Mavligit G M, Zukwiski A A, Ellis L M, Chuang V P, Wallace S
Department of Clinical Immunology and Biological Therapy, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
Cancer. 1995 Apr 15;75(8):2083-8. doi: 10.1002/1097-0142(19950415)75:8<2083::aid-cncr2820750809>3.0.co;2-h.
Gastrointestinal leiomyosarcoma metastatic to the liver is considered most resistant to any combination of systemic chemotherapy containing doxorubicin and/or ifosphamide.
Fourteen patients with gastrointestinal leiomyosarcoma metastatic to the liver were treated with hepatic chemoembolization infusion consisting of polyvinyl alcohol sponge particles mixed with cisplatin powder (150 mg) followed by an intrahepatic arterial infusion of vinblastine (10 mg/m2).
Ten major (> 50% regression) tumor responses were observed (70%) in patients lasting from 8 to 31+ months (median, 12 months) after an average of two hepatic chemoembolization procedures, usually 4 weeks apart. Transient side effects included right upper quadrant pain requiring narcotics, significant hepatic enzyme elevation, particularly of lactic dehydrogenase with a minimal increase in bilirubin, paralytic ileus requiring nasogastric suction up to 72 hours, urinary electrolyte losses (potassium+, magnesium++, sodium+) requiring supplements, and occasionally mild but transient leukopenia and thrombocytopenia.
Hepatic chemoembolization infusion appears to induce a high rate of durable tumor response in patients with notoriously chemoresistant gastrointestinal leiomyosarcoma metastatic to the liver.
转移至肝脏的胃肠道平滑肌肉瘤被认为对含阿霉素和/或异环磷酰胺的任何全身化疗方案组合均具有最强耐药性。
14例转移至肝脏的胃肠道平滑肌肉瘤患者接受了肝动脉化疗栓塞灌注治疗，该治疗是将聚乙烯醇海绵颗粒与顺铂粉（150mg）混合后进行灌注，随后肝动脉内灌注长春碱（10mg/m²）。
在平均进行两次肝动脉化疗栓塞治疗（通常间隔4周）后，观察到10例患者出现主要肿瘤反应（肿瘤缩小>50%）（70%），持续时间为8至31 +个月（中位数为12个月）。短暂的副作用包括需使用麻醉剂的右上腹疼痛、显著的肝酶升高，尤其是乳酸脱氢酶升高，胆红素仅有轻微升高、需进行长达72小时鼻胃管抽吸的麻痹性肠梗阻、需要补充的尿电解质丢失（钾+、镁++、钠+），以及偶尔出现的轻度但短暂的白细胞减少和血小板减少。
对于转移至肝脏且对化疗耐药的胃肠道平滑肌肉瘤患者，肝动脉化疗栓塞灌注似乎能诱导较高比例的持久肿瘤反应。
