经颞浅动脉灌注化疗治疗无法切除的晚期上颌恶性肿瘤的疗效分析*

摘要

目的：观察经颞浅动脉灌注化疗治疗无法切除的晚期上颌恶性肿瘤的疗效和毒副反应。方法16例无法切除局部晚期上颌恶性肿瘤患者，行选择性颞浅动脉插管后，根据化疗方案用微量输液泵经导管远心端药池输注相应化疗药物：多西他赛60～75mg/m2匀速灌注2h，d1；顺铂75mg/m2大剂量冲击2h，d1；氟尿嘧啶500mg/m2连续灌注120h，d1～d5；吡柔比星25mg/m2匀速灌注2h，d1～d3；吉西他滨1000mg/m2连续滴注30min，d1、d8。21天为1个周期，2个周期分别采用RECIST 1�1标准和NCI CTC 3�0标准评价近期疗效和毒副反应并随访远期生存情况。结果16例均可评价近期疗效，其中CR 1例， PR 10例，SD 5例，RR为68�8％，DCR为100�0％。14例获随访（87�5％），中位生存期和无进展生存期分别为26�0个月和4�0个月。全组未有4级毒副反应发生，无治疗相关性死亡，3级毒副反应主要为1例耳廓部分坏死、3例贫血及1例骨髓抑制，其余均为1～2级。结论无法切除的晚期上颌恶性肿瘤经动脉灌注化疗后能够取得较为满意的治疗效果，毒副反应可耐受。%Objective To observe the curative effect and side effects of continuous infusion chemotherapy via superficial tem-poral artery on the maxillary malignant tumors. Methods Sixteen patients with unresectable advanced maxillary malignant tumor were enrolled in this study. After implantation of catheter into the superficial temporal artery, the patients received corresponding chemother-apy drugs via micro-infusion pump of drug pool at distal end of the catheter. The chemotherapy drugs were used as follow:docetaxel 60-75mg/m2 , uniform perfusion for 2h, d1;cisplatin 75mg/m2 , high dose pulse for 2h, d1;fluorouracil 500mg/m2 , continuous infusion for 120h, d1-d5;pirarubicin 25mg/m2 , uniform perfusion for 2h, d1-d3;gemcitabine 1000mg/m2 , infusion for 30min, d1 , d8 . Twen-ty-one days was a cycle. The RECIST 1�1 and NCI CTC 3�0 criteria were employed to evaluate short-term effect and adverse reaction after two cycles. The patients were followed up for long-term survival. Results All patients were evaluable with 1 case of CR, 10 of PR and 5 of SD. The RR(CR+PR) and DCR(CR+PR+SD) were 68�8% and 100�0%. In 14 cases(87�5%) followed up, the median overall survival and progression-free survival were 26�0 and 4�0 months, respectively. No treatment-related deaths and grade 4 toxicities were observed. The common grade 3 toxicities include 1 case of ear necrosis, 3 cases of anemia and 1 case of bone marrow suppression. The rest were all grade 1-2. Conclusion The treatment of unresectable advanced maxillary malignant tumor of continuous infusion chemotherapy via superficial temporal artery had satisfying effect with tolerable side effects.