含亚砷酸方案介入治疗中晚期肝癌的疗效评价

Evaluation on effect and toxicity of arsenic trioxide in the treatment of middle-late hepatocarcinoma by transcatheter arterial chemoembolization

目的评价亚砷酸联合化疗药物及超液化碘油行肝动脉化疗栓塞术（TACE）治疗中晚期肝癌的疗效和不良反应。方法中晚期肝癌共65例随机分2组,A组32例行肝动脉灌注羟基喜树碱20mg或阿霉素50mg、顺铂60mg、超液化碘油5~20ml,B组33例在上述化疗药基础上加用亚砷酸20mg。观察其疗效与不良反应。结果A组客观有效率（CR＋PR）达43.8%（14/32）,获益率（CR＋PR＋NC）达71.2%（23/32）;B组客观有效率达51.1%（17/33）,获益率为93.9%（31/33）,两组客观有效率比较无显著性差异（P〉0.05）,获益率比较有显著性差异（P〈0.05）。患者血清AFP水平,A、B组治疗前后比较有非常显著性差异,A、B组治疗后比较有显著性差异。不良反应主要为骨髓抑制、恶心呕吐、疼痛、发热,两组均无Ⅳ度不良反应,无治疗相关性死亡。结论亚砷酸联合化疗药及超液化碘油行TACE治疗中晚期肝癌有较好疗效,不良反应较小,是肝癌介入治疗用药的较佳选择,值得临床推广。

Objective To evaluate the effect and toxicity of arsenic trioxide combined with chemotherapy drug and lipoidol-ultrafliud in the treatment of middle-late hepatocarcinoma by transcatheter arterial chemoembolization（TACE）. Methods 65 patients with middle-late hepatocarcinoma were divided into two groups at random. HCPT 20mg or Doxorubicin 50mg ,Cisplatin 60mg and lipoidol-ultrafliud 5-20ml were injected into hepatic artery by catheters in 32 patients of A group ; based on the medicine used in group A , 20mg of Arsenic trioxide was added in 33 patients of B group. The effect and toxicity were observed . Results The objective response rate of A group was 43.8%（14/ 32）,the clinical beneficial response rate （CR＋PR＋SD） was 71.2%（23/32）;The objective response rate of B group was 51.1%（17/33）,the clinical beneficial response rate （CR＋PR＋SD） was 93.9%（31/33）,the difference of objective response rate in two groups was not significant（P〉0.05）,but the difference of clinical beneficial response rate was significant. The lever of AFP was very significanly lowered in both groups after treatment compared with that before treatment ,it was also significantly different from group A to group B after treatment . Major adverse effects were mild bone marrow depression、nausea and vomiting、pain、pyrexia and hepatic damage, but there were not Ⅳdegree toxic response nor death related to treatment. Conclusion Arsenic trioxide combined with chemotherapy drug and lipoidol-ultrafliud in the treatment of middle-late hepatocarcinoma by TACE is effective and has less adverse effect ,which is a better choice for hepatocarcinoma interventional therapy.