动脉热灌注化疗联合超选择栓塞治疗不可切除结直肠癌肝转移的临床研究
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摘要
目的:研究动脉热灌注化疗联合超选择栓塞治疗不可切除结直肠癌肝转移的效果。方法:选取2014年1月—2016年7月我科诊治的39例结直肠癌肝转移患者,分为2组,研究组(22例)在肠系膜上动脉、肝固有动脉以51℃灌注化疗1 h,然后超选择至肝脏病灶的供血动脉,进行化疗栓塞。对照组(17例)接受传统的肝动脉化疗栓塞(TACE)治疗。比较2组的客观有效率、临床获益率及1年生存率。同时记录并比较两组的不良反应。结果:两组的客观有效率无统计学差异(27.3%vs.23.5%,P>0.05),临床获益率也无统计学差异(81.8%vs.76.5%,P>0.05)。但研究组的1年生存率显著高于对照组(63.2% vs.46.7%,P<0.05)。两组都未出现血管痉挛、闭塞等特殊并发症。结论:动脉热灌注化疗联合超选择栓塞治疗不可切除结直肠癌肝转移的远期效果优于传统TACE。
Objective: To evaluate the effect of transarterial hyperthemic perfusion chemotherapy combined with arterial superselective embolization for the treatment of unresectable colorectal cancer liver metastasis. Methods: A retrospective analysis of the clinical data of 39 cases with colorectal cancer liver metastasis was conducted. The treatment group included 22 cases. Transarterial hyperthemic perfusion(51 ℃, 1 h) was performed in superior mesenteric artery and hepatic artery respectively. And then super selective artery embolization was performed in the feeding artery of hepatic lesions. Control group included 17 cases who received traditional transcatheter arterial chemoembolization(TACE). The short-term effect was evaluated by objective response rate and clinical benefit rate. One year survival rate was used to evaluate the long-term effect.At the same time, adverse reactions of two groups were recorded. Results : There was no significant difference between the basic clinical characteristics of patients in two groups. The objective effective rate showed no significant difference( 27. 3 % vs. 23. 5 %, P > 0. 05) between the two groups and the clinical benefit rate also showed no significant difference( 81. 8 % vs. 76. 5 %, P > 0. 05). However, the one year survival rate of study group was significantly higher than the control group( 63. 2 % vs. 46. 7 %, P <0. 05). There were no artery vasospasm, occlusion, or any other serious adverse reactions in two groups.Conclusions: The long-term effect of transarterial hyperthemic perfusion chemotherapy combined with arterial superselective embolization on unresectable colorectal cancer liver metastasis is superior to that of conventional TACE.
Objective: To evaluate the effect of transarterial hyperthemic perfusion chemotherapy combined with arterial superselective embolization for the treatment of unresectable colorectal cancer liver metastasis. Methods: A retrospective analysis of the clinical data of 39 cases with colorectal cancer liver metastasis was conducted. The treatment group included 22 cases. Transarterial hyperthemic perfusion(51 ℃, 1 h) was performed in superior mesenteric artery and hepatic artery respectively. And then super selective artery embolization was performed in the feeding artery of hepatic lesions. Control group included 17 cases who received traditional transcatheter arterial chemoembolization(TACE). The short-term effect was evaluated by objective response rate and clinical benefit rate. One year survival rate was used to evaluate the long-term effect.At the same time, adverse reactions of two groups were recorded. Results : There was no significant difference between the basic clinical characteristics of patients in two groups. The objective effective rate showed no significant difference( 27. 3 % vs. 23. 5 %, P > 0. 05) between the two groups and the clinical benefit rate also showed no significant difference( 81. 8 % vs. 76. 5 %, P > 0. 05). However, the one year survival rate of study group was significantly higher than the control group( 63. 2 % vs. 46. 7 %, P <0. 05). There were no artery vasospasm, occlusion, or any other serious adverse reactions in two groups.Conclusions: The long-term effect of transarterial hyperthemic perfusion chemotherapy combined with arterial superselective embolization on unresectable colorectal cancer liver metastasis is superior to that of conventional TACE.
引文
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[13]秦叔逵,杨柳青,李进,等.雷替曲塞单药治疗不能耐受或不适合5-FU/CF治疗的局部晚期或复发转移性结直肠癌的全国多中心Ⅳ期临床研究[J].临床肿瘤学杂志,2017,22(3):203-208.
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[2]Chen W,Zheng R,Baade PD,et al.Cancer statistics in China,2015[J].CA Cancer J Clin,2016,66(2):115-132.
[3]蔡建强,蔡三军,秦新裕,等.结直肠癌肝转移诊断和综合治疗指南(2016)[J].中国实用外科杂志,2016,15(8):858-869.
[4]de Baere T,Tselikas L,Boige V,et al.Intra-arterial therapies for colorectal cancer liver metastases(radioembolization excluded)[J].Bull Cancer,2017,104(5):402-406.
[5]中华人民共和国国家卫生和计划生育委员会.原发性肝癌诊疗规范(2017年版)[J].临床肝胆病杂志,2017,33(8):1419-1431.
[6]Lencioni R,Montal R,Torres F,et al.Objective response by m RECIST as a predictor and potential surrogate end-point of overall survival in advanced HCC[J].J Hepatol,2017,66(6):1166-1172.
[7]姜松,李桂杰,周祝谦,等.Calli Spheres载药栓塞微球治疗中晚期肝癌临床效果评价[J/CD].中华介入放射学电子杂志,2017,5(3):174-178.
[8]Lahrsow M,Albrecht MH,Bickford MW,et al.Predicting treatment response of colorectal cancer liver metastases to conventional lipiodol-based transarterial chemoembolization using diffusionweighted mr imaging:value of pretreatment apparent diffusion coefficients(ADC)and ADC changes under therapy[J].Cardiovasc Intervent Radiol,2017,40(6):852-859.
[9]Gaba RC,Lewandowski RJ,Hickey R,et al.Transcatheter therapy for hepatic malignancy:standardization of terminology and reporting criteria[J].J Vasc Interv Radiol,2016,27(4):457-473.
[10]Ba M,Cui S,Wang B,et al.Bladder intracavitary hyperthermic perfusion chemotherapy for the prevention of recurrence of nonmuscle invasive bladder cancer after transurethral resection[J].Oncol Rep,2017,37(5):2761-2770.
[11]Zhang T,Pan Q,Xiao S,et al.Docetaxel combined with intraperitoneal hyperthermic perfusion chemotherapy and hyperthermia in the treatment of advanced ovarian cancer[J].Oncol Lett,2016,11(5):3287-3292.
[12]李毅斌,曹漫明,胡喜钢,等.射频消融术联合肝动脉化疗栓塞及西妥昔单抗治疗结直肠癌肝转移的疗效评价[J].介入放射学杂志,2016,25(2):129-133.
[13]秦叔逵,杨柳青,李进,等.雷替曲塞单药治疗不能耐受或不适合5-FU/CF治疗的局部晚期或复发转移性结直肠癌的全国多中心Ⅳ期临床研究[J].临床肿瘤学杂志,2017,22(3):203-208.
[14]刘毅勇.兔肝VX2瘤两种介入性热化疗方法的对比实验研究[J].现代肿瘤医学,2015,23(3):299-302.