Azizkhan R G, Tegtmeyer C J, Wanebo H J
Am J Surg. 1985 Feb;149(2):210-4. doi: 10.1016/s0002-9610(85)80066-0.
A malignant rectal carcinoid metastatic to the liver presents a formidable challenge. The uniformly fatal course in patients with liver metastases (average survival of 2 years) justifies an aggressive approach. Although in an occasional patient the tumor is resectable, most are managed by chemotherapy, which generally is of limited effectiveness. Although certain drug combinations such as 5-fluorouracil and streptozotocin have achieved higher response rates, these responses are often brief (3 to 4 months) and poorly documented. Surgical hepatic dearterialization and, more recently, hepatic intraarterial embolization are quite effective in inducing regression in a variety of hepatic neoplasms, including metastatic carcinoids, but these are usually temporary. We have been timely instructed on the value of combined therapy by a patient who is a long-term survivor of a metastatic carcinoid to the liver. She is the only survivor among a group of 14 patients who had an average survival of 17 months. This patient emphasizes the benefit of combined hepatic dearterialization and chemotherapy in patients with metastatic carcinoid to the liver. She initially had intrahepatic infusion of 5-fluorouracil and streptozotocin through the surgically placed hepatic artery and portal vein catheters, but this was curtailed after 2 months because of catheter sepsis. She then had four sequential selective hepatic intraarterial embolizations with Gelfoam over a 16 month period. She also received systemic therapy with 5-fluorouracil and streptozotocin during a major portion of this period (10 months). Significant tumor regression was documented radiologically. Although she had another trial with intrahepatic chemotherapy infusion using surgically placed catheters, this was again discontinued because of catheter sepsis, and systemic chemotherapy was resumed. Currently, the patient is asymptomatic, has excellent performance status, and continues to show objective tumor regression on a program of systemic therapy with fluorodeoxyuridine and doxorubicin. She has survived more than 7 years with liver metastases from a rectal carcinoid.
转移性至肝脏的恶性直肠类癌是一项严峻的挑战。肝转移患者的病程通常是致命的（平均生存期为2年），因此需要积极的治疗方法。虽然偶尔有患者的肿瘤可以切除，但大多数患者采用化疗，而化疗的效果通常有限。尽管某些药物组合如5-氟尿嘧啶和链脲佐菌素取得了较高的缓解率，但这些缓解往往是短暂的（3至4个月）且记录不充分。手术性肝动脉去血管化以及最近的肝动脉内栓塞在诱导包括转移性类癌在内的多种肝脏肿瘤消退方面相当有效，但这些通常是暂时的。一位肝脏转移性类癌的长期存活患者让我们及时认识到了联合治疗的价值。在一组平均生存期为17个月的14名患者中，她是唯一的幸存者。该患者强调了肝动脉去血管化和化疗联合治疗对肝脏转移性类癌患者的益处。她最初通过手术放置的肝动脉和门静脉导管进行肝内输注5-氟尿嘧啶和链脲佐菌素，但2个月后因导管败血症而中断。然后，她在16个月内先后进行了4次用明胶海绵的选择性肝动脉内栓塞。在此期间的大部分时间（10个月）她还接受了5-氟尿嘧啶和链脲佐菌素的全身治疗。影像学检查记录到肿瘤有显著消退。尽管她再次尝试通过手术放置的导管进行肝内化疗输注，但又因导管败血症而停药，随后恢复了全身化疗。目前，该患者无症状，身体状况良好，在接受氟脱氧尿苷和阿霉素全身治疗方案时仍显示出肿瘤客观消退。她因直肠类癌肝转移已存活超过7年。
