肝动脉灌注化疗联合或不联合三维适形放疗治疗肝静脉或下腔静脉瘤栓的中晚期肝癌：氟尿嘧啶和全身干扰素-α的应用

Hepatic arterial infusion chemotherapy using 5-fluorouracil and systemic interferon-α for advanced hepatocellular carcinoma in combination with or without three-dimensional conformal radiotherapy to venous tumor thrombosis in hepatic vein or inferior vena cava.

机构信息

Departments of Medicine and Molecular Science, Division of Frontier Medical Science, Programs for Biomedical Research, Graduate School of Biomedical Science Radiation Oncology, Division of Genome Radiobiology and Medical Science Diagnostic Radiology, Division of Medical Intelligence and Informatics, Hiroshima University, Hiroshima, Japan.

出版信息

Hepatol Res. 2012 May;42(5):442-53. doi: 10.1111/j.1872-034X.2011.00943.x. Epub 2011 Dec 16.

DOI:10.1111/j.1872-034X.2011.00943.x

PMID:22176468

Abstract

AIM

We investigated the efficacy of hepatic arterial infusion chemotherapy (HAIC) using 5-fluorouracil (5-FU) and systemic interferon (IFN)-α (HAIC-5-FU/IFN) for advanced hepatocellular carcinoma (HCC) with venous tumor thrombosis (VTT) in the hepatic vein trunk (Vv2) or inferior vena cava (Vv3).

METHODS

Thirty-three patients with HCC/Vv2/3 underwent HAIC with 5-FU (500 mg/body weight/day, into hepatic artery on days 1-5 on the first and second weeks) and IFN-α (recombinant IFN-α-2b 3 000 000 U or natural IFN-α 5 000 000 U, intramuscularly on days 1, 3 and 5 of each week). Three-dimensional conformal radiotherapy (3D-CRT) was used in combination with HAIC-5-FU/IFN in 14 of 33 patients to reduce VTT.

RESULT

The median survival time (MST) was 7.9 months, and 1- and 2-year survival rates were 30% and 20%, respectively. Evaluation of intrahepatic response after two cycles of HAIC-5-FU/IFN showed complete response (CR) in three (9%) and partial response (PR) in seven (21%), with an objective response rate of 30%. Multivariate analysis identified reduction of VTT (P = 0.0006), size of largest tumor (P = 0.013) and intrahepatic response CR/PR (P = 0.030) as determinants of survival. CR/PR correlated significantly with tumor liver occupying rate (P = 0.016) and hepatitis C virus Ab (P = 0.010). Reduction of VTT correlated significantly with radiotherapy (P = 0.021) and platelet count (P = 0.015). Radiotherapy-related reduction in VTT significantly improved survival of 16 patients with Vv3 and non-CR/PR response of HAIC-5-FU/IFN (P = 0.028).

CONCLUSION

As for advanced HCC with VTT of Vv2/3, HAIC-5-FU/IFN responsive patients could obtain favorable survival. Despite ineffective HAIC-5-FU/IFN, the combination with effective radiotherapy to VTT might improve patients' prognosis.

摘要

目的

我们研究了使用氟尿嘧啶（5-FU）和全身干扰素（IFN）-α（HAIC-5-FU/IFN）进行肝动脉灌注化疗（HAIC）治疗肝静脉主干（Vv2）或下腔静脉（Vv3）中晚期肝癌（HCC）伴静脉肿瘤血栓（VTT）的疗效。

方法

33 例 HCC/Vv2/3 患者接受 5-FU（500mg/体重/天，第 1 和第 2 周第 1 天至第 5 天经肝动脉给药）和 IFN-α（重组 IFN-α-2b 300 万 U 或天然 IFN-α 500 万 U，每周第 1、3 和 5 天肌内注射）HAIC。33 例患者中的 14 例联合使用三维适形放疗（3D-CRT）降低 VTT。

结果

中位生存时间（MST）为 7.9 个月，1 年和 2 年生存率分别为 30%和 20%。HAIC-5-FU/IFN 两个周期后肝内反应评估显示，完全缓解（CR）3 例（9%），部分缓解（PR）7 例（21%），客观缓解率 30%。多因素分析确定 VTT 减少（P=0.0006）、最大肿瘤大小（P=0.013）和肝内反应 CR/PR（P=0.030）是生存的决定因素。CR/PR 与肿瘤肝占位率显著相关（P=0.016）和丙型肝炎病毒 Ab（P=0.010）。VTT 减少与放疗（P=0.021）和血小板计数（P=0.015）显著相关。放疗相关的 VTT 减少显著改善了 16 例 Vv3 患者和 HAIC-5-FU/IFN 非 CR/PR 反应患者的生存（P=0.028）。