超选择子宫动脉与外周静脉灌注化疗宫颈癌组织内铂浓度的研究

A Comparative Study of the Difference of Infusion Chemotherapies Through Ultraselected Uterine Artery or Peripheral Vein on the Intratumoral Platinum Concentration in the Carcinoma of the Cervix

目的:对比卡铂超选择子宫动脉与外周静脉灌注化疗子宫颈癌组织内的药物浓度。方法:选择经病理活组织证实为宫颈癌、且癌灶较大易于取材的患者13例,随机分为超选择子宫动脉灌注化疗组(A组)和外周静脉灌注化疗组(B组),以卡铂300mg/m2,一次性给药。在灌注后0min、10min、20min分别钳取宫颈癌组织,用原子吸收光谱法测定其标本内铂离子浓度。结果:(1)峰值及曲线形态:A组癌组织铂离子浓度的高峰值出现在化疗结束后即刻,且随时间的延长而快速下降,呈一下降曲线;B组峰值出现在化疗后10分钟,随时间的延长呈一弓背向上的下降曲线。前者的峰值是后者的2.79倍,差异有统计学意义(P<0.05)。(2)灌注化疗结束后即刻,A组宫颈癌组织内铂离子浓度是B组的3.75倍,差异有统计学意义(P<0.05)。(3)A组癌组织内铂离子药时曲线下面积(AUC0～20min)是B组的2.10倍,差异有显著意义(P<0.05)。结论:无论癌组织内铂离子峰浓度还是AUC0～20min,超选择子宫动脉灌注化疗组均较外周静脉组明显增高,为评价动脉化疗疗效提供了基础理论依据及临床药代动力学参数。

Objective： To compare the intratumoral platinum concentrations of infusion chemotherapies with carboplatin through ultraselected uterine artery or peripheral vein for the carcinoma of the cervix. Methods： 13 patients with local advanced cervical cancer who had been confirmed by pathobiopsy were enrolled in the study. 13 patients were randomly divided into two groups. Group A with 6 patients were treated using intra-uterine artery carboplatin 300mg/m^2 , and group B with 7 patients using intra-vein carboplatin 300mg/m^2. The tumors were biopsied at 0,10 and 20 minutes after completion of the infusion. The platinum concentrations of samples were detected by flameless atomic absorption spectrophotometer. Results： （ 1 ） The peak values of platinum concentration in tissues were existed at 0 minute after inter-arterial infusion of carboplatin in the group A, and at 10 minute in the group B. The peak values of platinum concentration in tissues of the group A were 2.79 times higher than that of the group B, and there was significantly difference（ P 〈 0.05 ）. The platinum concentration in the cancer tissues decreased with time in the group A, and the pattern of first decline followed by rising curve with time was demonstrated in the group B. （2） At 0 minute after infusion chemotherapy, intratumor platinum concentrations of the group A were 3.75 times higher than that of the group B（ P 〈 0. 05 ）, and there was significantly difference. （3） AUC 0-20min of the group A was 2.10 times higher than that of the group B. The difference had statistical significance （P 〈 0.05）. Conclusion： Both for the peak value of platinum concentration in tissues and the area under the tissue concentration-time curve, the group A were significantly higher than those of the group B, which provides theoretical basis and laboratory parameter for evaluating the effect of the intra-arterial infusion chemotherapy.