吉西他滨联合奥沙利铂双路径给药治疗26例晚期原发性肝癌分析

Clinical study of double-way chemotherapy with gemcitabine and oxaliplatin in the treatment of advanced primary hepatocarcinoma

目的研究吉西他滨联合奥沙利铂双路径给药治疗晚期原发性肝癌的疗效和不良反应。方法吉西他滨1000mg／m^2，第1、8天。第1天采用Seldinger法插管进行肝动脉灌注化疗，第8天静脉滴注给药。奥沙利铂130mg／m^2，第2天，静脉滴注。21d为1个周期，至少完成2个周期的评价。结果26例患者共行化疗87个周期，其中CR1例（3．8％）；PR8例（30．8％）；SD11例（42．3％）；PD6例（23．1％）。总有效率（CR＋PR）为34．6％，临床获益率（CR＋PR＋SD）为76．9％。中位进展生存时间为2．8个月，中位生存期（MST）为7．8个月，6个月生存率为65．4％，（17／26），1年生存率为39．4％（13／26）。主要不良反应为血液毒性，Ⅲ～Ⅳ度骨髓抑制发生率中白细胞减少占周期数的11．5％（10／87），血红蛋白减少占9．2％（8／87），血小板减少占22，9％（20／87）。经短暂休息和对症治疗后均能恢复，无血小板减少相关的并发症发生。非血液学毒性轻微。结论吉西他滨联合奥沙利铂双路径给药治疗晚期原发性肝癌具有较好的临床疗效，不良反应较轻，患者耐受好，能有效改善疾病的相关症状，提高患者的生存质量，值得临床进一步研究。

Objective To observe the clinical efficacy and side effects of double -way chemotherapy with gemcitabine and oxaliplatin in the treatment of advanced primary hepatocellular carcinoma. Methods All the patients with advanced primary hepatic carcinoma were treated with gemcitabine 1 000mg/m^2. d, transatheter hepatic arterial chemotherapy on day 1, using seldinger technique , and genral chemotherapy by the way of veins on day 8; oxaliplatin 130mg/m^2. d, infusion on day 2 ;repeated every 21 days one cycle. All the patients received 2 cycle of chemotherapy at least. Results 26 patients were treated for 87 cycles of chemotherapy totally. There were 1 CR（3.8%）,8 PR（30.8%）, 11 SD（42.3%） and 6 PD （23.1%）,the overall response rate （CR＋PR） was 34.6% and clinical benefical rate （CR＋PR＋SD） was 76.9%. median time to progression （rnTTP） was 2, 8 months and median survival time （MST） was 7. 8 months. The 6-month survival rate was 65.4%（17/26） and the 1- year survival rate was 39.4%（13/26）. Hematologic toxicity was the main side reaction, which included leucopenia 11.5 % （ 10/87）, anemia 9.2 % （8/87）, thrombocytopenia 22.9 % （20/81）with the incidence of grade Ⅲ-Ⅳ in the whole cycles , and were relieved after release or corresponding treatment. There was no thrombocytopenia related complications occurred. Other side effect of nonhematology were slight . Conclusion The combination of gemcitabine and oxaliplation with double way on advanced primary hepatic carcinoman is effective and well tolerated. It can relieve the symptoms and improve the quality of life . It can be worthy of further clinical investigation.