亚砷酸-碘油乳剂介入治疗原发性肝癌的临床观察

Clinical study of lipiodol-arsenic trioxide emulsion in the treatment of primary hepatic carcinoma by interventional ways

目的 :评价亚砷酸 -碘油乳剂介入治疗原发性肝癌的近期疗效与毒副反应 ,探讨其与蒽环类抗肿瘤抗生素联合应用的可行性。方法 :亚砷酸注射液 2 0mg与适量碘油混合制成亚砷酸 -碘油乳剂 ,对 2 9例原发性肝癌患者进行介入治疗 ,如果治疗或随访中病变明显进展 (病灶增大或AFP升高 ) ,则联合蒽环类药物治疗 ,观察疗效与毒副反应。结果 :单纯应用亚砷酸 -碘油乳剂治疗 1～ 3次 ,2 9例患者中PR 6例 ,NC 18例 ,PD 5例 ,客观有效率为 2 0 7% ,获益率为 82 8% ;AFP平均由( 1110 9 3 6± 2 92 0 82 )IU/mL降至( 10 0 0 1 61± 2 880 67)IU/mL ,P >0 0 5。11例患者在治疗中加用蒽环类药物 ,8例病灶有不同程度的缩小 ,AFP平均由( 13 90 1 11± 4862 2 6)IU/mL降至 ( 5470 63± 2 5 97 79)IU/mL ,P <0 0 5。主要毒副反应为发热、恶心呕吐、肝区疼痛、血细胞减少及转氨酶升高等 ,全组未见不可逆毒副反应。结论 :亚砷酸 -碘油乳剂介入治疗原发性肝癌疗效确切 ,毒副反应小 ,与蒽环类抗肿瘤抗生素联合应用渴望提高疗效。

OBJECTIVE:To evaluate the effect and toxicity of lipiodol-arsenic trioxide emulsion in the treatment of primary hepatic carcinoma by interventional ways, and to explore the feasibility of its application combined with anthracycline.METHODS: Arsenic trioxide 20 mg and lipiodol were fully mixtured into lipiodol-arsenic trioxide emulsion, which were injected by catheters into hepatic artery of 29 patients with primary hepatic carcinoma. If the patients’ sicky conditions progressed in therapy or follow-up (tumor got larger or AFP increased), anthracycline would be used simultaneously. The effect and toxicity were observed.RESULTS: After 1-3 times of therapy simply with lipiodol-arsenic trioxide emulsion for all 29 patients, objective response rate was 20.7% with 6 cases of PR, 18 cases of NC and 5 cases of PD. AFP decreased from (11 109.36±2 920.82) IU/mL to (10 001.61±2 880.67) IU/mL averagely,P>0.05. Anthracycline was applied simultaneously in 11 patients, and tumors got smaller in 8 cases after that. AFP decreased from (13 901.11±4 862.26) IU/mL to (5 470.63±2 597.79) IU/mL averagely,P<0.05. The major side effects were pyrexia, nausea and vomiting, pain in hepatic region, mild bone marrow depression and hepatic damage. No irreversible toxic response occurred.CONCLUSIONS:Lipiodol-arsenic trioxide emulsion injection via hepatic artery by catheters is effective and less toxic to treat primary hepatic carcinoma. We longing for enhanced the effect by the application combine with anthracycline.