肝动脉灌注化疗联合XELOX方案治疗胃肠道恶性肿瘤肝转移的疗效及安全性分析  

Hepatic Artery Infusion and Systemic XELOX Chemotherapy for Gastric and Colorectal Cancer with Liver Metastasis:Analysis of Curative Effect and Safety

作　　者：肖宇[1] 马力文[1] 曹宝山[1] 王墨培[1] 陈森[1] 张煜[1] 

机构地区：[1]北京大学第三医院肿瘤化疗与放射病科,北京100083

出　　处：《中国微创外科杂志》2016年第1期5-8,共4页Chinese Journal of Minimally Invasive Surgery

摘　　要：目的探讨肝动脉灌注化疗（hepatic artery infusion chemotherapy,HAIC）联合XELOX方案对胃肠道恶性肿瘤肝转移的疗效和安全性。方法回顾性分析我院2002年1月~2008年12月不可切除的胃肠道恶性肿瘤肝转移41例资料,肝动脉灌注氟尿嘧啶脱氧核苷（fluorodeoxyuridine,FUDR）500 mg,第1~5天,静脉给予奥沙利铂130 mg/m2,第1天,口服卡培他滨1000 mg/m2,每天2次,第1~14天。18例为一线化疗,17例为二线化疗,6例为三/四线化疗。观察无进展生存期（progression-free survival,PFS）、有效率（response rate RR）及总生存期（overall survival,OS）,并评估药物不良反应。结果一线化疗18例RR 44.4%（8/18）,肝脏转移灶RR 50.0%（9/18）;二线化疗17例RR 23.5%（4/17）,肝脏转移灶RR 29.4%（5/17）。一线、二线及三/四线治疗的总体中位PFS分别为8、4、2.5月,肝转移灶中位PFS分别为10.5、5、4月。Ⅲ/Ⅳ度不良反应主要以白细胞减少（4例）、手足综合征（4例）、感觉神经障碍（3例）、腹泻（4例）为主,均对症治疗治愈。结论 HAIC联合XELOX方案治疗合并肝转移的晚期胃肠道恶性肿瘤有一定疗效,一线治疗生存获益更明显,不良反应可耐受。Objective To investigate the benefits and risks of hepatic arterial infusion chemotherapy（ HAIC） combined with systemic XELOX chemotherapy in gastric and colorectal cancer with unresectable liver metastasis. Methods From January 2002 to December 2008,41 patients with gastric and colorectal cancer with unresectable liver metastasis underwent HAIC and systemic XELOX chemotherapy. Hepatic arterial infusion of fluorodeoxyuridine（ 500 mg） was performed from the first to the fifth day. Venous administration of oxaliplatin（ 130 mg / m2） was given on the first day. Oral medication of capecitabine（ 1000 mg/m2） was given twice a day from the first to the fourteenth day. Among them,18 patients received first-line chemotherapy,17 received second-line chemotherapy,and 6 received third / forth-line chemotherapy. The main outcome measures included progression-free survival（ PFS）,toxic effects,response rate（ RR） and overall survival（ OS）. Results The RR of the first-line chemotherapy was 44. 4%（ 8 /18）,with the RR of liver metastasis being 50. 0%（ 9 /18）. The RR of the second-line chemotherapy was 23. 5%（ 4 /17）,with the RR of liver metastasis being 29. 4%（ 5 /17）. The median PFS for patients who received first-line,second-line,and third / forth-line chemotherapy were 8,4,and 2. 5 months,respectively,with the median PFS of liver metastasis being 10. 5,5,and 4 months,respectively. The most common Ⅲ / Ⅳ grade morbidity was leukocyte decreasing（ 4 cases）,hand-foot syndrome（ 4 cases）,peripheral neurosensory toxicity（ 3 cases）,and diarrhea（ 4 cases）,which were all cured with symptomatic treatment. Conclusions HAIC combined with systemic XELOX for gastric and colorectal cancer with unresectable liver metastasis is effective. Patients can achieve more survival benefit from first-line chemotherapy. The toxicities can be alleviated through treatment.

关 键 词：肝动脉灌注 肝转移 胃肠道肿瘤 

分 类 号：R735[医药卫生—肿瘤]