吉西他滨和奥沙利铂栓塞化疗联合三维适形放疗治疗晚期原发性肝癌疗效观察  

Transcatheter arterial chemoembolization with regimen GEMOX together with three- dimensional conformal radiotherapy for advanced primary hepatocellular carcinoma:a clinical observation

作　　者：刘学芬[1] 彭东[1] 李刚[1] 冉文华[1] 张力[1] 朱川[1] 任必勇[1] 刘华文[1] 莫小飞[1] 

机构地区：[1]重庆万州重庆三峡中心医院,404000

出　　处：《介入放射学杂志》2013年第4期292-296,共5页Journal of Interventional Radiology

基　　金：重庆市医学重点研究室建设项目资助(2007-14)

摘　　要：目的探讨吉西他滨、奥沙利铂(GEMOX)方案肝动脉化疗栓塞(TACE)联合三维适形放疗(3-DCRT)治疗晚期原发性肝癌的疗效和不良反应。方法经病理或影像学明确诊断的70例晚期原发性肝癌患者,采用GEMOX方案:吉西他滨0.8～1.0 g/m2,奥沙利铂85～100 mg/m2加入超液化碘油10～30 ml行TACE治疗,每月1次,连用2～3次。经TACE治疗后3～4周行3-DCRT:总剂量(DT)48～60Gy,每次4～5 Gy,隔天1次,每周3次,连续4周。结果 2例患者3-DCRT后4个月内死亡,未能评价疗效,其余68例原发性肝癌患者中完全缓解(CR)4.4%(3/68),部分缓解(PR)70.6%(48/68),稳定(SD)14.7%(10/68),进展(PD)10.3%(7/68);总有效率(CR+PR)75.0%(51/68),肿瘤控制率(CR+PR+SD)为89.7%(61/68)。总生存中位数10个月(8.4～11.6),无瘤生存时间中位数6.0个月(4.6～7.4),1、2、3年生存率分别为58.8%,29.4%和19.1%。常见的不良反应主要表现为白细胞减少、贫血、血小板减少、恶心、呕吐和发热等,患者均可耐受。结论 GEMOX方案TACE联合3-DCRT治疗晚期原发性肝癌疗效确切,不良反应可耐受,值得进一步研究。Objective To investigate the clinical effects and untoward reactions of transcatheter arterial chemoembolization （TACE） with regimen GEMOX together with three- dimensional conformal radiotherapy （3-DCRT） for the treatment of advanced inoperable primary hepatoceUular carcinoma （HCC）. Methods A total of 70 patients with pathologically or imaging confirmed advanced inoperable primary HCC were enrolled in this study. TACE with GEMOX regimen （gemcitabine 0.8 - 1.0 g/m2, oxaliplatin 85 - 100 mg/ m2 plus super-liquefactive iodized oil） was carried out once a month in all patients for 2 - 3 successive months. Three to four weeks after TACE, 3-DCRT was conducted with a total dose of 48 - 64 Gy （4 - 5 Gy per fraction at an interval of 48 hours）, and 3 fractions were given every week. The clinical results were analyzed. Results Two patients died four months after 3-DCRT was completed. The clinical effects of the remaining 68 patients were evaluated. Of the 68 patients, complete remission （CR） was obtained in 3 （4.4%）, partial remission （PR） in 48 （70.6%）, stable disease （SD） in 10 （14.7%）, and progress disease （PD） in 7 （10.3%）. The total effective rate （CR ＋ PR） was 75.0% （51/68）. The tumor control rate （CR ＋ PR ＋ SD） was 89.7% （61/68）. The survival time varied from 8.4 to 11.6 months with a median time of 10.0months. The median PFS was 6.0 months （95% CI： 4.6 - 7.4 months）. The overall survival rates at 1, 2 and 3 years were 58.8%, 29.4% and 19.1%, respectively. The common untoward reactions includedleucopenia, anemia, thrombocytopenia, nausea, vomiting and fever, which could be tolerated by the patients. Conchmion TACE with GEMOX regimen combined with 3-DCRT has definite therapeutic effect on inoperable primary hepatocellular carcinoma, and its untoward reactions can be tolerated by the patients. It is of value to make a further study on this technique.

关 键 词：原发性肝癌 动脉化疗栓塞 三维适形放疗 奥沙利铂 吉西他滨 

分 类 号：R735.7[医药卫生—肿瘤] R730.5[医药卫生—临床医学]