奈达铂联合羟基喜树碱经肝动脉治疗Ⅲ期肝细胞癌的临床研究

Clinical study on combination therapy of intraarterial nedaplatin and Hydroxycamptothecine for stage Ⅲ hepatocellular carcinoma

目的探讨奈达铂联合羟基喜树碱方案（nedaplatin and hydroxycamptothecine,NO方案）与超液化碘油乳剂治疗Ⅲ期肝细胞癌的疗效及安全性。方法 120例Ⅲ期肝细胞癌患者,用NO方案与超液化碘油乳剂化疗栓塞治疗。治疗方案为奈达铂100 mg/m^2行肝动脉灌注,结合羟基喜树碱40 mg/m^2和超液化碘油5-30mL混合成乳剂栓塞。参照WHO抗癌药物毒性分级标准观察毒性反应,Child-Pugh分级观察肝脏损害。随访患者生存期。结果 120例患者,血液学毒性表现为骨髓抑制作用,中性粒细胞计数下降：Ⅰ度33.3%,Ⅱ度12.5%,Ⅲ、Ⅳ度8.3%。恶心呕吐：Ⅱ、Ⅲ度91.7%。肝脏Child-Pugh分级：术后21例由A级升至B级,4例由A级升至C级,10例由B级升至C级。肾毒性方面未见尿素氮（BUN）和血清肌酐（Cr）值升高。随访120例患者的生存期为5-35个月,中位值20个月。结论 NO方案联合超液化碘油乳剂化疗栓塞治疗Ⅲ期肝细胞癌,是安全的和有效的,并能改善患者的生活质量。

【Objective】To evaluate the efficiency and safety of nedaplatin and hydroxycamptothecine in the treatment of stageⅢ hepatocellular carcinoma（HCC）.【Methods】120 patients with diagnosis of HCC were received trans-arterial chemoembolization（TACE）.During TACE,first,nedaplatin at dose of 100 mg/m2 was used to intra-arterial infusion,then Hydroxycamptothecine with ultra-lipoidal iodide oil（5~30 mL） emulsion for arterial embolization at dose of 40 mg/m2 were used.The toxicity and hepatic injury were observed according to WHO anticancer drug toxicity criterion and Child-Pugh classification criterion,respectively.The survival time was also observed during follow-up.【Results】In 120 patients,the toxicity of blood was bone marrow restrain.Decreased in white blood cell count was observed： grade I in 33.3% of patients,grade II in 12.5% and grade III-IV in 8.3%.Grade II-III nausea and vomiting developed in 91.7% of the patients.Hepatic injury became aggravated in 21 from A to B class patients,in 4 from A to C class,and in 10 from B to C class according to Child-Pugh classification criterion.The median survival time was 20 months with a range of 5 to 35 months.【Conclusion】Nedaplatin combinated with hydroxycamptothecine with ultra-lipoidal iodide oil emulsion was safe and efficient in the management of patients with stage Ⅲ hepatocellular carcinoma.Trans-arterial chemoembolization（TACE） can improve quality of life.