单纯大剂量新型重组肿瘤坏死因子灌注治疗骨肉瘤的初步研究报告

PURE AND HIGH-DOSAGE NEW-RECOMBINANT TUMOR NECROSIS FACTOR IN ISOLATION PERFUSI ON FOR OSTEOSARCOMA

目的 :探讨单纯大剂量新型重组肿瘤坏死因子对骨肉瘤的抗肿瘤效果 ,以及其对人体的毒副作用。方法 :5例经过病理确诊的下肢骨肉瘤患者 ,采用股动静脉插管 ,体外循环隔离加温灌注 ,从氧合器加入新型重组肿瘤坏死因子 5 0 0万单位至70 0万单位 ,灌注区肿瘤组织内温度保持在 41～ 42℃之间 ,持续 6 0 min。灌注后 2～ 3周行肿瘤段骨切除 ,人工膝关节置换术。结果 :新型肿瘤坏死因子灌注后 ,5例患者疼痛明显减轻 ,肿瘤缩小 3.5～ 5 .0 cm灌注区有不同程度的发热和灌注区域的炎症样红肿 ,1例出现寒战 ,2例发生低血压 ,无肾衰。组织学发现肿瘤坏死率达 88%～ 96 %。随访 3个月至 2 0个月 ,平均 6个月。 4例存活 ,1例术后 3个月肺转移死亡 ,无 1例发生局部复发。结论 :单纯大剂量新型重组肿瘤坏死因子具有较好的抗肿瘤效果及明显的镇痛作用。

Objective:To study the therapeutic effect of recombinant tumor neceosis factor (rTNFSAM2) using isolation limb perfusion (ILP) with hyperthermia for ostosarcomaMethods:Five patients received ILP,The rTNFSAM2 was injected as a bolus into the arterial line,and the dosages ranged from 5 to 7 millions unit under hyperthermic conditions (41 ℃ to 42℃) for 60 minutesResults:Five patients was observed with fever (372℃ to 397℃),and inflammational swelling in ILPregionOne had shiver,and two had moderae hypotensionNone of the patients had kidney failure,tumor lessening by 35 cm^5 cmNecrosis of the tumour tissue occurred in 88%～96% The most representative type of necrosis was coagulationes and haemorrhageFollowup time of 6 months (ranging from 3 to 20 months) showed that 4 of the 5 patients are alive,and one patient died of metastatic tumour of lung 3 months after ILPNone of the patient had recurrence of tumourConclusion:This study suggests that pure and highdos newrecombinant tumor necrosis factor in ILP for Osteosarcoma may produce good efficacy under hyperthermic conditions (41℃ to 42℃)Toxicity of tumor necrosis factor can be reduced by taking effectiv ILP and hyperhydration