局部灌注化疗显著抑制pTNM IIIB期结直肠癌肿瘤病灶的生长  

Trans-catheter arterial infusion chemotherapy(TAI) significantly reduces tumor size of colorectal neoplasm in pTNM stage IIIB

作　　者：施东华[1] 王小林[1,2] 许剑民[3] 程洁敏[1] 龚高全[1] 陈颐[1] 刘凌晓[1,2] 李国平[1] 李长煜[1] 

机构地区：[1]复旦大学附属中山医院放射科,上海200032 [2]上海市影像医学研究所,上海200032 [3]复旦大学附属中山医院普外科,上海200032

出　　处：《复旦学报（医学版）》2013年第2期174-179,共6页Fudan University Journal of Medical Sciences

摘　　要：目的评估术前经导管动脉内灌注化疗(transcatheter arterial infusion chemotherapy,TAI)对pTNMIIIB期结直肠癌肿瘤病灶生长的影响,阐明局部灌注化疗在IIIB期结直肠癌术前降期治疗中的临床价值。方法临床拟诊结直肠癌患者常规行腹、盆腔核磁共振成像检查,对于影像学表现为cTNMⅢ期共120例患者利用随机数字表分为A、B组,A组患者直接行肿瘤病灶手术切除;B组患者切除术前一周予以TAI化疗。术后评估肿瘤的病理分期,两组中剔除非pTNM IIIB期患者,以A、B组各20例作为观察对象,测量其术前肿瘤病灶的影像学直径及切除术后肿瘤病灶的实际直径。根据NCI不良反应分级CTCAE 3.0版评估TAI化疗后第5天患者不良反应发生情况,同时进行体力状态Karnofsky评分。结果术前接受TAI化疗的病例(B组)与术前未接受局部TAI化疗的病例(A组)相比,肿瘤平均直径明显缩小(P<0.01),而TAI治疗的不良反应能够通过内科支持治疗后改善,不影响择期进行外科手术;TAI对患者的生存质量和体力状态亦无明显不良影响。结论术前经导管动脉内灌注化疗明显抑制pTNM IIIB期结直肠癌肿瘤病灶的生长,对结直肠癌术前的降期治疗具有一定价值。Objective To evaluate impact of preoperative trans-catheter arterial infusion chemotherapy（TAI） on tumor growth in treatment of pTNM stage IIIB colorectal neoplasm,and to illustrate clinical value of TAI in preoperative tumor down staging.Methods Abdomen and pelvic magnetic resonance imaging（MRI） was performed in patients suspected of colorectal neoplasm.Patients who were diagnosed cTNM stage Ⅲ by MRI were randomly allocated into two groups（A and B）.Group A（n=60） underwent tumor resection directly.Group B（n=60） received TAI via hepatic artery and mesenteric artery 1 week before tumor resection.Disease pathological staging（pTNM） was evaluated after surgical resection,patients not in pTNM stage IIIB were rejected.Finally,we selected 20 cases from each group for observation,tumor size of each subject was measured using MRI at the time of enrollment.Actual tumor size was measured with the help of pathologists after surgery.Adverse reaction was evaluated 5 days after TAI treatment according to NCI CTCAE v3.0,patients′ karnofsky performance score was also evaluated at the same time.Results Tumor size in group B was reduced significantly when compared with group A（P0.01）.Adverse reaction of TAI treatment would be relieved by supportive care,it didn′t interfere with operation;Also it dealt no harmfulness to patients′ quality of life and performance status.Conclusions Preoperative TAI treatment can suppress tumor growth significantly on pTNM IIIB colorectal neoplasm,and was beneficial to preoperative tumor down staging.

关 键 词：结直肠癌 经导管动脉内灌注化疗(TAI) 肿瘤分期 pTNM分期 

分 类 号：R735.3[医药卫生—肿瘤]