奈达铂联合5-Fu经肝动脉治疗Ⅲ期肝细胞癌的临床研究

Clinical study on combination therapy of intrahepatic artery nedaplatin and 5-Fu for stageⅢhepatocellular carcinoma.

目的探讨奈达铂联合5-Fu方案(NF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 161例Ⅲ期肝细胞癌患者,用NF方案与超液化碘油乳剂化疗栓塞治疗。治疗方案为奈达铂100mg·m^(-2)行肝动脉灌注,结合5-Fu 1000mg·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 161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39.8%,Ⅱ度29.8%,Ⅲ～Ⅳ度17.4%。恶心呕吐:Ⅱ～Ⅲ度96.8%。肝脏Child-Pugh分级:术后32例由A级升至B级,4例由A级升至C级,9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161例患者的生存期为5～35个月,中位值20个月。结论 NF方案联合超液化碘油乳剂化疗栓塞治疗Ⅲ期肝细胞癌是安全有效的,并且能改善病人的生活质量。

Objective To evaluate the efficiency and safety of nedaplatin and 5-Fu in the treatment of stage m hepatocellular carcinoma（HCC）. Method 161 patients with HCC received trans-arterial chemoembolization （TACE）. The intra-arterial strategy consisited of nedaplatin （100 mg.m-2） , 5-Fu （1000 mg.m-2） and ultra-lipoidal iodide oil （5-30 mL）. The toxicity and hepatic injury were evaluated according to WHO anticancer drug toxicity criterion and Child-Pugh classification criterion, respectively. The survival time was also recorded during follow-up. Results In 161 patients, the toxicity of blood was bone marrow restrain. Decrease in white blood cell count was recorded： grade I in 39.8% of patients, grade II in 29.8 % and grade III-IV in 17.4 %. Grade II - III nausea and vomiting developed in 96.8% of the patients. Hepatic injury beeame aggravated in 32 patients from A to B class, in 4 patients from A to C class, and in 9 patients from B to C class according to Child-Pugh classification criterion. The median survival time was 20 months with a range from 5 to 35 months. Conclusion Nedaplatin combined with 5-Fu and ultralipoidal iodide oil emulsion was safe and efficient in the treatment of patients with stage ]]] hepatocellular carcinoma. Trarrs-arterial chemoembolization （FACE） can improve life quality.