含奥沙利铂方案TACE治疗原发性肝癌的临床观察

Clinical observation of transcatheter arterial chemoembolization with oxaliplatin treatment for primary hepatocarcinoma

目的观察含奥沙利铂方案经皮肝动脉化疗栓塞术（TACE）治疗中晚期原发性肝癌的疗效和不良反应。方法 2008年4月至2010年4月,37例患者经手术或活检组织病理诊断以及临床诊断为中晚期原发性肝癌,接受TACE治疗。动脉灌注药物包括奥沙利铂130mg/m2,替加氟15~20mg/kg,肿瘤血管栓塞药物为吡柔比星25~40mg/m2＋10~20m l进口超液态碘化油乳化剂,部分患者加用明胶海绵栓塞。间隔4~6周复查血常规、肝肾功能、AFP、CT或MR I。疗效和不良反应分别按照WHO实体瘤近期疗效和抗癌药物急性及亚急性毒性反应分度标准评价。结果全组37例患者均顺利完成至少1次TACE治疗并可评价疗效,获CR 3例（8.1%）,PR 20例（54.0%）,NC 12例（32.4%）,PD 2例（5.4%）,有效率为62.2%（23/37）,中位无进展生存时间为132天（95%C I：89~174天）。37例患者治疗1疗程后肝区疼痛、食欲不振、腹水、黄疸改善率分别为97.1%、86.5%、100.0%和57.1%。。主要不良反应为发热、恶心、呕吐及骨髓抑制（白细胞减少为主）,大部分均为1~2级,仅5例发生1级神经毒性。结论含奥沙利铂方案TACE治疗中晚期原发性肝癌的疗效较好,临床症状显著改善,不良反应轻。

Objective To observe efficacy of primary hepatocarcinoma patients by transcatheter arterial chemoembolization with oxaliplatin treatment.Methods All 37 primary hepatocarcinoma patients were enrolled from April 2008 to April 2010,who received transcatheter arterial chemoembolization with oxaliplatin 130mg/m2,ftorafur 15-20mg/kg and pirarubicin 25-40mg/m2,and 10-20ml lipiodol emulsion.Repeated treatment was given after 4-6 weeks.Results Three cases were evaluated as complete response,20 cases as partial response,12 cases as no change,2 cases as progression.The response rate was 62.16%（23/37） and the median progression-free survival was 132 days（95%CI：89-174）.The rate of recovery was hepatalgia（97.1%）,appetite（86.5%）,ascites（100.0%）,jaundice（57.1%）,respectively.Toxicities were mild nausea,vomiting,leucopenia and periphery neuritis with lower incidence.Conclusion Transcatheter arterial chemoembolization with oxaliplatin treatment is effective and safe for primary hepatocarcinoma patients,which improves the quality of life.