Ceci G, Bella M, Melissari M, Gabrielli M, Bocchi P, Cocconi G
Servizio di Oncologia Medica, Ospedale Maggiore, Parma, Italy.
Cancer. 1988 May 15;61(10):1988-91. doi: 10.1002/1097-0142(19880515)61:10<1988::aid-cncr2820611010>3.0.co;2-5.
A fatal massive hepatic necrosis with widespread thrombotic occlusion of the small hepatic veins developed in two of 68 patients treated with DTIC for advanced melanoma in a randomized study. Thirteen similar reactions, in patients treated with single-agent DTIC, are reported in the literature. Several clinical and pathologic features distinguish this DTIC toxicity from Budd-Chiari syndrome and veno-occlusive disease (both well-known types of possibly drug-related hepatic vascular disease) and make it a distinctive syndrome. We were impressed by the repeated occurrence of this complication in a relatively small set of patients, in contrast with the rarity of the literature reports. We suggest that this dramatic complication could occur more frequently than commonly thought. Therefore, caution should be used with DTIC, particularly in curable patients.
在一项随机研究中，68例接受达卡巴嗪治疗晚期黑色素瘤的患者中有2例发生了致命的大面积肝坏死，并伴有肝小静脉广泛血栓形成性闭塞。文献报道了13例接受单药达卡巴嗪治疗的患者出现的类似反应。一些临床和病理特征将这种达卡巴嗪毒性与布加综合征和肝静脉闭塞病（均为可能与药物相关的肝血管疾病的著名类型）区分开来，使其成为一种独特的综合征。与文献报道的罕见情况形成对比的是，我们对这一并发症在相对较少的一组患者中反复出现印象深刻。我们认为，这种严重并发症的发生频率可能比通常认为的更高。因此，使用达卡巴嗪时应谨慎，尤其是在可治愈的患者中。
