三氧化二砷经导管动脉介入治疗口腔鳞癌(附三例报告)

Arsenic trioxide chemotherapy by transartery catheterization for management of oral squamous cell carcinoma——With three cases reports.

目的 :在体外实验研究证实砷剂对口腔粘膜鳞癌有明显抗癌的基础上 ,进一步探索三氧化二砷经导管动脉介入治疗口腔粘膜鳞癌的临床治疗效果。材料和方法 :选择临床无手术适应症的口腔鳞癌患者 3例 ,进行经动脉导管介入三氧化二砷治疗口腔恶性肿瘤。选择肿瘤区域供血分支动脉 ,经皮或皮肤小切口插入导管 ,1%亚甲胺蓝定位后并埋入泵站于皮下 ,注入 0 .1%肝素冲洗。三氧化二砷注射液稀释为 10 0 μmol L ,微量输液泵输液器针刺入泵站 80ml 小时 ,输入稀释为 10 0 μmol L浓度As2 O3 ,2 5 0ml 次 ,每天二次 ,每五天为一个疗程。疗效判断方法 :治疗前后测定肿瘤最大与最小直径 (A与B) ,缓解率 =[(AXB -A′×B′) (AXB) ]× 10 0 %。疗效判定 :临床治愈 (CR) ,治疗后肿块或溃疡临床观察消失 ,表面形成疤痕样组织 ;临床显效 (PR)肿块缩小超过 5 0 % ;无效 (NR)肿块缩小不足5 0 %。结果 :3例患者经二个疗程的治疗 ,2例临床治愈 ,1例部分缓解 ,随访 12～ 2 4个月 ,均存活无远处转移。治疗中的毒副作用较小仅 1例患者存在皮肤搔痒现象。结论 :经动脉导管介入三氧化二砷可能是治疗口腔粘膜鳞癌的一种较为有效方法 ,特别是对于一些晚期不能手术的病员更具价值 ,且存在操作简便 ,定位明确等优点。

Objective: Based on the promising anti-tumor effect on arsenic trioxide on the oral SCC cells indicated by in vitro experimental study, a clinical trial has been carried out in an attempt to explore its clinical application. Methods: Three cases of SCC in oral cavity were chosen into the clinical trial who were inoperable due to their advanced stage or poor systemic condition. After local anesthesia was administered, the arterial branch that dominated the blood supply of the tumor region was exposed and then catheterized by way of a minor skin incision. One percentage of methylene blue was injected to trace the anatomic site. Thereafter, arsenic trioxide solution was administered at the concentration of 100(mol/L, by using an electric pump, with injection volume of 250ml each time. The velocity of the pump injection was 80ml per hour. The therapeutic course included twice administration per day with five consecutive days in one week. The final outcome was evaluated by the universal criteria for chemotherapy. Results: The three cases underwent two course of As 2O 3 chemotherapy by transarterial catherization. Complete remission was achieved in two cases, Which Partial remission was found in another patient according to the following up results from one to two years after treatment. All the cases were still alive without any distant metastasis. There were no severe complications among the three cases except one case of skin itching. Conclusions: The result of the clinical trial proves that arsenic trioxide chemotherapy by transarterial catheter is a valuable a means for the treatment of oral squamous cell carcinoma, especially for the advanced inoperable cases. Large sample trial needs to be further conducted to develop more sophisticated methodology and the mechanism of its anti-tumor effect is worth of in-depth investigation as well in future. [