网络首发:2011-05-20,
纸质出版:2011
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肝动脉灌注氟尿苷优化结直肠癌肝转移患者的化疗方案的探索性研究[J]. 中山大学学报(医学科学版), 2011,32(3).
A Pilot Study of Hepatic Arterial Infusion Floxuridine to Optimize Chemotherapy for Patients with Inoperable Liver Metastases from Colorectal Cancer[J]. Journal of Sun Yat-sen University (Medical Sciences), 2011, 32(3).
【目的】 评价mFOLFOX全身化疗的基础上联合肝动脉灌注氟尿苷(FUDR)治疗不可手术切除的结直肠癌肝转移患者的临床疗效和安全性【方法】 2006年 7月至2010年5月
入组48例患者行DSA导引下的经皮肝动脉药盒植入
导管头端置于肝固有动脉
每日用FUDR 0.1 ~ 0.2 mg/kg
同时加入地塞米松2 mg
持续经药盒泵入肝动脉灌注14 d;奥沙利铂85 mg/m2
静滴2 h
第115天;亚叶酸钙200 mg/m2
静滴2 h
第115天;5-氟尿嘧啶1400 mg/m2
持续静滴22 h
第1
15天;每28天重复化疗方案按美国癌症研究所常见毒性判定标准3.0版评价不良反应每2个治疗周期后按实体瘤的疗效评价标准(RECIST)评价客观疗效
并按照同时性或异时性肝转移既往化疗史
动脉灌注FUDR的剂量进行分层分析【结果】可评价疗效的48例患者均接受大于1周期的联合化疗
中位随访13个月后
全组病例的CR 0例
PR 36例(75%)
SD 9例(18.7%)各分层亚组的客观有效率均大于63%(63%~85%)其中12例(25%)患者转化为可手术切除和/或接受局部射频消融治疗病例中常见不良反应为1~2度的血小板减少
白细胞减少
恶心呕吐和腹泻
外周感觉神经毒性;Ⅲ级不良反应发生率8.3%治疗过程中病情未进展的45例患者生活质量得到改善(P < 0.01)【结论】 mFOLFOX全身化疗联合肝动脉灌注FUDR治疗不可手术切除的结直肠癌肝转移患者疗效确切
具有较高的客观有效率
不良反应可耐受
能保障患者的生活质量
是值得推广验证的新联合化疗方案
【Objective】To observe the efficacy and safety of mFOLFOX systemic chemotherapy plus continually hepatic arterial infusion (HAI) of floxuridine (FUDR) in the patients with inoperable liver metastases from colorectal cancer. 【Methods】Between July 2006 and May 2010
48 patients underwent DSA-guided percutaneous implantation of port-catheter system (PCS)
with catheter tip placed in proper hepatic artery. FUDR was delivered in a 14-day infusion at 0.1 - 0.2 mg/kg per day plus 25 mg dexamethasone via hepatic artery PCS. Systemic chemotherapy was delivered on day 1 and day 15 with dose of oxaliplatin 85 mg/m2
5-FU 1400 mg/m2 and leucovorin 200 mg/m2. The treatment cycles was repeated 28 days later. All toxic effects were graded according to the National Cancer Institute Common Toxicity Criteria (version 3.0). Response was evaluated according to RECIST criteria every two cycles. Subgroup analysis was done not only by metastatic time order but also by previous history of chemotherapy and the dose of FUDR. 【Results】 48 valuable patients had received at least 1 cycle of chemotherapy plus HAI FUDR. After a median follow-up of 13 months
no patients had complete response
36 cases (75%) had partial response and 9 cases (18.7%) had stable disease. Patients in every subgroup received high response more than 63% (63%-85%). 12 patients were ultimately able to undergo surgery resection/radiofrequency ablation. Common adverse events (AE) in 48 patients were 1 to 2 degrees of thrombocytopenia
neutropenia
nausea
vomiting and diarrhea
sensory peripheral neurotoxicity. Grade 3 AE was 8.33%. The quality of life was improved in 45 patients with non progress disease during treatment (P<0.01). 【Conclusion】On the basis of mFOLFOX systemic chemotherapy
combination with HAI FUDR for treatment of patients with inoperable liver metastases from CRC is effective. This regimen has a higher objective response rate. And AE could be tolerated to keep the quality of life of patients. This promising chemotherapy regimen is worth to be advised.
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