Developing Cardiovascular Complications n Some chemotheraperapeutic agents evoke cardiotoxicity only when the drug is administered at high dose :examples include CHF and pericarditis with platinum drugs.n Systolic dysfunction and pericarditis with cyclophosphamide.n LV dysfunction with anthracyclines第六十一 頁 ，共一百一十二 頁 。n Administering anthracyclines by continuous infusion over 24 to 92 hours rather than by rapid intravenous infusion could reduce the cardiotoxicity of these drugs.n Busulfan causes tachyarrythmias, hypertension or hypotension, and LV dysfunction when injected but not when taken orally .第六十二 頁 ，共一百一十二 頁 。n The bination of IL2 and interferon significantly increases hypotension, but delivering interferon alone for the first 2 weeks followed by IL2 has much less cardiovascular toxicity .(interval )n The bination of paclitaxel and doxorubicin caused CHF in 20% of cases if the interval between doxorubicin and paclitaxel was 15 to 30 minutes, but increasing the interval to 4 to 16 hours reduced the cardiotoxicity of this bination.第六十三 頁 ，共一百一十二 頁 。n Advanced age is a known risk factor for anthracycline cardiotoxicity n Cardiovascular side effects from a particular drug occur in a specific subset of cancer patients ① Cardiovascular plication from cisplatin only in patients with metastatic testicular cancer ② Episodes of cardiotoxicity from lowdose ifosfmide being more mom in patients with lymphoma. ③ Alemtuzumab being associated with LV dysfunction in patients with mycosis fungoides.第六十四 頁 ，共一百一十二 頁 。 cardiotoxicity Associated With Radiation Therapyn Radiationinduced heart disease is higher in patients given high doses of radiation therapy concurrent with doxorubicin.n Vascular inj