内支架置入联合FOLFOX-4方案治疗肝癌并下腔静脉及右心房癌栓6例

Stent placement combined with FOLFOX-4 regimen for primary liver cancer patients with inferior vena cava and right atrium tumor thrombus

目的:探讨血管内支架置入联合FOLFOX-4方案系统化疗治疗肝癌合并下腔静脉及右心房癌栓的疗效.方法:回顾性分析行血管内支架置入联合FOLFOX-4方案系统化疗治疗6例原发性肝癌并下腔静脉癌栓及右心房癌栓患者,记录并发症发生情况及疗效,随访生存期.结果:6例患者均一次性成功置入血管支架,下腔静脉平均压力下降16mmH2O,患者下腔静脉梗阻症状均明显改善.6例患者均可客观评价化疗疗效,以右心房癌栓为靶病灶,PR5例,SD1例.4例患者血清AFP下降超过50%.至2011-10随访结束时,接受治疗患者仍存活2例,中位总存活时间(overall survival,OS)为8.2mo,中位肿瘤进展时间(tumor progression time,TTP)为5mo.全部患者未见因化疗不良反应终止化疗,其中骨髓抑制(白细胞减少,Ⅰ-Ⅱ度)3例,消化系反应(恶心、呕吐、纳差,Ⅰ-Ⅱ度)5例,神经毒性(神经感觉异常Ⅰ-Ⅱ度)1例,乏力3例,发热1例.结论:对于肝癌并下腔静脉及右心房癌栓患者,血管内支架置入能即刻改善下腔静脉梗阻症状,联合FOLFOX-4方案系统化疗,使生存期延长.

AIM：To evaluate the efficacy and safety of stent placement combined with FOLFOX-4 regimen for primary liver cancer patients with inferior vena cava and right atrium tumor thrombus.METHODS：A retrospective study was performed on 6 primary liver cancer patients with inferior vena cava and right atrium tumor thrombus who underwent stent placement combined with FOLFOX-4 regimen.RESULTS：Six stents were placed successfully in 6 patients.The pressure gradient across the stenotic segments of the inferior vena cava declined from 34 mmH2O to 18 mmH2O,and obstruction of the inferior vena cava was improved quickly.All patients were assessable for the objective ef-ficiency.Right atrium tumor thrombus served as a target lesion.Partial response（PR） was achieved in 5 cases,and stable disease（SD） in 1 case.Serum AFP levels decreased by more than 50% in 4 cases.Median overall survival（OS） was 8.2 mo,and median time to tumor progression（TTP） was 5 mo.During chemotherapy,there were 2 cases of leucopenia,5 cases of nausea and vomiting,1 cases of neurotoxicity,3 cases of fatigue and 1 cases of fever,all of which were tolerable.CONCLUSION：Stent placement,which could improve the symptoms of inferior vena cava obstruction,combined with FOLFOX-4 regimen therapy can prolong OS and TTP in primary liver cancer patients with inferior vena cava and right atrium tumor thrombus.