Kuroda Makoto, Kobayashi Yoshinao, Urawa Naohito, Yamamoto Mika, Mifuji Rumi, Araki Jun, Tanaka Hideaki, Horiike Shinichiro, Itani Toshio, Furjita Naoki, Konishi Masayoshi, Iwasa Motoh, Kaito Masahiko, Adachi Yukihiko
Division of Clinical Medicine and Biomedical Sciences, Department of Gastroenterology and Hepatology Institute of Medical Sciences, Mie University Graduate School of Medicine, Tsu, Japan.
Hepatogastroenterology. 2007 Mar;54(74):518-21.
BACKGROUND/AIMS: Transcatheter arterial chemoinfusion (TACI) is the main therapeutic modality for advanced hepatocellular carcinoma (HCC) with portal thrombus. However, TACI is not sufficient to improve prognosis. In this study, we evaluated the response to hepatic arterial infusion of 5-fluorouracil (5-FU) in combination with subcutaneous interferon (IFN)-alpha in patients with advanced HCC.
Ten patients (men, 8; women, 2; mean age, 55-77) with advanced HCC were enrolled in this study. Hepatic arterial infusion of 5-FU (500 mg/24 hrs) was performed for 5 days on the first and second week. IFN-alpha (5 x 10(6) International Units) was subcutaneously administered three times a week for 4 weeks (1 therapeutic course). Response to therapy was evaluated by abdominal computed tomography at the end of two courses of therapy.
Seven patients received more than two courses of therapy. One patient (14%) showed complete response (CR). Four patients had stable disease (SD) (57%) and the remaining 2 patients had progressive disease (PD) (29%). Tumor markers decreased in all patients except 1 with PD. The 6-month survival rate was 40%. Therapy was discontinued in 3 patients due to severe adverse effects; all of these patients were over 70 years old, and had moderate liver dysfunction (Child-Pugh score of Grade B) before initiation of therapy.
The goal of the therapy with hepatic arterial infusion of 5-FU in combination with subcutaneous IFN-alpha was attained in only 14% among our advanced HCC patients. The tumor completely disappeared in 1 patient, suggesting that this therapeutic modality may be of potential benefit in advanced HCC patients. However, this therapy should be performed with caution in patients with poor hepatic function (grade B or C of Child-Pugh score) and in those more than 70 years old.
背景/目的：经导管动脉化疗灌注（TACI）是伴有门静脉血栓形成的晚期肝细胞癌（HCC）的主要治疗方式。然而，TACI不足以改善预后。在本研究中，我们评估了晚期HCC患者肝动脉灌注5-氟尿嘧啶（5-FU）联合皮下注射α干扰素（IFN）的疗效。
本研究纳入了10例晚期HCC患者（男性8例，女性2例；平均年龄55 - 77岁）。在第一周和第二周，连续5天进行肝动脉灌注5-FU（500 mg/24小时）。α干扰素（5×10⁶国际单位）皮下注射，每周3次，共4周（1个疗程）。在两个疗程结束时，通过腹部计算机断层扫描评估治疗反应。
7例患者接受了两个以上疗程的治疗。1例患者（14%）显示完全缓解（CR）。4例患者病情稳定（SD）（57%），其余2例患者病情进展（PD）（29%）。除1例PD患者外，所有患者的肿瘤标志物均下降。6个月生存率为40%。3例患者因严重不良反应停止治疗；所有这些患者年龄均超过70岁，且在治疗开始前有中度肝功能不全（Child-Pugh评分B级）。
在我们的晚期HCC患者中，肝动脉灌注5-FU联合皮下注射IFN-α治疗仅14%达到了治疗目标。1例患者肿瘤完全消失，提示这种治疗方式可能对晚期HCC患者有潜在益处。然而，对于肝功能差（Child-Pugh评分B级或C级）和70岁以上的患者，应谨慎进行这种治疗。
