Müller H, Nakchbandi V, Chatzisavvidis I, von Voigt C
Department of Oncologic Surgery, Carl von Hess-Hospital, D-97762 Hammelburg, Germany.
Hepatogastroenterology. 2003 Nov-Dec;50(54):1919-26.
BACKGROUND/AIMS: In order to improve local and systemic efficacy of chemotherapeutic interventions we have used a combination of high concentrated plus low continuous regional chemotherapy modulated by GM-CSF cytokine in the treatment of inoperable colorectal liver metastases.
Sixty-six patients with disseminated inoperable colorectal liver metastases received continuous intra-arterial chemotherapy with 5-FU plus GM-CSF short time application plus chemoembolization Melphalan via an angiographically positioned hepatic artery catheter. The regimen consisted of the following steps: On day 1 + 2 1400 mg/m2 5-FU administered intra-arterially in a continuous circadian mode, 60 mg/m2 Rescuvolin given i.v. as a 2-hour infusion, 80 micrograms/m2 GM-CSF given i.a. as a 1-hour infusion, day 3 chemoembolization with 25 mg/m2 Melphalan plus Lipiodol and Gelfoam.
66 patients (38 male/28 female) with a median age of 60.4 years and a median Karnofsky index of 87.3 were treated with 299 cycles of immunochemoembolization. Fifty-four percent of these patients had received prior systemic chemotherapy. Side effects were manifested in all patients, mainly upper abdominal pain lasting one to four days and grade 1 or 2 vomiting. Systemic side effects were mild and transient with a very low rate of leukopenia. Using World Health Organization response criteria, the following responses could be demonstrated CR 1.0%, PR 42.4%, MR 24.2%, SD 18.2%, NR 12.1%. Time to progression was 8 months. Median survival has not been reached after an observation time of 28 months. Two-year survival was 66%. There was no statistically significant difference between chemonaive patients and patients pretreated by any kind of systemic therapy.
Repetitive high concentrated regional chemotherapy by use of chemoembolization combined with continuous administered 5-FU and supplemented with GM-CSF is an effective tool in the therapy of disseminated colorectal liver metastases as front line as well as a second-line treatment.
背景/目的：为提高化疗干预的局部和全身疗效，我们采用高浓度加低剂量持续区域化疗联合粒细胞巨噬细胞集落刺激因子（GM-CSF）细胞因子治疗无法手术切除的结直肠癌肝转移。
66例无法手术切除的播散性结直肠癌肝转移患者通过血管造影定位的肝动脉导管接受持续动脉内化疗，即5-氟尿嘧啶（5-FU）加短时间应用GM-CSF，再加上美法仑化疗栓塞。治疗方案包括以下步骤：第1天和第2天，以昼夜连续模式动脉内给予1400mg/m² 5-FU，静脉输注2小时给予60mg/m² 亚叶酸钙，动脉内输注1小时给予80μg/m² GM-CSF，第3天用25mg/m²美法仑加碘油和明胶海绵进行化疗栓塞。
66例患者（38例男性/28例女性），中位年龄60.4岁，中位卡诺夫斯基指数87.3，接受了299个周期的免疫化疗栓塞治疗。其中54%的患者曾接受过全身化疗。所有患者均出现副作用，主要为持续1至4天的上腹部疼痛和1或2级呕吐。全身副作用轻微且短暂，白细胞减少发生率极低。根据世界卫生组织的反应标准，可显示以下反应：完全缓解（CR）1.0%，部分缓解（PR）42.4%，轻度缓解（MR）24.2%，疾病稳定（SD）18.2%，疾病进展（NR）12.1%。疾病进展时间为8个月。观察28个月后，中位生存期尚未达到。两年生存率为66%。未接受过化疗的患者与接受过任何全身治疗的患者之间无统计学显著差异。
采用化疗栓塞联合持续给予5-FU并补充GM-CSF的重复高浓度区域化疗是治疗播散性结直肠癌肝转移的有效一线及二线治疗手段。
