胃肠癌肝转移经肝动脉栓塞及皮下药盒持续灌注化疗的疗效初探

Preliminary results of chemoembolization and continuous hepatic infusion chemotherapy for treatment of patients with liver metastases from gastrointestinal cancer

目的 本研究观察经肝动脉栓塞化疗和(或)肝动脉插管持续灌注化疗治疗晚期胃肠癌肝转移的临床疗效。方法 22例无外科手术指征的晚期胃肠癌肝转移患者经肝动脉介入治疗共72次,单采取Seldinger法肝动脉内插管皮下埋置药盒持续灌注化疗48次,或先用吡柔比星(THP)60mg/m2和DDP50mg/m2加入超液化碘油10-30ml进行肝动脉栓塞化疗再联合肝动脉持续灌注化疗共24次。肝动脉插管灌注的方案:CF 200mg/m2,d1,d14,静脉滴入;顺铂(DDP)50mg/m2,d1,或用奥沙利铂100-130mg/m2,d1,从皮下药盒处缓慢推入;5-Fu 2000-2500mg/m2,d1,d14,装入美国百特公司的便携式输液泵持续动脉灌注48h。结果 总有效率(完全缓解+部分缓解)为59.0％。肿瘤负荷<30％者的有效率为77.8％,明显高于肿瘤负荷>30％者(46.2％,P<0.005)。本组患者主要不良反应为肝功能损害、发热及胃肠道反应等,经相应对症处理可缓解。结论 经肝动脉栓塞及插管持续化疗是治疗胃肠癌肝转移的安全有效方法,值得临床推广。

Objective To evaluate the efficacy of continuous hepatic artery infusion chemotherapy and chemoembolization in the treatment of liver metastases from gastrointestinal cancer. Methods A total of 22 cancer patients were treated 72 times with continuous hepatic artery infusion chemotherapy and chemoembolization. Infusion chemotherapy alone was performed 48 times, or pirarubicin 60 mg/m2 and cisplatin 50 mg/m2 mixed with lipi-odol ultra-fluid for chemoembolization combined with infusion chemotherapy were performed 24 times. Chemothera-peutic agents for continuous hepatic arterial infusion used were calcium folinate 200 mg/m2 , d1-d2/d14-d15, and fluorouracil 2 000-2 500 mg/m2 d1-d2/d14-d15,cisplatin 50 mg/m2 d1 or oxaliplatin 100-130 mg/m2 d1 .Results An overall response rate (CR+ PR) of the cases was 59.0% .The response seemed to correlate with the intrahe-patic tumour burden. A 77.8% response rate was observed in intrahepatic tumour burden less than 30% versus 46. 2% response rate in those with tumor burden higher than 30% ( P < 0.005). There was no severe side effect or complications. Conclusion Continuous transcatheter hepatic artery infusion chemotherapy and chemoembolization may be a safe and effective methods for the treatment of the patients with liver metastases from gastrointestinal cancer and worthwhile for further study.