结直肠癌肝转移经肝动脉栓塞及持续灌注化疗的临床疗效

Continuous Hepatic Artery Infusion Chemotherapy andChemoembolization for Treatment of Patients withLiver Metastases from Colorectal Cancer

背景与目的:结直肠癌肝转移患者经肝动脉介入栓塞或静脉持续滴注化疗药物,治疗效果有所提高,但尚存肿瘤局部化疗药物浓度不够高,化疗药物对肿瘤细胞的杀伤力不够强,晚期结肠直肠癌的治疗效果仍然不够好的缺陷。本文将动脉介入与持续灌注化疗药物两种方法相结合,观察结直肠癌肝转移患者经肝动脉介入栓塞或持续灌注化疗的临床疗效。方法:对26例结直肠癌肝转移患者经肝动脉介入治疗93次,单用肝动脉持续灌注化疗42次,肝动脉介入栓塞联合持续灌注化疗51次。化疗药物选用阿霉素(ADM)、顺铂(DDP)、丝裂霉素(MMC)、醛氢叶酸(CF)和5-氟尿嘧啶(5-FU)。先将ADM30mg/m2和MMC6mg/m2加入超液化碘油10-30ml中进行肝动脉灌注栓塞,然后留置导管进行持续动脉滴注。方案为CF200mg/m2,d1-3,静脉滴注;DDP80mg/m2d1,如肾功能改变则改用Vp-1660mg/m2,d1-3,应用电动输液泵动脉滴注;5-FU2500mg/m2,采用便携式输液泵将5-FU持续动脉滴注72h。结果:近期疗效以实体瘤疗效评价标准评价,CR1例,CR率3.85%;PR14例,PR率53.84%,总有效率为57.69%。本组0.5、1、2、3和5年生存率分别为92.31%、76.92%、38.46%、23.07%和3.85%,肝转移后中位生存期为11.5个月。全组病人出现的不良反应主要有肝功能损害、胃肠道反应和骨髓抑制,经护肝、制酸。

Background &Objective: Although previous studies showed that hepatic artery chemoembolization or continuous intravenous with infusion chemotherapeutic agent can improve the effects of the treatment of liver metastases from colorectal cancer, the results remained unsatisfactory because of the lower concentration of local chemotherapeutic agent.This study was designed to evaluate the efficacy of continuous hepatic artery infusion chemotherapy and chemoembolization for the treatment of liver metastases from colorectal cancer. Methods: A total of 26 patients with liver metastases from colorectal cancer were treated 93 times by continued hepatic artery infusion chemotherapy and chemoembolization. Infusion chemotherapy alone was performed 42 times, and infusion chemotherapy combined with chemoembolization were 51 times. Chemotherapeutic agents used were Adriamycin 30 mg/m2 d1, Mitomycin 6 mg/m2 d1,Cisplatin 80 mg/m2 d1,or Etoposide 60 mg/m2 d1-3, Calcium folinate 200 mg/m2, d1-3, and Fluorouracil 2 500 mg/m2. Adriamycin and Mitomycin were mixed with lipiodol ultra fluid for chemoembolization. Response rates were assessed by CT and B ultrasonic wave scanning. Results: An overall response rate of the cases was 57 69%. The median survival period was 11 5 months. The 0 5, 1, 2, 3,and 5 year survival rate was 92 31%, 76 92%, 38 46%, 23 07%,and 3 85%, respectively. There was no severe side effect or complication. Conclusion: Continuous transcatheter hepatic artery infusion chemotherapy and chemoembolization are useful methods for the treatment of the patients with liver metastases from colorectal cancer, which may the life quality and life span of the patients.