FOLFOX6/FOLFIRI优化给药全身化疗联合TACE治疗结直肠癌肝转移

Optimized administration of FOLFOX6/FOLFIRI systemic chemotherapy combined with TACE in treatment of colorectal liver metastases

目的观察FOLFOX6/FOLFIRI方案(奥沙利铂或伊立替康+亚叶酸钙+5-氟尿嘧啶)优化给药全身化疗联合经导管肝动脉化疗栓塞(transcatheter hepatic arterial chemoembolization,TACE)治疗结直肠癌肝转移(colorectal liver metastases,CRLM)的疗效和安全性。方法回顾性分析2009年11月至2018年11月本院收治的89例CRLM患者,分为两组:化疗联合TACE组45例采用FOLFOX6和(或)FOLFIRI方案常规剂量优化给药的全身化疗联合TACE;单纯化疗组44例仅采用FOLFOX6和(或)FOLFIRI方案全身化疗;均28 d为1个周期。治疗2个周期后比较两组患者的近期疗效及不良反应发生情况,并随访比较患者的1、2和3年生存率。结果化疗联合TACE组治疗的客观缓解率为71.1%,高于单纯化疗组的47.7%(P<0.05);患者1、2和3年生存率和中位生存期分别为91.1%、55.6%、31.1%和30.8个月,均高于单纯化疗组的70.5%、31.8%、13.6%和18.8个月(均P<0.05)。化疗联合TACE组除出现短暂发热和轻度肝区胀痛等栓塞后综合征外,肝功能损害较单纯化疗组严重,而骨髓抑制、消化道反应和神经毒性等均较单纯化疗组轻(均P<0.05)。结论对于不可切除的CRLM,FOLFOX6/FOLFIRI方案优化给药的全身化疗联合TACE治疗较传统全身化疗具有更高的近期疗效,可延长患者生存期,且不良反应可耐受。

Objective To observe the efficacy and safety of FOLFOX6/FOLFIRI regimen(oxaliplatin or irinotecan+calcium folinate+5-fluorouracil)optimized systemic chemotherapy combined with transcatheter hepatic arterial chemoembolization(TACE)in the treatment of colorectal liver metastases(CRLM).Methods A total of 89 patients with CRLM admitted to our hospital from November 2009 to November 2018 were retrospectively analyzed.The patients were divided into two groups:the chemotherapy+TACE group(45 patients treated with FOLFOX6/FOLFIRI regimen with routine dose optimization for systemic chemotherapy combined with TACE)and the chemotherapy group(44 patients receiving only systemic chemotherapy of FOLFOX6/FOLFIRI regimen).A course of treatment was both 28 days.After 2 cycles of treatment,the short-term efficacy and the occurrence of adverse reactions were compared between the two groups,and the 1-,2-,and 3-year survival rates of patients were compared during follow-up.Results The objective response rate of the chemotherapy+TACE group was 71.1%,which was higher than that of the chemotherapy group(47.7%,P<0.05).The 1-,2-and 3-year survival rates and median survival time of the chemotherapy+TACE group were 91.1%,55.6%,31.1%and 30.8 months,respectively,which were all higher than those of the chemotherapy group(70.5%,31.8%,13.6%and 18.8 months,all P<0.05).Post-embolism syndromes such as transient fever and mild pain in the liver area occurred in the chemotherapy+TACE group.Liver function damage was more serious in the chemotherapy+TACE group than that in the chemotherapy group(P<0.05),while bone marrow suppression,digestive tract reaction and neurotoxicity were less serious than those in the chemotherapy group(all P<0.05).Conclusions For unresectable CRLM,FOLFOX6/FOLFIRI regimen optimized systemic chemotherapy combined with TACE has a higher short-term efficacy than traditional systemic chemotherapy alone,prolongs patient survival,and has tolerated adverse reactions.