Pasqual E, Bacchetti S, Cagol P P
Department of Surgical Sciences, Surgical Unit of Semeiotica Chirurgica, University of Udine.
J Exp Clin Cancer Res. 2003 Dec;22(4 Suppl):229-32.
Locoregional chemotherapy in the 80's was considered an effective palliative treatment for unresectable hepatic metastases: it significantly improved the response rates if compared with systemic chemotherapy but didn't modify the survival (7,19). With the advent of new drugs supporting effective systemic chemotherapy it was disregarded for many years. Recently, following the advent of new drugs and the developing of new association scheme, it has regained interests also for its adjuvant and neoadjuvant role to hepatic resections (1,2,3,9,13,14,15,18). Loco-regional drug administration is feasible through two different administration routes, portal system and hepatic artery; the hepatic arterial infusion, in terms of tumor tissue antiblastic concentration, seems to be the most effective (6) Current schemes of chemotherapy for liver metastases are based on continuous infusions using implantable pumps (11, 12) but confirmation, in term of tissue drug concentration, that continuous infusions do better than bolus infusions is still lacking. To address this specific aspect we have experimentally compared these two different administration modalities using an anthracyclin, Epiadryamicin (EPI), with high plasmatic clearance and main biliary escretion (8,16).
20世纪80年代，局部区域化疗被认为是一种针对不可切除肝转移瘤的有效姑息治疗方法：与全身化疗相比，它显著提高了缓解率，但并未改变生存率（7,19）。随着支持有效全身化疗的新药出现，它被忽视了许多年。最近，随着新药的出现和新联合方案的发展，它因其在肝切除术中的辅助和新辅助作用而重新受到关注（1,2,3,9,13,14,15,18）。局部区域给药可通过两种不同的给药途径实现，即门静脉系统和肝动脉；就肿瘤组织抗瘤药物浓度而言，肝动脉灌注似乎是最有效的（6）。目前肝转移瘤的化疗方案基于使用植入式泵进行持续输注（11,12），但在组织药物浓度方面，仍缺乏证据证实持续输注优于大剂量推注。为了解决这一具体问题，我们使用一种血浆清除率高且主要经胆汁排泄的蒽环类药物表柔比星（EPI），通过实验比较了这两种不同的给药方式（8,16）。
