雷替曲塞联合奥沙利铂TACE治疗BCLCB/C期肝细胞癌的安全性及疗效  

The safety and efficacy of raltitrexed combined with oxaliplatin in TACE treatment for BCLC B/C hepatocellular carcinomas

作　　者：黄芳[1] 龚环宇[1] 熊正平[2] 

机构地区：[1]中南大学湘雅三医院感染科,长沙410013 [2]湖南省肿瘤医院介入科

出　　处：《介入放射学杂志》2018年第1期76-79,共4页Journal of Interventional Radiology

摘　　要：目的探讨雷替曲塞联合奥沙利铂方案(raltitrexed and oxaliplatin,RO方案)与碘油乳剂治疗BCLC B/C期肝细胞癌的疗效及安全性。方法 183例BCLC B/C期肝细胞癌患者,用RO方案与碘油乳剂化疗栓塞治疗。治疗方案为雷替曲塞3 mg/m^2行肝动脉灌注,奥沙利铂130 mg/m^2结合碘油5~30 ml混合成乳剂栓塞。参照WHO抗癌药物毒性分级标准观察毒性反应,Child-Pugh分级观察肝脏损害。随访患者生存期。结果 183例患者,血液学毒性表现为骨髓抑制作用,其中药物引起中性粒细胞计数减少、贫血和血小板减少发生率分别为21.9%、8.3%和2.7%;中性粒细胞计数下降分度:Ⅰ度15.8%,Ⅱ度5.5%,Ⅲ度0.6%,Ⅳ度0。恶心呕吐:Ⅰ~Ⅱ度71.6%。肝脏损害为转氨酶及胆红素升高。术前Child-Pugh A级96例,B级87例;术后48例由A级升至B级,6例由A级升至C级,12例由B级升至C级。本组患者未出现心脏、泌尿系统或神经系统毒性。随访183例患者的生存期为5~35个月,中位值20个月。结论 RO方案联合碘油乳剂化疗栓塞治疗BCLC B/C期肝细胞癌,是安全的和有效的,而且能改善病人的生活质量。Objective To evaluate the efficacy and safety of trascatheter arterial chemoembolization （TACE） with rahitrexed and oxaliplatin （RO） regimen as well as lipiodol emulsion in treating BCLC B/C hepatoeellular carcinomas. Methods A total of 183 patients with BCLC B/C hepatocellular carcinoma were treated with TACE by using RO regimen and lipiodol emulsion. The therapeutic regimen included raltitrexed 3 mg/m2 for hepatic artery perfusion, oxaliplatin 130 mg/m2 mixed with lipiodol 5-30 ml emulsion for embo- lization. The toxicities were assessed according to WHO anti- cancer drug toxicity grading standards. Liver damage was determined by Child-Pugh classification. All the patients were followed up and the survival time was calculated. Results In 183 patients, the hematologic toxicity was characterized by hone marrow suppression. The incidences of neutropenia, anemia and thrombocytopenia were 21.9%, 8.3% and 2.7%, respectively. The degree Ⅰ , Ⅱ , Ⅲ and IV of neutrophil count decrease were seen in 15.85%, 5.46%, 0.55% and 0% of patients, respectively. Nausea and vomiting of degree Ⅰ - Ⅱ was observed in 71.58% of patients. Liver function damage was presented as elevated transaminase and elevated bilirubin level. Preoperative Child-Pugh grade A was seen in 96 patients and grade B in 87 patients. Child-Pugh grade was elevated from preoperative grade A to postoperative grade B in 48 patients, from preoperative grade A to postoperative grade C in 6 patients, and from preoperative grade B to postoperative grade C in 12 patients. In this~ series, no symptoms or signs of cardiac urinary or nervous system toxicity were observed. The survival y： time of 183 patients was 5-35 months, with the median survival time being 20 months. Conclusion For the treatment of BCLC B/C hepatoeellular carcinomas, TACE using RO regimen and lipiodol emulsion is safe and effective, and it can reliably improve the quality of life of patients. （J Intervent Radiol, 2018, 27： 76-79）

关 键 词：癌 肝细胞/治疗 肝肿瘤/药物疗法 化学栓塞 治疗性 雷替曲塞 奥沙利铂 

分 类 号：R735.7[医药卫生—肿瘤]