碘油平阳霉素瘤内注射联合反应停治疗复发性中晚期肝癌

Intratumoral injection of lipiodol pingyangmycin combined with thalidomide in treatment of recurrent advanced liver cancer

目的:为肝动脉化疗栓塞(TACE)治疗后复发而又不再适合行TACE治疗的中晚期肝癌患者探索一种经济安全的治疗手段。方法:将55例行TACE治疗后复发的肝癌患者分为两组。治疗组在B超或CT引导下,将平阳霉素8～16mg与超液态碘油5～10mL充分乳化后,经皮肝肿瘤内注射;同时口服反应停50mg,每天3次,共14d。对照组采用最佳支持治疗,同时口服常用抗癌中成药。以生存时间为主要终点,至疾病进展时间为次要终点。采用SPSS11.5统计软件进行survival分析及χ2检验。结果:(1)治疗组与对照组3、6、12个月生存率分别为81.1%、64.9%和9.2%vs60.0%、36.0%和5.1%,中位生存期为7.92个月vs5.25个月。经统计学分析,P=0.0465,两组之间差异有显著性;(2)治疗组病情稳定3个月但6个月后病情发展8例,占29.6%;随访至今无新的病灶产生并稳定6个月以上7例,占25.9%,受益率为55.5(29.6±25.9)%;对照组病情稳定3个月但6个月后病情发展4例,占14.3%,随访至今无新的病灶产生并稳定6个月以上4例,占14.3%,受益率为28.6(14.3±14.3)%。两组受益率比较,P=0.043,差异有显著性。结论:碘油平阳霉素瘤内注射+反应停治疗复发性中晚期肝癌不管是生存时间还是受益率都优于对照组,而且该方法简单易行,经济安全,特别适合于基层医疗单位推广,值得进一步探讨。

Objective To explore an economical and safe therapy for the patients with recurrent advanced liver cancer who had been treated by TACE but no longer suitable for it.Methods 55 patients were assigned to receive either intratumoral injections of pingyangmycin of 8 to 16 mg completely emulsified with UFL of 5 to 10 mL and oral thalidomide of 50mg thrice daily for 14 days（study group） or best supportive care plus common traditional Chinese medicines for cancer（control group）.Survival time was the primary endpoint and time to disease progression was the secondary endpoint.Statistical software Spss11.5 was used to analyze survival and to conduct χ2 test.Results 3-, 6-, or 12-months survival and median survival time differed significantly betwewn the two groups（81.1% vs.60.0% , 64.9% vs.36.0% or 9.2% vs.5.1%;7.92 months vs.5.25 months;P= 0.0465）.In the study group, the disease was stable for 3 months but then started to develop 3 months later in 8 patients（29.6.0%）, and the disease was stable and no new lesions occurred in 7（25.9%）, the rate of profit was 55.5（29.6 ± 25.9）%.In the control group, the disease was stable for 3 months but then started to develop 3 months later in 4 patients（14.3%）, and the disease was stable and no new lesions occurred in 4（14.3%）, the rate of profit was 28.6（14.3 ± 14.3）%.There was a significant difference in the rate of profit between the two groups（P = 0.043）.Conclusions Intratumoral injection of lipiodol pingyangmycin combined with thalidomide is superior to the supportive therapy plus Chinese medicines in the survival and rate of profit.It is sample, feasible, economical, safe, particularlly suitable for primary care units,and worth to further study.