Huang G T, Yang P M, Sheu J C, Hsu H C, Sung J L, Wang T H, Chen D S
Department of Internal Medicine, Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine, Taipei, Republic of China.
Hepatogastroenterology. 1990 Oct;37(5):452-6.
Intratumor injection of OK-432, a biological response modifier, in the treatment of small HCC was studied in 7 inoperable patients. After evaluation with ultrasound (US), computed tomography (CT), angiography and US-guided biopsy, implantation of a steel coil in the tumor, intratumor injection was performed under US guidance. After completion of the treatment, liver biopsy and image studies were again done to evaluate the extent of tumor necrosis. One patient was alive and well without recurrence 19 months after treatment. Four had recurrent tumors at different site of the liver 4 months, 9 months, 9 months and 8 months later. Two died of progressive malignancy 3 months and 8 months later. In the 6 patients with elevated serum alpha-fetoprotein (AFP) levels, 4 had decreased AFP after treatment, and the 2 mortalities had steadily increased AFP. The most common side effects are fever and chills. Transient abdominal pain with elevated transaminase activities, cough with hemoptysis, and vomiting were seen in 1 case each. After treatment, the biopsy specimens showed total necrosis of HCC. Although the T4/T8 ratio of peripheral blood was increased as compared with that before treatment in 4 cases, peritumoral cytotoxic T lymphocyte and monocyte infiltration were seen in one specimen only, and another 7 examined specimens showed negative staining with monoclonal antibodies of T cells. We conclude that intratumor injection of OK-432 is an alternative treatment for small HCC in inoperable cases. The effectiveness may be due to the direct tumoricidal mechanism of OK-432.
我们对7例无法手术的小肝癌患者进行了瘤内注射生物反应调节剂OK-432的治疗研究。经超声（US）、计算机断层扫描（CT）、血管造影及US引导下活检评估后，在肿瘤内植入钢圈，然后在US引导下进行瘤内注射。治疗结束后，再次进行肝活检及影像学检查以评估肿瘤坏死程度。1例患者在治疗后19个月存活且无复发。4例分别在4个月、9个月、9个月和8个月后于肝脏不同部位出现复发肿瘤。2例分别在3个月和8个月后死于进行性恶性肿瘤。在6例血清甲胎蛋白（AFP）水平升高的患者中，4例治疗后AFP下降，2例死亡患者的AFP持续升高。最常见的副作用是发热和寒战。1例出现短暂腹痛伴转氨酶活性升高，1例出现咳嗽伴咯血，1例出现呕吐。治疗后，活检标本显示肝癌完全坏死。虽然4例患者外周血T4/T8比值较治疗前升高，但仅1份标本可见肿瘤周围细胞毒性T淋巴细胞和单核细胞浸润，另外7份检查标本用T细胞单克隆抗体染色均为阴性。我们得出结论，瘤内注射OK-432是无法手术的小肝癌的一种替代治疗方法。其有效性可能归因于OK-432直接的杀瘤机制。
