Konno T, Tabaru K, Isogai M, Nagamitsu A, Oda T
First Dept. of Surgery, Kumamoto University School of Medicine.
Gan To Kagaku Ryoho. 1998 Feb;25 Suppl 1:10-8.
The first drug only for arterial injection, SMANCS/Lipiodol, which offers targeted chemotherapy for hepatocellular carcinoma (HCC), now commercially available. Based on our experience using SMANCS/Lipiodol for 424 patients with HCC, the golden standard of how to use SMANCS/Lipiodol for complete necrosis of tumor was described. The initial dose of SMANCS/Lipiodol was varied 2 to 6 mg per body, mainly depending on the size of the tumor. All feeding arteries of HCC have to be verified on angiogram, and the drug must be injected via an adequate artery. Sometimes, a tumor changes its feeding arteries. Additional administrations with an interval of one month were done till the entire tumor was filled with SMANCS/Lipiodol (grade 4). One or two months after achievement of grade 4, we must examine how much drug was removed from tumor on CT. If the entire tumor is not filled with the drug, further injections are recommended to maintain grade 4. Almost all tumors shrank in 3 to 4 months while maintaining grade 4. Frequent administration of low doses (1-3 mg per body) is recommended. Discontinvation of administration was done on the following findings; tumor size reduction of over 90% or complete disappearance of tumor stain. With arterial injection therapy of SMANCS/Lipiodol, survival of patients with unresectable HCC was prolonged, especially in 272 patients who were good candidates for therapy. (Those with Child C liver cirrhosis, with a tumor occupying all four segments of the liver, and/or with extrahepatic spread at initial arterial injection of the drug were excluded.) The 1, 2, 5, and 10 year survival rates were 83%, 58%, 34%, and 25%, respectively.
首款仅用于动脉注射的药物SMANCS/碘油，可对肝细胞癌（HCC）进行靶向化疗，现已上市。基于我们对424例HCC患者使用SMANCS/碘油的经验，描述了如何使用SMANCS/碘油实现肿瘤完全坏死的金标准。SMANCS/碘油的初始剂量为每体2至6毫克，主要取决于肿瘤大小。HCC的所有供血动脉都必须在血管造影上得到确认，并且药物必须通过合适的动脉注射。有时，肿瘤会改变其供血动脉。每隔一个月进行额外给药，直到整个肿瘤充满SMANCS/碘油（4级）。达到4级后的一两个月，我们必须在CT上检查从肿瘤中清除了多少药物。如果整个肿瘤没有充满药物，建议进一步注射以维持4级。几乎所有肿瘤在3至4个月内缩小，同时维持4级。建议频繁给予低剂量（每体1 - 3毫克）。在出现以下情况时停止给药：肿瘤大小缩小超过90%或肿瘤染色完全消失。通过SMANCS/碘油动脉注射治疗，不可切除HCC患者的生存期延长，尤其是在272例适合治疗的患者中。（排除那些Child C型肝硬化、肿瘤占据肝脏所有四个肝段和/或在初次动脉注射药物时伴有肝外转移的患者。）1年、2年、5年和10年生存率分别为83%、58%、34%和25%。
