胆系肿瘤化学治疗进展

Chemotherapy progression on biliary tract carcinoma

胆系肿瘤包括胆囊癌和胆管癌，发病率呈上升趋势。本病病因复杂，症状不典型，诊断时通常已处于晚期，预后极差。临床研究显示，对于不能手术的进展期患者，化疗和（或）姑息性胆道减压可以提高患者的生活质量。一系列Ⅱ期临床研究结果提示，单药化疗的客观有效率为8％～30％，而联合化疗的有效率为10％～60％。由于胆系肿瘤发生率低，目前尚无大型Ⅲ期临床研究探讨不同化疗方案在生存期和生活质量上的影响，但Ⅱ期临床研究的共识是，时于一般情况好或有肿瘤相关症状的进展期患者应该给予姑息化疗，而出现严重非肿瘤相关疾病的患者应该避免化疗；内镜操作，如PTCD或ERCP支架和光动力治疗，是重要的支持治疗，时于恶性胆道梗阻患者可以应用胆汁引流延长生存和改善生活质量。在目前试验的化疗药物中，健择的毒性比似乎最好，但疗效仍不满意，需要联合其他药物。在联合方案中，健择联合奥沙利铂（GEMOX）方案似乎是最好的方案之一，总生存期长达15．4个月；而从近期疗效来看，健择联合顺铂（GP）方案目前的结果最好，总有效率达64％。随着分子生物学的研究进展，相信针时胆系肿瘤的靶向治疗将成为可能。

The mobidity of biliary tract carcinoma, including gallbladder carcinoma and cholangiocarcinoma, has an increasing tendency. The very poor prognosis of such disease is mainly caused by complicated etiology, atypical symptom and advanced stage when diagnosed. Clinical research has shown that chemotherapy and/or palliative biliary tract decompression can improve the quality of life（QOL）. Series of phase Ⅱ clinical studies indicated that objective response rates of agent alone and combined regimen were between 8 % - 30 % and 10 % - 60 %, respectively. Because of the low mobidity, there still has no large phase Ⅲ clinical study currently investigating the influences of different chemotherapeutic regimens on overall survival and QOL. However, the general knowledge of phase Ⅱ studies suggests that, palliative chemotherapy should be administrated to those with well performance status and those advanced stage patients who have tumor-related symptoms; and chemotherapy should be avoided to those who have severe diseases unrelated to carcinoma. Endoscope techniques, such as PTCD or ERCP and photodynamic therapy, are important supportive care and can prolong survival time and improve QOL of those patients with malignant obstruction of biliary tract. Among the different drugs tested in this disease, gemcitabine seems to have the best efficacy： toxicity ratio, However, efficacy results remain disappointing, and combination schedules need to be developed to improve the results. Among them, the gemcitabineoxaliplatin （GEMOX） combination seems to be one of the most promising schedules and the overall survival time lasts to 15.4 months. Gemcitabine-cisplatin（GP） combination currently has a best result with the overall response rate of 64%. Following with the biological studies, it will bring us the opportunity of development of future targeted therapies in biliary tract cancer.