吉西他滨联合卡铂经肝动脉治疗Ⅲ期肝细胞癌的临床研究

Transhepatic arterial chemoembolization with gemcitabine and carboplatin for the treatment of stageⅢhepatocellular carcinoma

目的探讨吉西他滨联合卡铂方案(GC方案)与超液化碘油乳剂治疗Ⅲ期肝细胞癌的疗效及安全性。方法61例Ⅲ期肝细胞癌患者采用GC方案与超液化碘油乳剂化疗栓塞治疗。治疗方案为卡铂300 mg/m^2行肝动脉灌注,结合吉西他滨1000 mg/m^2和超液化碘油5～30 ml混合成乳剂栓塞。参照WHO抗癌药物毒性分级标准观察毒性反应,Child-Pugh分级观察肝脏损害。随访患者生存期。结果本组CR 0例,PR 37例,SD 13例,PD 11例,总有效率60.7%。61例患者的血液学毒性表现为骨髓抑制作用,中性粒细胞计数下降,其中Ⅰ度占39.3%,Ⅱ度占29.5%,Ⅲ～Ⅳ度占18.0%。恶心呕吐Ⅱ～Ⅲ度占96.8%。肝脏Child-Pugh分级显示,术后16例由A级升至B级,2例由A级升至C级,6例由B级升至C级。随访61例患者的生存期为5～35个月,中位生存期20个月。结论GC方案联合超液化碘油乳剂化疗栓塞治疗Ⅲ期肝细胞癌是安全有效的,能够改善患者的生活质量。

Objective To evaluate the efficiency and safety of transhepatic arterial chemoembolization （TACE） with gemcitabine and carboplatin for the treatment of stage Iil hepatocellular carcinoma （I-ICC）. Methods Sixty-one I-ICC patients were treated by TACE. During TACE, At first, intra-arterial infusion of carboplatin 300 mg/m2, then gemcitabine 1000 mg/m2 with 5-30 ml of ultra-lipoidal iodide oil emulsion was used for arterial embolization. The toxicity and hepatic damage were observed according to WHO anticancer drug toxicity criteria and Child-Pugh classification criteria, respectively. The survival time was also observed during follow-up. Results The blood toxicity was bone marrow suppression presented as grade I leucopenia in 39.3%, grade Ⅱ in 29.5%, grade Ⅲ - IV in 18.0%. Grade Ⅱ - Ⅲ nausea and vomiting developed in 96.8% of the patients. Hepatic function damage became aggravated in 16 patients from A to B class, in 2 from A to C class, and in 6 from B to C class according to Child-Pugh classification criteria. The median survival time was 2 0 months with a range of 5 to 3 5 months. Conclusion Traushepatic arterial chemoembolization using carboplatin and mixture of gemcitabine with ultra-lipoidal iodide oil emulsion is safe and effective in the management of stage Iil hepatocellular carcinoma. This regimen can also improve their quality of life.