FOLFOX方案肝动脉化疗栓塞并留管灌注联合替吉奥治疗胃癌术后肝转移的临床疗效评价

摘要

目的 探讨FOLFOX方案肝动脉化疗栓塞(TACE)并留管灌注联合替吉奥治疗胃癌术后肝转移的价值.方法 回顾性分析60例胃癌术后肝转移的患者随机分为2组,A组(FOLFOX方案TACE并留管灌注联合替吉奥组)32例,采用Seldinger法插管入肝转移瘤供血动脉,用奥沙利铂50 mg+超液化碘油进行化疗栓塞.随后将导管头端留置在肝总动脉,经导管序贯泵入奥沙利铂100 mg,2h,脱氧氟尿苷针3.0g,44h.泵入脱氧氟尿苷前静脉滴注亚叶酸钙300 mg;1周后口服替吉奥40 mg 每日2次,连用2周,休息1周为1周期.B组(TACE+常规动脉灌注化疗组)28例作为对照,化疗栓塞药物同A组,在肝总动脉用奥沙利铂100 mg+脱氧氟尿苷1.0 g行灌注化疗,每4周重复治疗1次.2组均连续4次介入治疗.治疗后按mRECIST标准行影像学检查评价有效率,随访14个月,比较近期疗效、1年生存率、至疾病进展时间.结果 A组近期有效率81.25%优于B组57.14%(P<0.05),A组1年生存率96.88%高于B组75.00%,A组至疾病进展时间(11.51±0.48)个月长于B组的(7.87±0.58)个月,2组比较差异均有统计学意义(P<0.05,P<0.01).2组间不良反应差异无统计学意义(P>0.05).结论 应用FOLFOX方案TACE并留管灌注联合替吉奥治疗胃癌术后肝转移的疗效优于TACE并常规动脉灌注化疗,值得进一步研究应用.%Objective To assess the therapeutic effect of TACE and arterial infusion chemotherapy with FOLFOX regimen through indwelling catheter combined with Sl in the treatment of hepatic metastasis after gastric resection. Methods Sixty cases with hepatic metastasis after gastric resection were retrospectively analyzed. In group A ( TACE and arterial infusion chemotherapy with FOLFOX regimen through indwelling catheter combined with Sl group, n = 32 ), the catheter was inserted into tumor feeding artery using Seldinger technique, oxaliplatin 50 mg and lipiodol were used for chemo-embolization treatment. Subsequently the catheter tip was indwelled in the common hepatic artery. Patients received continuous hepatic arterial infusion of oxaliplatin 100 mg 2 hours and floxuridine 3. 0 g 44 hours. Calcium folinate 300 mg was given by intravenous drip before infusing floxuridine. One week later, Sl was taken orally 40 mg twice daily for 2 weeks, then stop one week are the one cycle. In group B ( TACE and arterial infusion chemotherapy group, n = 28 ), the same chemotherapy drugs were used for chemo-embolization. Patients received common hepatic arterial infusion of oxaliplatin 100 mg and floxuridine 1.0 g. Every four weeks treatment was repeated once as a cycle. All patients received four course of treatment. After treatment, efficiency was evaluated with images according to mRECIST standard. The patients were followed up for 14 months. Short term effect, one year survival rate, time to progression ( TTP ) were compared between two groups. Results The effective rate of group A and group B was 81. 25% and 57. 14% respectively ( P <0. 05 ). The survival rate for one year in group A was 96. 88% , but in group B was 75.00% ( P <0.05 ). The TTP in group A was ( 11.51 0.48 ) months, but in group B was ( 7. 87 0. 58 ) months ( P <0. 05 ). There were no significant difference in adverse events between two groups ( P >0. 05 ). Conclusion The treatment effects of hepatic metastasis after gastric resection by TACE and arterial infusion chemotherapy with FOLFOX regimen through indwelling catheter combined with Sl was better than by TACE and arterial infusion chemotherapy. This treatment method was valuable for further research and application.