肝动脉化疗栓塞序贯沙利度胺靶向治疗中晚期肝癌近期疗效观察

摘要

Objective: To observe the late efficacy of the regimen of transcatheter arterial chemoembolization ( TA-CE) sequential thalidomide treated on advanced hepatocellular carcinoma. Serum vascular endothelial growth factor (VEGF) and alpha - fetoprotein (AFP) were monitored before and after the treatment. Adverse reactions were also observed. Methods: All 54 cases of unresectable advanced hepatocellular carcinoma were randomly divided into two groups,each of 27 cases. The treatment group was treated with TACE sequential thalidomide,the control group treated by TACE alone. In treatment group,each patient received thalidomide from 100 to 200mg/d,the administration was not less than three months. Each patient was treated with TACE at least two times,levels of VEGF and AFP were detected before TACE and 4 weeks later. Results;The overall response rate of treatment group was 59. 3% (CR + PR), 48. 1% in control group,there was no significant difference statistically (P>0. 05). In treatment group,the disease control rate was 77.8% ,but it was only 59.3% in control group, (P<0.05). After TACE , the serum VEGF level of treatment group was significantly lower (144. 35 ± 70. 63ng/L vs 254.35 ±154.48ng/L) than control group( P < 0. 05 ) ,but in control group, there was no difference on the VEGF before and after TACE ( P > 0. 05 ) . After TACE, the patients which the AFP declined in the treatment group was higher than in control (18 vs 13) ,the difference was significant (P<0. 05). In treatment group,the adverse reaction rates such as the lethargy,fatigue,dizziness,rash and other symptoms were higher than control,but the toxicities can be well tolerated. Conclusion;In advanced hepatocellular carcinoma,the scheme of TACE sequential thalidomide can improve disease control rate. To some extent,the levels of VEGF and AFP can be reduced and the toxicities can be tolerated.%目的:观察肝动脉化疗栓塞(TACE)序贯沙利度胺治疗中晚期肝癌近期疗效,监测治疗前后血清血管内皮生长因子(VEGF)、甲胎蛋白(AFP)变化情况,观察毒副反应.方法:将不能手术切除的中晚期肝癌54例随机分为两组,每组27例.治疗组采用TACE序贯沙利度胺；对照组单纯行TACE.治疗组沙利度胺100-200mg/d,口服至少3个月.两组患者至少行TACE术2次,于术前及术后4周检测VEGF、AFP水平.结果:治疗组有效率为59.3％,对照组为48.1％,差异无统计学意义(P＞0.05)；治疗组疾病控制率77.8％,对照组为59.3％,差异有统计学意义(P＜0.05)；治疗组术后血清VEGF水平较对照组术后显著降低(144.35±70.63ng/L vs 254.35 ± 154.48ng/L),差异有统计学意义(P＜0.05)；对照组内TACE前后血清VEGF水平比较差异无统计学意义(P＞0.05)；治疗组术后与对照组术后AFP降低例数比较,治疗组高于对照组(18 vs13),差异有统计学意义(P＜0.05)；治疗组嗜睡、疲劳、头昏、皮疹等症状较对照组高,两组毒副反应均可耐受.结论:TACE术序贯沙利度胺治疗中晚期肝癌能提高疾病控制率,一定程度上降低血清VEGF、AFP水平,且毒副反应可控,值得进一步研究.