Ishida Kiyotaka, Hirooka Masashi, Hiraoka Atsushi, Kumagi Teru, Uehara Takahide, Hiasa Yoichi, Horiike Norio, Onji Morikazu
Third Department of Internal Medicine, Ehime University School of Medicine, Touon, Ehime 791-0295, Japan.
Jpn J Clin Oncol. 2008 Sep;38(9):596-603. doi: 10.1093/jjco/hyn076.
Transcatheter arterial embolization (TAE) with gelatin sponge particles and iodized oil often yields poor results when used to treat unresectable multifocal hepatocellular carcinoma (HCC). The present study retrospectively investigated the utility of a novel combination chemotherapy regimen for treating multifocal HCC resistant to TAE.
Thirteen consecutive patients with unresectable multifocal HCC and resistance to TAE were treated with combination chemotherapy consisting of arterial chemoembolization with degradable starch microspheres (DSM) (150-4500 mg on Day 1), mitomycin-C (4-8 mg on Day 1), continuous arterial infusion of 5-fluorouracil (1250 mg/120 h), cisplatin (25-50 mg/120 h) and l-leucovorin (125 mg/120 h) for 10-19 weeks.
The response rate was 84.6%, with complete response in one patient and partial response (PR) in 10 patients. In four of 10 patients with PR, the tumor was not observable, although the tumor marker did not completely decline to the normal range. The 1-, 2- and 3-year survival rates were 100, 28.9 and 9.6% in all, and 100, 33.3 and 0% in six patients with portal vein tumor thrombosis (PVTT). The median survival was 22.1 months in all and 17.1 months in six patients with PVTT. Thrombocytopenia of Grade III or higher was observed in eight patients. Laparoscopic splenectomy was performed before therapy in four patients with platelet counts of <70,000/mm(3), and during therapy in five patients with severe thrombocytopenia.
This novel chemotherapy regimen achieved favorable results and may be useful in treating patients with unresectable multifocal HCC resistant to TAE.
对于无法切除的多灶性肝细胞癌（HCC），使用明胶海绵颗粒和碘化油进行经动脉栓塞化疗（TAE）往往效果不佳。本研究回顾性调查了一种新型联合化疗方案治疗对TAE耐药的多灶性HCC的效用。
连续13例无法切除的多灶性HCC且对TAE耐药的患者接受联合化疗，包括用可降解淀粉微球（DSM）进行动脉化疗栓塞（第1天150 - 4500毫克）、丝裂霉素-C（第1天4 - 8毫克）、持续动脉输注5-氟尿嘧啶（1250毫克/120小时）、顺铂（25 - 50毫克/120小时）和左亚叶酸钙（125毫克/120小时），持续10 - 19周。
缓解率为84.6%，1例患者完全缓解，10例患者部分缓解（PR）。在10例PR患者中的4例，尽管肿瘤标志物未完全降至正常范围，但肿瘤不可见。所有患者的1年、2年和3年生存率分别为100%、28.9%和9.6%，6例门静脉癌栓（PVTT）患者的1年、2年和3年生存率分别为100%、33.3%和0%。所有患者的中位生存期为22.1个月，6例PVTT患者为17.1个月。8例患者出现III级或更高等级的血小板减少。4例血小板计数<70,000/mm³的患者在治疗前进行了腹腔镜脾切除术，5例严重血小板减少的患者在治疗期间进行了该手术。
这种新型化疗方案取得了良好效果，可能对治疗对TAE耐药的无法切除的多灶性HCC患者有用。
