FOLFOX方案治疗晚期原发性肝癌临床观察

Clinical study on FOLFOX4 therapeutic regimen in treatment of advanced stage primary hepatic carcinoma

目的探讨奥沙利铂（L-OHP）联合亚叶酸钙（CF）／5-氟脲嘧啶（5-Fu）组成的FOLFOX4方案治疗晚期原发性肝癌病人的疗效与安全性。方法12例晚期原发性肝癌病人，采用FOLFOX4方案进行治疗，FOLFOX4方案：L-OHP85mg／m^2静脉滴入2h，d1、d15；CF200mg，静脉滴入，持续2h，d1、d2和d15、d16；5-FU400mg／m^2，静脉推注d1、d2、d15、d16，600mg／m^2，静脉滴入持续22h，d1、d2、d15、d16；每28d为1周期。2周期评价疗效和毒性。治疗前后查肝肾功能，血常规，AFP，ECG，CT或MRI、B超等。疗效和不良反应按WHO疗效及不良反应评价标准评价。结果11例病人，均可以评价客观疗效，其中CR无病例，PR2例，SD4例，PD5例：总有效率为18．18％，稳定率54．54％，10例AFP增高的病人中4例AFP下降，下降率为40％。生存期最短的为3mo，最长的8mo；中位生存期为5．8mo。FOLFOX最少为2周期，最多4周期，共30周期。常见的毒副反应为轻、中度白细胞减少72．72％（8／11）和轻度周围神经毒性（2／11）。结论经过初步应用，以FOLFOX4方案静脉化疗对于晚期原发性肝癌的疗效较好，安全性高，且不良反应较轻，病人易于耐受，值得进一步研究应用。

Objective To investigate the therapeutic effect and safety of FOLFOX4 therapeutic regimen composed of oxaliplatin （ L-OHP ） combined with calcium folinate （ CF ） /5-flurouracil （ 5-Fu ） in treatment of advanced stage primary hepatic carcinoma. Methods 12 patients with advanced stage primary hepatic carcinoma were treated with FOLFOX4 therapeutic regimen; L-OHP85mg/m^2 was given through intervenous drop infusion within 2 hours at dl and dlS; CF200mg was given within 2 hours through intervenous drop infusion at d1, d2, d15, d16; 5-FU 400mg/m^2 was given through intravenous injection at d1, d2, d15, and d16, and 600mg/m^2 through intervenous drop infusion within 22 hours at d1, d2, d15, and d16; 28 days were considered as one cycle. After two cycles, the therapeutic effect and toxicity were evaluated. Liver and renal function, blood routine, AFP, ECG, CT or MRI, B-ultrasound and other examinations were taken. The therapeutic effect and side effect were evaluated according to the WHO evaluation criterion. Results 11 patients could be evaluated the objective therapeutic effect, of which CR was 0, PR was 2, SD was 4, and PD was 5; Total effective rate was 18.18%, Stabilization rate was 54.54%, 4 of the 10 patients with elevated AFP level got an decrease on the AFP level after treatment, and the rate was 40%. The shortest survival duration was 3 months, the longest was 8 months, and the median was 5.8 months. The treatment time varied between 2 and 4 cycles, 30 cycles in all. The common side effects were light to middle class hypolekocytosis （72.72%, 8/11 ） and light class peripheral neurotoxicity（2/11）. Conclusions After primary application, the therapeutic effects of the FOLFOX4 therapeutic regimen in treatment advanced stage primary hepatic carcinoma might be good and safe, the side effects might be slight, the patients could tolerate well, and deserves to be further investigated and applied.