改良XELOX方案治疗结直肠癌伴肝转移的临床研究  

A clinical study on modified XELOX regimen for the treatment of colorectal cancer with hepatic metastases

作　　者：李慧[1] 江旭[1] 杨朝爱[1] 王卫星[1] 陈文会[1] 刘敬禹[1] 马青[1] 杨继金[1] 

机构地区：[1]第二军医大学附属长海医院介入科,上海200433

出　　处：《实用放射学杂志》2015年第9期1506-1510,共5页Journal of Practical Radiology

基　　金：上海市科委课题项目（14411960300）;第二军医大学附属长海医院＂1255＂学科特色提升项目（CH125520805）.

摘　　要：目的：探讨改良 XELOX 方案治疗结直肠癌伴肝转移的有效性和安全性。方法回顾性分析本院收治的18例结直肠癌伴肝转移患者的临床资料,均经活检病理、结肠镜证实、原发灶未切除,且接受至少2个疗程的改良 XELOX 方案的治疗。改良XELOX 方案即指将传统 XELOX 方案中的静脉滴注奥沙利铂更改为动脉灌注且留置导管缓慢泵注1 h。每2个月通过 CT 和/或MRI 检查肝内转移灶,肠镜检查原发灶。随访其生存时间,按 RECIST 标准评价客观疗效。通过 SPSS 19.0软件运用 Kaplan-Meier 法进行分析。结果（1）18例患者均可评价疗效,共行115次肝 TACE 术。中位 OS 为14.0个月,95% CI（9.6,18.4）,中位PFS 为8.0个月,95% CI（5.2,10.8）,获 CR 2例,PR 7例,SD 4例,PD 5例,有效率（RR）为50.0%,临床受益率（CBR）为72.2%；（2）治疗后不良反应主要为发热、恶心、呕吐、疼痛、肝功能受损、骨髓抑制、外周感觉神经毒性等,多为Ⅰ～Ⅱ度,无治疗相关性死亡。其中每例均有不同程度的发热；恶心、呕吐共有13例发生。其次主要为疼痛、肝功能异常,但仅局限于 TACE 治疗后3～5 d；严重程度分级均在2级以内（包括2级）。结论改良 XELOX 方案治疗结直肠癌伴肝转移瘤患者疗效确切,具有较高的客观有效率,能改善患者的生活质量,增加手术切除机会,不良反应可耐受。Objective To discuss the effect and safety of modified XELOX regimen for the treatment of colorectal cancer with he-patic metastases.Methods A retrospective analysis on the clinical data in 18 patients with colorectal cancer with hepatic metastases was performed in our hospital.The diagnosis in all patients was confirmed by biopsy and colonoscopy,and the primary lesion was not resected but with at least 2 courses treatment with modified XELOX regimen （intravenous infusion of oxaliplatin changed into ar-terial perfusion and 1-hour slow perfusion with indwelling catheter）.The intrahepatic metastases were detected by CT and/or MRI and the primary focus was examined by enteroscopy every 2 months.A follow-up on survival time was performed and the objective response was evaluated in accordance with RECIST criteria.SPSS 1 9.0 was used for an analysis by Kaplan-Meier method.Results （1）Curative effect was evaluated in all 18 patients and TACE has been used for 1 1 5 times.The median OS was 14.0 months with 95% CI （9.6,18.4）,and the median PFS was 8.0 months with 95% CI （5.2,10.8）including CR in 2,PR in 7,SD in 4 and PD in 5.The efficiency rate （RP）was 50.0% and the clinical benefit rate （CBR）was 72.2%;（2）The posttreatment adverse reactions mainly included fever,nausea,emesis,pain,impaired liver function,myelosuppression and peripheral sensory neuropathy,most of which were at Level Ⅰ-Ⅱ without treatment-related death.Fever with different degrees occurred in all patients,and nausea and emesis in 13.Pain and abnormal liver function occurred within 3-5 days after TACE with less than Level 2.Conclusion Modified XELOX regimen is practically effective in treating colorectal cancer with hepatic metastases.With a high objective response rate,it can improve patients＇living quality and increase excision rate with tolerable adverse reactions.

关 键 词：结肠 直肠 肝脏 转移 肿瘤 介入 

分 类 号：R735.3[医药卫生—肿瘤] R815[医药卫生—临床医学]