Koike S, Fujimoto S, Guhji M, Endoh F, Shrestha R D, Kokubun M, Kobayashi K, Kiuchi S, Ooi T, Okui K
1st Dept. of Surgery, School of Medicine, Chiba University.
Gan To Kagaku Ryoho. 1988 Aug;15(8 Pt 2):2601-5.
Intra-arterial chemotherapy combined with mitomycin C (MMC) and degradable starch microspheres (DSM) was prescribed repeatedly for 14 patients with inoperable hepatic metastasis. This intra-arterial treatment was repeated 2.7 times on the average. The average dose of DSM and MMC in a single infusion was 685 +/- 201 mg and 13.8 +/- 3.8 mg, respectively. To analyse the degradation time of DSM, MMC concentrations in the peripheral blood were measured by HPLC method. RI-angiography using 99mTc macroaggregated albumin(MAA) was performed to estimate the hemodynamic changes in the liver. Antitumor efficacy was evaluated in terms of tumor regression measured by CT scan. An objective tumor response was observed in 9/14 patients(64.2%): CR 1/14; PR 6/14; MR 2/14. Elevated CEA levels were decreased in 11/12 patients (91.7%). Based on the peripheral MMC blood levels after combined infusion with DSM and MMC, an occlusion of intrahepatic vessels with DSM continued at least for 30 minutes. Again, RI-angiography with 99mTc-MAA plus DSM revealed the increased accumulation in the tumor, compared to 99mTc-MAA only. Side effects possibly attributable to DSM were observed in 14/38 treatments, though they were slight and temporary. Thus, these results indicate that this combined intra-arterial infusion of DSM and MMC achieve, higher regional selectivity.
对14例无法手术切除的肝转移患者反复进行动脉内化疗联合丝裂霉素C（MMC）和可降解淀粉微球（DSM）治疗。这种动脉内治疗平均重复2.7次。单次输注时DSM和MMC的平均剂量分别为685±201mg和13.8±3.8mg。为分析DSM的降解时间，采用高效液相色谱法测定外周血中MMC的浓度。使用99mTc标记的大颗粒白蛋白（MAA）进行放射性核素血管造影，以评估肝脏的血流动力学变化。通过CT扫描测量肿瘤退缩情况来评估抗肿瘤疗效。9/14例患者（64.2%）观察到客观肿瘤反应：完全缓解（CR）1/14；部分缓解（PR）6/14；疾病稳定（MR）2/14。12例患者中有11例（91.7%）癌胚抗原（CEA）水平升高有所下降。根据联合输注DSM和MMC后外周血中MMC水平，DSM对肝内血管的阻塞至少持续30分钟。再次，与仅使用99mTc-MAA相比，99mTc-MAA加DSM的放射性核素血管造影显示肿瘤内的积聚增加。14/38次治疗中观察到可能归因于DSM的副作用，不过这些副作用轻微且为暂时性。因此，这些结果表明，这种DSM和MMC联合动脉内输注具有更高的区域选择性。
