肝动脉灌注奥沙利铂合并栓塞治疗晚期肝癌的临床观察

Clinical observation of interventional chemotherapy with oxaliplatin combinated with chemotherapy treating hepatic carcinoma

目的:观察奥沙利铂(Oxaliplatin,LOHP)肝动脉灌注栓塞化疗对晚期原发性和继发性肝癌的临床疗效和毒副作用。方法:32例晚期肝癌患者,其中原发性肝癌20例,转移性肝癌12例,经皮股动脉穿刺插管至腹腔动脉,并超选至肝肿瘤的供血血管后灌注药物,LOHP130mg/m2,氟尿嘧啶脱氧核苷(FUDR)500～750mg/m2,并以丝裂霉素(MMC)6～8mgm2+超液化碘油10～30ml乳化后进行血管栓塞。对于转移性肝癌在介入化疗后第2天起并给予FUDR350～500mg/m2、四氢叶酸钙(CF)200mg/m2静脉滴注,连用3天,间隔4～6周重复给药1次。疗效和毒副反应按WHO实体瘤近期疗效和抗癌药毒性评定标准评定。结果:全组32例均可进行评价。CR2例,PR13例,PD1例,SD16例,有效率(CR+PR)为46.9%,其中原发性肝癌的有效率为40.0%,转移性肝癌的有效率为58.3%。毒副反应主要是恶心、呕吐、白细胞减少及一过性肝功能损害,末梢神经炎的发生率并不高,程度也不重;未见心脏、肾脏损害。结论:采用以奥沙利铂为主的肝介入疗法治疗晚期肝癌疗效肯定,安全性好,患者可以耐受,值得进一步研究。

Objective：To observe the clinical effect in the patients with advanced liver cancer after interventional chemotherapy using oxaliplatin （ L-OHP, OXA ） combinated with 5-fluorouracil deoxyribonucleoside （ FUDR ）. Methods： Among the 32 patients, there were 20 cases of primary, hepatic carcinoma, 12 cases of metastatic hepatic carcinoma. In all cases transfemoral catheterization was applied,catheterial head was placed into tumors feeding artery （common hepatic artery, left or right hepatic artery, hepatic segmental artery） , Chemotherapeutic protocol was oxpliplatin （ 130mg/m^2 ） , 5-fluorouracil deoxyribonucleoside （ 500-750mg/m^2 ） , following by mitomycin （ MMC 6-8mg/m^2） with lipiodol（10-30ml） embolization. From the second day after TACE the group of metastatic hepatic carcinoma were treated with 5-fluorouracil deoxyribonucleoside （350-500mg/（ m2 ·d） ） and citrovorum factor （ CF 200mg/（ m2 · d） ） i. v. d for three days, repeated treatment was given after 4-6 weeks. Results ： CR 2 cases,PR 13 cases, SD 16 cases. The resuh of the treatment showed response rate of all cases was 46.9% ,and the group of metastatic hepatic carcinoma was 58. 33%. Toxicities include mild nausea, vomiting, leucopenia and periphery neuritis with lower incidence,and there were transient liver function injuries only. Conclusion： Transarterial chemotherapy with oxaliplatin and lipiodol embolization is an effective,hypotoxicity and safety method for the patients with advanced liver cancer.