Ryder S D, Rizzi P M, Metivier E, Karani J, Williams R
Department of Diagnostic Radiology, King's College Hospital, London.
Gut. 1996 Jan;38(1):125-8. doi: 10.1136/gut.38.1.125.
Chemoembolisation has been extensively used as primary treatment for unresectable hepatocellular carcinoma (HCC). In this unit, 185 patients with a new diagnosis of HCC not amenable to surgery were seen between 1988 and 1991. Intended therapy for these patients was chemoembolisation with doxorubicin (60 mg/m2) and lipiodol, repeated at six week intervals until it was technically no longer possible or until complete tumour response had been obtained. Chemoembolisation was possible in 67 of the 185 (37%). Reasons for exclusion were portal vein occlusion (n = 36), decompensated cirrhosis (n = 44), distant metastases (n = 5), diffuse tumour or unsuitable anatomy (tumour or vasculature) (n = 11), patient refusal (n = 11), and other (n = 11). Patients excluded from treatment survived for a median of 10 weeks (range 3 days-19 months). In patients treated, 18 had small HCC (< 4 cm) and 49 had large or multifocal HCC. Chemoembolisation was carried out a median of two sessions for small and three sessions for large tumours. Ten of 18 patients with small HCC showed a 50% or greater reduction in tumour size. Five of 49 patients with large or multifocal tumours showed a response to treatment. Median overall survival for treated patients was 36 weeks (range 3 days-4 years). One patient has subsequently undergone liver transplantation with no recurrence and minimal residual disease at transplantation. Two other patients are alive three years after chemoembolisation, one with no evidence of recurrent disease. No patient was thought suitable for surgery after their response to chemoembolisation. Chemotherapy related complications were seen in 22%. Complications were significantly more common in patients with larger tumours and poor liver reserve. Five patients died as a result of chemotherapy related complications. In conclusion, only one third of UK patients with unresectable HCC are treatable by chemoembolisation. Results with small tumours are encouraging, with a high response rate and the possibility of surgical intervention in previously inoperable disease. Large tumours, however, show a poor response and a significant incidence of side effects, suggesting that this treatment offers little benefit in advanced disease.
化疗栓塞已被广泛用作不可切除肝细胞癌（HCC）的主要治疗方法。在本研究中，1988年至1991年间共诊治了185例新诊断为无法手术切除的HCC患者。这些患者的预期治疗方案是采用阿霉素（60mg/m²）和碘油进行化疗栓塞，每六周重复一次，直至技术上不再可行或获得完全肿瘤缓解。185例患者中有67例（37%）可行化疗栓塞。排除原因包括门静脉阻塞（n = 36）、失代偿性肝硬化（n = 44）、远处转移（n = 5）、弥漫性肿瘤或解剖结构不适合（肿瘤或血管）（n = 11）、患者拒绝（n = 11）以及其他（n = 11）。未接受治疗的患者中位生存期为10周（范围3天至19个月）。接受治疗的患者中，18例为小肝癌（< 4cm），49例为大肝癌或多灶性肝癌。小肝癌患者化疗栓塞的中位次数为2次，大肝癌患者为3次。18例小肝癌患者中有10例肿瘤大小缩小50%或更多。49例大肝癌或多灶性肝癌患者中有5例对治疗有反应。接受治疗患者的中位总生存期为36周（范围3天至4年）。1例患者随后接受了肝移植，移植时无复发且残留疾病极少。另外2例患者化疗栓塞后三年仍存活，其中1例无复发证据。化疗栓塞后，没有患者被认为适合手术。22%的患者出现了化疗相关并发症。并发症在肿瘤较大和肝储备功能差的患者中更为常见。5例患者死于化疗相关并发症。总之，在英国，只有三分之一的不可切除HCC患者可通过化疗栓塞治疗。小肿瘤的治疗结果令人鼓舞，缓解率高，且有可能对先前无法手术的疾病进行手术干预。然而大肿瘤的反应较差，副作用发生率较高，这表明该治疗方法对晚期疾病益处不大。
