吉西他滨联合奥沙利铂双路径给药治疗26例晚期原发性肝癌分析

目的研究吉西他滨联合奥沙利铂双路径给药治疗晚期原发性肝癌的疗效和不良反应。方法吉西他滨1000mg／m^2，第1、8天。第1天采用Seldinger法插管进行肝动脉灌注化疗，第8天静脉滴注给药。奥沙利铂130mg／m^2，第2天，静脉滴注。21d为1个周期，至少完成2个周期的评价。结果26例患者共行化疗87个周期，其中CR1例（3．8％）；PR8例（30．8％）；SD11例（42．3％）；PD6例（23．1％）。总有效率（CR＋PR）为34．6％，临床获益率（CR＋PR＋SD）为76．9％。中位进展生存时间为2．8个月，中位生存期（MST）为7．8个月，6个月生存率为65．4％，（17／26），1年生存率为39．4％（13／26）。主要不良反应为血液毒性，Ⅲ～Ⅳ度骨髓抑制发生率中白细胞减少占周期数的11．5％（10／87），血红蛋白减少占9．2％（8／87），血小板减少占22，9％（20／87）。经短暂休息和对症治疗后均能恢复，无血小板减少相关的并发症发生。非血液学毒性轻微。结论吉西他滨联合奥沙利铂双路径给药治疗晚期原发性肝癌具有较好的临床疗效，不良反应较轻，患者耐受好，能有效改善疾病的相关症状，提高患者的生存质量，值得临床进一步研究。

奥沙利铂联合氟尿嘧啶与亚叶酸钙治疗晚期原发性肝癌疗效观察

目的:探讨以奥沙利铂为主联合氟尿嘧啶、亚叶酸钙治疗晚期原发性肝癌临床疗效及安全性。方法:20例晚期原发性肝癌患者,给予奥沙利铂130 mg/m2,第1天,静脉滴注;亚叶酸钙200 mg,第1～5天,静脉滴注;5-FU,400 mg/m2,第1～5天静脉滴注。3周重复,2个周期评价疗效,以REC IST评价标准评价疗效及NC ICTC评价不良反应。结果:20例患者,完全缓解0例,部分缓解3例,稳定8例,进展9例,总有效率为(CR+PR)15%,临床获益率为(CR+PR+SD)55%,19例患者临床症状改善,主要不良反应包括恶心、乏力、腹泻、白细胞下降、周围神经毒性,但均为轻度,患者可耐受。结论:以奥沙利铂为主联合氟尿嘧啶、亚叶酸钙化疗治疗晚期原发性肝癌具有较好疗效及安全性,患者耐受性好,值得进一步探讨。

吉西他滨联合奥沙利铂治疗晚期原发性肝癌的临床观察

【目的】观察吉西他滨联合奥沙利铂化疗方案静脉注射治疗晚期原发性肝癌的疗效及不良反应。【方法】9例晚期原发性肝癌患者,接受吉西他滨/奥沙利铂组成的方案进行治疗,吉西他滨1000mg/m2,第1、8天各注射1次,奥沙利铂130mg/m2,第1天,3周为一疗程。按WHO标准评价疗效及毒副作用。【结果】9例患者均可以评价客观疗效,其中PR1例,占11.1%,SD5例,占55.6%,PD3例,占33.3%。临床获益率(CR+PR+SD)66.7%。6例AFP升高患者中4例有不同程度的下降。3例PD患者中的主要症状(疼痛,乏力和纳差)有明显改善。9例患者Kamosiky评分稳定或升高。主要的不良反应为血液学毒性。【结论】吉西他滨联合奥沙利铂治疗晚期原发性肝癌有较好的近期疗效,毒副作用可以耐受,值得进一步试用。

以奥沙利铂为主的方案治疗晚期原发性肝癌的疗效观察

目的观察奥沙利铂（Oxaliplatin,L-OHP）为主的联合方案静脉治疗晚期原发性肝癌的疗效及不良反应。方法24例晚期原发性肝癌患者,采用L-OHP130 mg·m^-2d1,亚叶酸钙（CF）200 mg d1-5,5-氟尿嘧啶（5-FU）400 mg·m^-2d1-5方案进行治疗和严密观察,每例完成2-3周期后评价疗效及不良反应。结果24例中无完全缓解病例（CR）,部分有效（PR）4例（16.7%）稳定（SD）15例（60.8%）,进展（PD）5例（24.5%）,总有效率（CR＋PR）为16.7%,临床受益率（CR＋PR＋SD）为79.2%,甲胎蛋白下降幅度为70.8%（17/24）。主要不良反应为胃肠道反应及骨髓抑制,但都可耐受。结论含奥沙利铂方案静脉化疗晚期原发性肝癌有效,安全性高,不良反应轻,患者易于耐受,值得进一步研究。

吉西他滨联合顺铂治疗晚期原发性肝癌的临床观察

目的观察吉西他滨(商品名健择)联合顺铂化疗治疗晚期原发性肝癌的疗效及毒副反应。方法34例失去手术机会的晚期肝癌患者,给予GP方案化疗四个周期,观察其疗效及毒副反应。结果CR 1例、PR 9例,MR10例,SD8例,PD6例,RR 29．4%(10/34)。45．8%(11/24)的病人AFP较治疗前基线下降超过50%。21例疗前有肝区疼痛的患者,疼痛全部于化疗两个周期后消失。不良反应主要为骨髓抑制,Ⅲ-Ⅳ度白细胞减少为17．6%(6/34),Ⅲ-Ⅳ度血小板减少为14．7%(5/34);非血液学毒性方面,除少数病人有轻度恶心外,胆红素、转氨酶升高均不超过正常值上限1．5倍,尿素氮、肌酐未发现有明显升高。临床获益患者中位TTP4．5个月,MST12．8个月,一年生存率60．7%。结论GP方案化疗治疗晚期肝癌具有较好的客观疗效,副反应轻,能明显减轻病人的痛苦,延长病人的生命,值得进—步探讨、研究。

瘤内注射重组溶瘤病毒联合FOLFOX-4方案治疗晚期肝癌

目的观察和评价超声引导下瘤体内注射重组溶瘤病毒(H101)联合FOLFOX-4方案治疗晚期肝癌的疗效及安全性。方法 :22例晚期原发性肝癌患者,采用超声引导下肝内瘤体内注射重组溶瘤病毒(H101)联合FOLFOX 4方案进行治疗,分别以RECIST标准和NCI CTC标准观察和评价其疗效和毒性。结果 :共22例患者,有20例可以评价客观疗效,其中获得PR 5例,SD7例,PD 8例;患者的肿瘤进展时间(TTP)为1.2-6.1个月,中位TTP 3.1个月。22例中,11例临床症状和KPS评分有明显改善,AFP阳性的17例患者中,有11例下降,5例明显下降(AFP下降超过原始基线的1/2)。22例患者均可评价毒性,主要不良反应为轻、中度的发热(45.6%),白细胞减少(44.5%)和腹泻(33.7%)。结论 :本试验证实,瘤体内注射重组溶瘤病毒(H101)联合FOLFOX 4方案治疗国人晚期原发性肝癌,疗效确切;较单纯全身化疗有更高的有效率;安全性高,不良反应较轻,患者易于耐受,值得进一步研究试用。

1例晚期原发性肝癌患者的循证治疗

目的借助循证医学的方法为一例晚期原发性肝癌患者确定治疗目标及治疗方案。方法在充分评估患者情况后提出临床问题,从Cochrane图书馆(2010年4期)、PubMed(1980～2010)、EMbase(1990～2010)和万方数据库(1990～2010)上检索,收集与原发性肝癌诊断、治疗有关的证据,并对所获证据进行评价,而后结合医生的经验及患者的愿望制定治疗方案。结果共检出相关文献153篇,最终纳入系统评价/Meta分析13篇,随机对照试验23篇及临床指南4篇。通过对检索结果进行分析结合患者意愿,为患者制定出STACE+3D–CRT+对症支持治疗的综合治疗方案。通过6个月的随访,证实该方案对患者有满意的疗效,远期疗效仍在进一步观察中。结论采用循证治疗的方法,为晚期原发性肝癌患者制定个性化的合理治疗方案,可以有效提高治疗效果,提高患者生存质量。

Comprehensive treatment of advanced primary live cancer with intraperitoneal chemotherapy or in combination with other therapies:therapeutic observation of 72 cases

Objective： To evaluate the effect of intraperitoneal chemotherapy or in combination with other therapies in patients with advanced primary liver cancer. Methods： 72 patients with advanced primary liver cancer with no indication for surgery received intraperitoneal chemotherapy in combination with other therapies including transcatheter arterial chemoembolization （TACE）, radiofrequency catheter ablation （RFA）, percutaneous ethanol injection therapy （PELT） and radiotherapy. Of them, 29 cases were complicated with hilar or retroperitoneal multiple lymph node metastases, 14 with portal vein embolus, 15 with intrapedtoneal and diaphragmatic metastases, 6 with chylous ascites, one with cancerous ascites, and 7 with suspected cancerous ascites （referring to large amounts of ascites without hypoproteinemia while exfoliative cytology of the ascites was positive）. The mean maximum tumor size was 8.2 cm in diameter. Liver function at the initial treatment was Child A in 53 cases, and Child B in 19 cases. I ntrapedtoneal chemotherapy was performed in all these patients. The intraperitoneal chemotherapy protocols included： 5-FU 0.5-0.75 g/d for 10-15 consecutive days, with a total dosage of 5-12.5 g, and at the last day of chemotherapy 10 mg mitomycin （MMC） or 100 mg carboplatin was injected. For 7 cases of cholangiocarcinoma, Gemzar 800-1000 mg was administered additionally. A majority of all these patients received another one or two therapy methods followed by intraperitoneal chemotherapy. TACE was performed in the patients with multiple tumors or nodule more than 5 cm in diameter in the liver, RFA or PElT with nodule fewer than 4 in number and 5 cm or less than 5 cm in diameter and radiotherapy, only for metastases, with metastatic lymph nodes, localized metastasis within the abdominal cavity or portal vein embolus. Interval time between two methods was one month or so. Two months after the sequential therapy, repeated treatment would be given if general medical condition and liver function were perfect at that time. Results： The median survival time of the group was 13.97 ± 6.27 months. The 1- and 2-year survival rates were 59.7% and 30.6% respectively. The mean survival time of the patients with liver function Child A was 15.91 ± 5.49 months, and that of the patients with Child B was 8.55 ± 5.09 months. The difference was statistically significant （P 〈 0.05）. Conclusion： Intraperitoneal chemotherapy or in combination with other therapies in patients with advanced primary liver cancer with metastases to abdominal cavity is an effective method. It can prolong the survival time and improve life quality for a certain percentage of patients with advanced pnmary liver cancer.

Clinical study of FOLFOX4 regimen for patients of advanced hepatocellular carcinoma

Objective:The aim of our study was to observe the efficiency and toxicity of oxaliplatin (L-OHP) combined with CF/5-FU in patients with advanced primary hepatocellular carcinoma.Methods:Twenty patients with advanced primary hepatocellular carcinoma had recurrence/metastasis after multiple courses of TACE (cisplatin and epirubicin,etc.).All patients were treated with FOLFOX4 regimen of the combination of oxaliplatin and leucovorin and 5-fluorouracil.Treatment was repeated every 2 weeks until disease progression or unacceptable adverse effects occurred.The efficiency was evaluated according to RECIST criteria,and toxicities according to American National Cancer Institute Common Toxicity Criteria (NCI CTC),respectively.Results:Twenty patients were assessable for the objective efficiency and for toxicity.No patient achieved complete response (CR),4 patients were partial response (PR),8 patients were stable disease (SD),8 patients were disease progression (PD);Time to tumor progression (TTP) of the patients ranged from 1.5 to 4.8 months,median TTP was 2.2 months;Overall survival (OS) of the patients ranged from 3 to 10.2 months,median OS was 5 months.The 2 patients' serum AFP level decreasing.Sixteen patients relieved the symptoms obviously,stabilized or raised up Karnofsky Score.The toxicities were mainly grade I-II arrest of bone marrow (50%),mild neurotoxicity (30%) and mild reaction of gastrointestinal tract (40%).Conclusion:FOLFOX4 regimen is effective and safe for patients with advanced primary hepatocellular carcinoma.It can be worthy of further clinical investigation.

Therapy Response of Chinese Herbal Medicine in Advanced Liver Cancer： A Retrospective Observational Clinical Trial

Aiming at starting the ball rolling and contributing humble effort to promote CTM （Chinese traditional medicine）, we performed the present study to assess the therapy response of Chinese herbal decoction compared to conventional therapy on critical ill patients of advanced liver cancer. A total of 6 patients （1 female and 5 males） with histologically confirmed liver cancer were included in this retrospective observational clinical trial. We administered Chinese medicine （Gan Decoction, mixed with a variety of effective herbal components） to help them to recover from poor condition. In the meantime, conventional treatment of surgical resection and artery catheterization chemotherapy was applied in cases compared. In 3 cases of CTM combined treatment, the tumor marker level decreased. Residual intrahepatic metastatic sites reduced according to ultrasonography/CT imaging, and the patients felt free from the complaint of abdominal discomfort. The quality of life has been improved, we managed to have prolonged the PFS （Progression-Free-Survival） and TTP （Time-to-Progression） from the onset to date. While in 3 cases with conventional treatment only of surgical resection and artery catheterization chemotherapy, we were not able to decrease the level of tumor marker, metastatic lesions increased according to ultrasonography/CT imaging, and the patient＇s condition worsen more. We failed in having prolonged the PFS and TTP in the compared cases of conventional treatment only. The retrospective clinical study showed no OS （overall survival） benefit for liver cancer patients treated with Gan Decoction, while the QOL （quality of life） evaluation seemed to predict survival better. Chinese herbs might be an additional choice with its better benefits and tolerability in the treatment of primary liver cancer.