【摘要】 目的探讨吉西他滨、奥沙利铂(GEMOX)方案肝动脉化疗栓塞(TACE)联合三维适形放疗(3-DCRT)治疗晚期原发性肝癌的疗效和不良反应。方法经病理或影像学明确诊断的70例晚期原发性肝癌患者,采用GEMOX方案:吉西他滨0.8～1.0 g/m2,奥沙利铂85～100 mg/m2加入超液化碘油10～30 ml行TACE治疗,每月1次,连用2～3次。经TACE治疗后3～4周行3-DCRT:总剂量(DT)48～60Gy,每次4～5 Gy,隔天1次,每周3次,连续4周。结果 2例患者3-DCRT后4个月内死亡,未能评价疗效,其余68例原发性肝癌患者中完全缓解(CR)4.4%(3/68),部分缓解(PR)70.6%(48/68),稳定(SD)14.7%(10/68),进展(PD)10.3%(7/68);总有效率(CR+PR)75.0%(51/68),肿瘤控制率(CR+PR+SD)为89.7%(61/68)。总生存中位数10个月(8.4～11.6),无瘤生存时间中位数6.0个月(4.6～7.4),1、2、3年生存率分别为58.8%,29.4%和19.1%。常见的不良反应主要表现为白细胞减少、贫血、血小板减少、恶心、呕吐和发热等,患者均可耐受。结论 GEMOX方案TACE联合3-DCRT治疗晚期原发性肝癌疗效确切,不良反应可耐受,值得进一步研究。更多还原

【Abstract】 Objective To investigate the clinical effects and untoward reactions of transcatheter arterial chemoembolization(TACE) with regimen GEMOX together with three-dimensional conformal radiotherapy(3-DCRT) for the treatment of advanced inoperable primary hepatocellular carcinoma(HCC).Methods A total of 70 patients with pathologically or imaging confirmed advanced inoperable primary HCC were enrolled in this study.TACE with GEMOX regimen(gemcitabine 0.8-1.0 g/m2,oxaliplatin 85-100 mg/ m2 plus super-liquefactive iodized oil) was carried out once a month in all patients for 2-3 successive months.Three to four weeks after TACE,3-DCRT was conducted with a total dose of 48-64 Gy(4-5 Gy per fraction at an interval of 48 hours),and 3 fractions were given every week.The clinical results were analyzed.Results Two patients died four months after 3-DCRT was completed.The clinical effects of the remaining 68 patients were evaluated.Of the 68 patients,complete remission(CR) was obtained in 3(4.4%),partial remission(PR) in 48(70.6%),stable disease(SD) in 10(14.7%),and progress disease(PD) in 7(10.3%).The total effective rate(CR + PR) was 75.0%(51/68).The tumor control rate(CR + PR + SD) was 89.7%(61/68).The survival time varied from 8.4 to 11.6 months with a median time of 10.0 months.The median PFS was 6.0 months(95% CI: 4.6-7.4 months).The overall survival rates at 1,2 and 3 years were 58.8%,29.4% and 19.1%,respectively.The common untoward reactions included leucopenia,anemia,thrombocytopenia,nausea,vomiting and fever,which could be tolerated by the patients.Conclusion TACE with GEMOX regimen combined with 3-DCRT has definite therapeutic effect on inoperable primary hepatocellular carcinoma,and its untoward reactions can be tolerated by the patients.It is of value to make a further study on this technique.更多还原