射频消融联合^(131)I-chTNT治疗中晚期肝癌的安全性分析

Efficacy and safety of ^(131)I-chTNT combined with radiofrequency ablation in treatment of advanced hepatocellular carcinoma

目的分析射频消融(RFA)联合^(131)I肿瘤细胞核人鼠嵌合单克隆抗体^(131)I-chTNT治疗中晚期肝癌的安全性和疗效。方法回顾性分析34例原发性肝癌患者的临床资料,分为射频消融组22例,射频消融+^(131)I-chTNT注射组(联合组)12例,随访时间5~48个月,评价其生存期和安全指标,包括肝损伤、骨髓毒性及甲状腺损伤等。结果联合组术后7d复查血红细胞、血小板未见明显下降,血白细胞指数略升高,具有统计学意义。术后7dALT、AST明显升高,TBIL轻微升高。与术前相比,ALT、AST的差异有统计学意义,TBIL的差异无统计学意义。治疗后1个月查甲状腺功能,T_3、T_4、TSH、FT_3、F_4与术前比较无明显变化。联合组治疗术后1个月复查增强CT或增强MRI,其中CR2例,PR8例,SD1例,PD1例。联合组中位总生存期较单纯射频治疗组有延长的趋势(P=0.052)。结论对于中晚期肝癌,射频消融联合^(131)I-chTNT瘤内注射治疗中晚期肝癌是安全有效,未对肝功能、骨髓、甲状腺功能等产生不良影响。但尚需大样本研究其不良反应。

Objective To evaluate the efficacy and safety of 131I- chTNT combined with radiofrequency ablation in treatment of advanced hepatocel ular carcinoma. Methods Thirty four patients with hepatocel ular carcinoma were treated with radiofrequency ablation （RFA group, n=22） or radiofrequency ablation combined with 131I- chTNT（combination group, n=12 cases） and fol owed up 5~48 months, the clinical data were retrospectively analyzed. The survival and safety indicators （including liver damage, bone marrow toxicity and thyroid lesions）were analyzed and compared between two groups, Results In combination group the red blood cel s, platelets were not declined, leucocytes was significantly elevated which has statistical significance and ALT and AST increased significantly, TBIL was not changed at d7 after operation, compared with those preoperatively. There were no significant changes in thyroid function, T3, T4, TSH, FT3 and FT4 1 month after treatment compared with those preoperatively. The contrast enhanced CT or MRI results showed there were 2 cases of CR, 8 cases of PR, 1 case of SD and1 case of PD at 1 month after treatment. There was an increasing tendency of median overal survival incombination group than that in RFA group （P=0.052）. Conclusion For advanced hepatocel ular carcinoma, RFA combined with vivatuxin treatment is safe and ef-fective, but it stil need large sample study to confirm.