动脉化疗挽救性二线治疗晚期胰腺癌的临床价值

The study of clinical value of transarterial chemical perfusion as second-line threapy for late stage pancreatic cancer

目的：探讨晚期胰腺癌一线化疗失败后，以动脉灌注联合化疗作为挽救性二线治疗的临床价值。方法回顾性分析上海市松江区中心医院和上海交通大学附属仁济医院同仁分院放射介入科近3年（2010-2012）收治的35例吉西他滨一线化疗失败的晚期胰腺癌患者，采用股动脉穿剌，胃十二指肠动脉、胰背动脉、胰大动脉、胰尾动脉，相关肋腰动脉，以及肠系膜上动脉等肿瘤相关供血动脉插管，行化疗药物灌注。方案为：顺铂30 mg/m2，吉西他滨1000 mg/m2，每3～4周为1个疗程，总疗程不限。结果35例共行局部化疗217个周期，最少行1个周期，最多9个周期，平均6.2个周期。其中：CR 1例，PR 6例，SD 15例，有效率（ CR＋PR）为20％，疾病控制率（ DCR）为68.75％，中位生存期为9.6个月，中位 TTP 为3.7个月。 CBR总有效率、稳定率和无效率分别为51.4％、25.7％和22.9％。疼痛评分改善者88.57％（31/35），42.86％（15/35）疼痛缓解持续时间为3～20 d （中位时间11 d），17.14％（6/35）疼痛缓解20 d以上，疼痛缓解维持时间最长160 d。半数患者有不同程度的不良反应，Ⅲ、Ⅳ度白细胞减少占17.14％（6/35），8.57％（3/35）。结论将动脉灌注联合化疗作为晚期胰腺癌挽救性二线治疗是具有临床价值的，具有较好的疾病控制率和疼痛缓解率。

Objective To discuss arterial infusion chemotherapy as second-line treatment for advanced pancreatic carcinoma salvage after failed vein chemotherapy.Methods 35 cases with Ⅳ stage pancreatic carcinoma , all cases are failed first-line chemotherapy of Gemcitabine.Via femoral artery puncture , gastroduodenal artery , the dorsal pancreatic artery , pancreatic artery , pancreatic tail artery , the rib waist artery, superior mesenteric artery and tumor related to blood supply artery intubation and chemical drug perfusion.Plan：Cisplatin 30 mg/m2 , Gemcitabine 1 000 mg/m2.Treatment for every 3-4 weeks, there is no limit on the total number.Results 35 cases were local chemotherapy for 217 cycles, at least 1 cycle, a maximum of 9 cycles, 6.2 cycles on average.Among which：CR 1 case, PR 6 cases, SD 15 cases, effective rate （ CR＋PR） is 20%,disease control rate （ DCR） is 68.75%.The median survival time was 9.6 months.The median TTP was 3.7 months.Total effective rate of CBR , the stability rate of CBR and inefficiency rate of CBR were 51.4%,25.7% and 22.9% respectively.Pain score improvement 88.57%（31/35）,42.86%（15/35）Pain relief last for 3 -20 days（ median time11 days）.17.14%（6/35）Pain relief last for more than 20 days.Pain relief maintain the most elderly 160 days.Half of the patients have different degree of side reaction ,Ⅲ,Ⅳdegree leukopenia accounted for 17.14%（6/35）, 8.57%（3/35）.Conclusion The arterial perfusion chemotherapy as second-line treatment of advanced pancreatic cancer salvage is of clinical value , with better disease control rate and the rate of pain relief.