Abrams R A, Pajak T F, Haulk T L, Flam M, Asbell S O
Johns Hopkins Oncology Center, Baltimore, Maryland 21287-8922, USA.
Cancer J Sci Am. 1998 May-Jun;4(3):178-84.
To analyze the observed therapeutic impact of the post-induction components of three treatment programs utilized sequentially between 1983 and 1991 for patients with unresectable alpha-fetoprotein-positive hepatoma.
Over a 7.5-year period, three treatment regimens were sequentially utilized: (1) RTOG 83-19, (2) a Johns Hopkins Oncology Center Institutional Pilot Program, and (3) RTOG 88-23. Each treatment program began with an induction phase of external-beam hepatic irradiation (2100 cGy/7 fractions), with concurrent doses of intravenous chemotherapy intended to be radiosensitizing. After induction, patients received cycles of one of the following: (1) intravenous doxorubicin and 5-fluorouracil (5-FU) with or without 131I-polyclonal antiferritin (RTOG 83-19); (2) intrahepatic artery cisplatin (Hopkins Institutional Pilot); or (3) intrahepatic artery cisplatin with or without 131I-polyclonal antiferritin (RTOG 88-23). Analysis of survival results was performed with multivariate and Cox regression methods.
The addition of intravenous 131I-polyclonal antiferritin to post-induction cycles of either intravenous doxorubicin and 5-FU or intrahepatic artery cisplatin did not enhance survival. Intrahepatic artery cisplatin treatment yielded median survival duration of 9.1 months and survival at 12 and 24 months of 37% and 9%, respectively. These results were significantly superior to those resulting from use of intravenous doxorubicin and 5-FU (P = 0.0001; median survival duration 3.6 months; 12- and 24-month survival results 17% and 4%, respectively). A significant survival difference for the cisplatin regimen remained even when patients were stratified by previously identified prognostic factors and the results were appropriately adjusted.
Patients with unresectable alpha-fetoprotein-positive hepatocellular carcinoma experienced improved survival and decreased toxicity when managed with post-induction cycles of intra-arterial cisplatin as compared with intravenous doxorubicin and 5-FU. Intravenous 131I-polyclonal antiferritin did not improve survival when added to either post-induction regimen but dramatically increased hematologic toxicities.
分析1983年至1991年间依次采用的三种治疗方案中诱导治疗后各组成部分对无法切除的甲胎蛋白阳性肝癌患者的观察到的治疗效果。
在7.5年的时间里，依次采用了三种治疗方案：（1）RTOG 83 - 19，（2）约翰霍普金斯肿瘤中心机构试点方案，以及（3）RTOG 88 - 23。每个治疗方案都以外照射肝脏诱导期（2100 cGy/7次分割）开始，同时给予旨在起到放射增敏作用的静脉化疗。诱导治疗后，患者接受以下其中一种方案的多个周期治疗：（1）静脉注射阿霉素和5 - 氟尿嘧啶（5 - FU），加或不加131I - 多克隆抗铁蛋白（RTOG 83 - 19）；（2）肝动脉内注射顺铂（霍普金斯机构试点方案）；或（3）肝动脉内注射顺铂，加或不加131I - 多克隆抗铁蛋白（RTOG 88 - 23）。采用多变量和Cox回归方法对生存结果进行分析。
在静脉注射阿霉素和5 - FU或肝动脉内注射顺铂的诱导治疗后周期中添加静脉注射131I - 多克隆抗铁蛋白并不能提高生存率。肝动脉内注射顺铂治疗的中位生存时间为9.1个月，12个月和24个月的生存率分别为37%和9%。这些结果显著优于使用静脉注射阿霉素和5 - FU的结果（P = 0.0001；中位生存时间3.6个月；12个月和24个月的生存结果分别为17%和4%）。即使根据先前确定的预后因素对患者进行分层并对结果进行适当调整，顺铂方案的生存差异仍然显著。
与静脉注射阿霉素和5 - FU相比，无法切除的甲胎蛋白阳性肝细胞癌患者采用肝动脉内注射顺铂的诱导治疗后周期进行治疗时，生存率提高且毒性降低。在任何一种诱导治疗后方案中添加静脉注射131I - 多克隆抗铁蛋白均不能提高生存率，但会显著增加血液学毒性。
