动脉内灌注的新辅助化疗在晚期直肠癌的应用

New adjuvtant chemotherapy via arterial infusion for rectal cancer

目的探讨动脉内灌注的新辅助化疗(NACT)对晚期直肠癌的疗效。方法对36例不能切除的晚期直肠癌采用动脉置泵灌注化疗的新辅助化疗,为MFH方案:5-Fu 500 mg/m2,丝裂霉素(MMC)6 mg/m2,拓喜(HCPT)20 mg/m2,每周1次,两周1个疗程,休息4周后重复,共2—3个疗程。结果完全缓解(CR)6例,部分缓解(PR)23例,稳定(MR)7例。有效率(CR+PR)为80.5％,CR 6例全部获得手术切除,PR 23例中手术切除15例。术后病理检查发现癌细胞均有不同程度的核固缩、碎裂、胞浆凝固、变性,细胞间质水肿、纤维增生、炎细胞浸润,血管内膜增厚、血栓形成。结论动脉内灌注的新辅助化疗作为晚期直肠癌综合治疗的一部分,对改善病期,使不可能手术患者变为可能手术,提高手术切除率可以发挥重要作用,并使癌肿组织学形态发生明显改变。

Objective To evaluate the clinical effects of new adjuvant chemotherapy via arterial infusion in treatment of rectal cancer. Methods 36 patients with rectal cancer were given new adjuvant chemotherapy via arterial infusion. Chemotherapy plan was as follows: 5-fluorouracil(5-Fu)500 mg/m2, cyclophosphamide(MMX) 6 mg/m2 and hydroxycamptothecin(HCPT)20 mg/m , once per week,2 weeks a course,2-3 courses in total.Results After new adjuvant chemotherapy via arterial infusion,6 cases achieved CR, 23 cases achieved PR,7 cases achieved MR and the respond rate(CR + PR) was 80.5% . Changes such as karyopyknosis,karyorrhexis, coagulation and necrosis of cytoplasm in cancer cells around the vessels were found in all cases. Interstitial edema, invasion of inflammatory cells,fibroelastosis around cancer cells, thickening of vascular intima, thrombosis and inflammation of vessels were also found at the same site. Conclusions The new adjuvant chemotherapy reported here as a part of combination therapy plays a significant role in the effective treatment of otherwise non-resectable rectal cancer.