雷替曲塞TACE治疗胃癌术后肝转移的近期疗效观察

Interventional perfusion chemoembolization with raltitrexed for postoperative hepatic metastasis from gastric cancer:analysis of short-term effect

目的探讨雷替曲塞在TACE治疗中晚期原发性肝癌中的疗效及安全性。方法收集2012年1月至2015年1月胃癌术后肝转移患者52例，将患者随机分为观察组（n=26）和对照组（n=26）。观察组：雷替曲塞（3mg／m2）联合奥沙利铂（100mg／m2）、吡柔比星（40mg／m2）行TACE治疗；对照组：5．氟尿嘧啶（500mg／m2）联合奥沙利铂（100mg／m2）、吡柔比星（40mg／m2）行TACE治疗。每间隔4～6周行1次TACE。TACE术2个周期根据改良的实体瘤疗效评价标准（RECIST）评价疗效。评价两组介入治疗的客观有效率（RR）、疾病控制率（DCR）及不良反应发生率。结果观察组和对照组的RR分别为50．0％、19．2％（P（0．05）；DCR分别为84．6％、53．8％（P〈0．05）。两组的不良反应主要为恶心、呕吐、骨髓抑制、发热及转氨酶升高等，差异均无统计学意义（P〉0．05）。结论雷替曲塞较5．氟尿嘧啶在TACE治疗胃癌术后肝转移近期疗效显著，不良反应可耐受。

Objective To evaluate the efficacy and safety of transcatheter arterial chemoembolization （TACE） with raltitrexed in treating postoperative hepatic metastasis from gastric cancer. Methods A total of 52 patients with postoperative hepatic metastasis from gastric cancer, who were admitted to authors＇ hospital during the period from January 2012 to January 2015, were collected. The patients were randomly divided into the study group （n=26） and the control group （n=26）. TACE using rahitrexed （3 mg/m2） combined with oxaliplatin （100 mg/m2） and epirubicin （40 mg/m2） was performed for the patients of the study group; while TACE using fluorouracil （5-FU,500 mg/m2） combined with oxaliplatin （100 mg/m2） and epirubicin （40 mg/ m2） was employed for the patients of the control group. TACE was carried out once every 4-6 weeks. Two weeks after the treatment, the response was evaluated based on RECIST criteria. The objective response rate （RR）, disease control rate （DCR） as well as the incidence of adverse reactions of the two groups were calculated. Results The RRs of the study group and the control group were 50.00% and 19.23% respectively, and the difference was statistically significant （P〈0.05）. The DCRs of the study group and the control group were 84.61% and 53.85% respectively, and the difference was also statistically significant （P〈 0.05）. The main adverse events in both groups were nausea, vomiting, bone marrow suppression, fever, elevation of transaminase level, etc., the differences between the two groups were not statistically significant （P〉0.05）. Conclusion In treating postoperative hepatic metastasis from gastric cancer with TACE, combinationuse of raltitrexed with epirubicin and oxaliplatin is superior to 5-FU combined with epirubicin and oxaliplatin in achieving more excellent short-term effect, besides, the adverse reactions can be well tolerated by the patients.