Rajan D K, Soulen M C, Clark T W, Baum R A, Haskal Z J, Shlansky-Goldberg R D, Freiman D B
Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia 19104, USA.
J Vasc Interv Radiol. 2001 Feb;12(2):187-93. doi: 10.1016/s1051-0443(07)61824-7.
To evaluate the response to and survival after chemoembolization with cisplatin, doxorubicin, mitomycin-C, Ethiodol, and polyvinyl alcohol for patients with sarcomas metastatic to the liver that are surgically unresectable.
Sixteen patients were treated. Primary tumors included 11 gastrointestinal leiomyosarcomas, two splenic angiosarcomas, one leiomyosarcoma of the broad ligament, one leiomyosarcoma of the inferior vena cava, and one malignant fibrous histiocytoma of the colon. Chemoembolization with cisplatin, doxorubicin, mitomycin-C, Ethiodol, and polyvinyl alcohol particles was performed 1-5 times at approximately monthly intervals (mean, 2.8). Pre- and posttreatment cross-sectional imaging was performed 1 month after completion of treatment and then every 3 months. Thirty-day response was graded according to World Health Organization/Eastern Cooperative Oncology Group criteria. Survival was calculated with use of Kaplan-Meier analysis.
Two patients (13%) exhibited partial morphologic response, 11 patients (69%) were morphologically stable, and three (19%) demonstrated progression of disease 30 days after completion of treatment. Among the 13 responders, two underwent partial hepatectomy after initial treatment. Seven developed intrahepatic progression at a mean of 10 months and a median time of 8 months. The remaining four patients had no documented intrahepatic progression at the time of last imaging follow-up. Nine patients developed extrahepatic progression at a mean time of 6.3 months and a median time of 6 months, of whom four underwent additional surgical resection. Response to therapy was based on time of first intervention. Cumulative survival from time of diagnosis with use of Kaplan-Meier analysis was 81% at 1 year, 54% at 2 years, and 40% at 3 years. Median survival time was 20 months. Cumulative survival from initial chemoembolization was 67% at 1 year, 50% at 2 years, and 40% at 3 years, with a median survival time of 13 months. The thirty-day mortality rate was zero.
Durable tumor response with chemoembolization is possible in this form of metastatic disease, which is highly resistant to systemic chemotherapy.
评估顺铂、阿霉素、丝裂霉素-C、碘油和聚乙烯醇对无法手术切除的肝转移肉瘤患者进行化疗栓塞后的反应及生存期。
16例患者接受治疗。原发肿瘤包括11例胃肠道平滑肌肉瘤、2例脾血管肉瘤、1例阔韧带平滑肌肉瘤、1例下腔静脉平滑肌肉瘤和1例结肠恶性纤维组织细胞瘤。采用顺铂、阿霉素、丝裂霉素-C、碘油和聚乙烯醇颗粒进行化疗栓塞，每隔约1个月进行1 - 5次（平均2.8次）。治疗完成后1个月进行治疗前后的横断面成像，然后每3个月进行一次。根据世界卫生组织/东部肿瘤协作组标准对30天反应进行分级。采用Kaplan-Meier分析计算生存期。
2例患者（13%）表现出部分形态学反应，11例患者（69%）形态稳定，3例患者（19%）在治疗完成后30天疾病进展。在13例有反应的患者中，2例在初始治疗后接受了部分肝切除术。7例患者平均在10个月、中位时间8个月时出现肝内进展。其余4例患者在最后一次影像随访时无肝内进展记录。9例患者平均在6.3个月、中位时间6个月时出现肝外进展，其中4例接受了额外的手术切除。治疗反应基于首次干预时间。采用Kaplan-Meier分析，从诊断时起的累积生存率1年时为81%，2年时为54%，3年时为40%。中位生存时间为20个月。从初始化疗栓塞起的累积生存率1年时为67%，2年时为50%，3年时为40%，中位生存时间为13个月。30天死亡率为零。
对于这种对全身化疗高度耐药的转移性疾病，化疗栓塞有可能产生持久的肿瘤反应。
