含三氧化二砷介入方案治疗原发性肝癌的临床研究

Clinical study of arsenic trioxide in the treatment of primary hepatic carcinoma by interventional ways

目的评价三氧化二砷(As_2O_3)联合化疗药物及超液化碘油行肝动脉化疗栓塞术(TACE)治疗原发性肝癌(PHC)的疗效和不良反应。方法将确诊的60例PHC随机分2组,治疗组(A组),30例,采用三氧化二砷20mg、卡铂300mg、丝裂霉素10mg及超液态碘油适量行TACE术,对照组(B组),30例,采用卡铂300mg、丝裂霉素10mg及超液态碘油适量行TACE术。观察其疗效与不良反应。结果治疗组有效率(CR%+PR%)达60%(18/30),获益率(CR%+PR%+NC%)达93.3%(28/30);对照组有效率达46.7%(14/30),获益率为76.7%(23/30),两组有效率比较无统计学差异(P>0.05);获益率比较差异有统计学差异(P<0.05)。患者血清AFP、VEGF水平,治疗组、对照组治疗前比较无统计学差异,治疗后比较有有统计学差异。不良反应主要为骨髓抑制、恶心呕吐、疼痛、发热及转氨酶升高等,两组均无Ⅳ度不良反应,无治疗相关死亡发生。结论三氧化二砷联合化疗及超液化碘油行TACE治疗PHC有较好疗效,不良反应较小,是肝癌介入治疗用药的较佳选择,值得临床推广。

Objective To evaluate the clinical effect and toxicity of arsenic trioxide combined with chemotherapy drug and ultra-liquefied lipiodol in the treatment of primary hepatic carcinoma by transcatheter arterial chemoembolization （TACE）. Methods 60 patients with hepatic carcinoma were divided into two groups at random, mitomycin 10mg, Cisplatin 300rag and ul- tra-liquefied lipiodol 5-20ml were injected into hepatic artery by catheters in 30 patients of the control group （ B group）; based on the medicine used in group B, 20mg of arsenic trioxide was added in 30 patients of A group. The effect and toxicity were observed. Results The objective response rate of A group was 60%（18/32）, the clinical beneficial response rate （CR＋PR＋SD） was 93.3 % （28/30）. The objective response rate of B group was 46.7 % （17/30）, and the clinical beneficial response rate （CR＋PR＋SD） was 76.7 % （23/30）. The difference of objective response rate in two groups was not significant （P〉 0.05）, but the difference of clinical beneficial response rate was significant. The lever of AFP was very significantly lowered in both groups after treatment It was also significantly different from group A to group B after treatment while not before treatment. The major adverse effects were mild bone marrow de- pression, nausea and vomiting, pain, pyrexia and hepatic damage, but there were not 1V degree toxic response nor death related to treatment. Conclusion Arsenic trioxide combined with chemotherapy drug and ultra-liquefied lipiodol in the treatment of mid- die-late hepatocarcinoma by TACE is effective and has less adverse effect, which is a better choice for hepatocarcinoma interven- tional therapy.