肿瘤热化疗中化疗药物的选择

Selection of Chemotherapeutics in Thermochemotherapy of Tumor

目的：肿瘤治疗进入综合治疗时代，临床已应用热疗联合化疗和／或放疗治疗多种肿瘤，但热化疗中还有许多问题需要明确，如最佳的温度和作用时间，热化疗是药物的选择等。方法：通过总结许多国内外的基础试验研究和临床应用结果，评价肿瘤热化疗的协同作用。结果：体外细胞试验表明化疗药物的毒性与治疗温度和时间相关，温度37．0～41．0℃（41．5℃）合并药物时，细胞生存率急剧下降，而除ADR外，41．0～43．0℃时细胞生存率下降不明显。体内实验表明9种药物中，除BIN外热增长比例（TER）在41．5℃和43．0℃无明显区别，其中马法兰的TER最高。热化疗的临床研究还处于初期，但用马法兰和TNF进行隔离肢体热灌注治疗黑色素瘤和软组织肉瘤效果确切。结论：热疗联合化疗有协同抗肿瘤作用，应进一步深入研究。

Objective： To discuss the optimal temperature（OT） and action time（AT）, selection of chemothempeufies in the thermochemotherapy（TCT） of tumor. Methods： The synergistic action in the TCT of tumor was evaluated by summarizing the basal experimental investigation and clinical application of the internal and external. Results： Exosomatic cell test showed that the toxicity of chemotherapeutics was relative to treating temperature and time. When the temperature was 37.0- 41.0℃（41.5℃） with medication, cell survival rates decreased suddenly except Adr; the test in vivo showed that out of the 9 drugs, L- Sarcolysinum＇ s（L- PAM） TER（ = Thermal Enhancement Ratio） was the highest at 41.5℃and 43.0℃, except BLM without significant difference. Although the clinical study on TCT is still in the initial stage, hyperthermic isolated limb perfusion with L- PAM and TNF in the treatment of melanoma and soft - tissue sarcoma has got good effects. Conclusion： Thermotherapy combined with chemotherapy has synergistic action against tumor, which should be further studied.