绒癌脑转移的动脉灌注化疗

Intra-arterial chemotherapy for the brain metastasis of choriocarcinoma

目的：观察动脉灌注化疗对绒癌脑转移的治疗效果。方法：对１４例绒癌脑转移患者，采用脑转移灶同侧的颈动脉灌注化疗、结合全身静脉化疗，动脉化疗用ＭＴＸ或５－Ｆｕ，静脉化疗用５－Ｆｕ、ＫＳＭ。结果：头痛、呕吐于治疗１～３周得到缓解，失语、颅神经损害和偏瘫等在３～８周缓解。４例经ＣＴ、ＭＲＩ检查证实脑转移灶于４～１２周消退。五年生存率为５０．０％（６／１２）。１例生育１正常小孩。副反应为动脉插管一侧的口腔溃疡和脱发较对侧重。影响疗效的因素为耐药病例；巩固治疗；药物剂量和病情严重程度。结论：动脉灌注化疗是对绒癌脑转移有效、安全的治疗方法。

Objective: To determine the value of intra-arterial chemotherapy for the brain metastasis of choriocarcinoma. Method: 14 cases with brain metastasis of choriocarcinoma were treated by intra-arterial chemotherapy via carotid arteria combined with systemic chemotherapy. MTX (Methotrexate) or 5-Fu (5-Fluorouracil) were used for intra-arterial chemotherapy, 5-Fu and KSM (Actinomycin D) were used for systemic chemotherapy. Result: Headache, vomiting were disappeared in 1～3 weeks, aphasis, focal neurologic signs and hemiplegia were disappeared in 3～8 weeks, and the brain metastatic tumor in 4 cases disappeared proved by CT scan or MRI in 4～12 weekd sfter the beginig of treatment. Five year survival rate was 50.0% (6/12). Side effect was mild, but mouth ulceration and alopecia of the same side of IA chemotherapy were more serious than that of the opposite sied. Influence factors on prognosis were (1) drug resistance, (2) consolidation courses, (3) dose of drug, (4) advanced stage (brain herniation). Conclusion: Intra-arterial chemotherapy is a safe and valuable method for the brain metastasis of choriocarcinoma.