摘要
目的 :探讨局部动脉介入治疗在中、晚期及治疗后复发或未控的大肠癌综合治疗中的应用及其价值。方法 :5 0例中、晚期及治疗后复发或未控的大肠癌患者进行局部动脉介入治疗。 35例可评价患者的年龄范围为 2 7～ 76岁 ,中位年龄为 4 8岁。全部病例均采用Seldinger技术经股动脉穿刺 ,行局部动脉灌注化疗及 /或栓塞治疗 ,并按肿瘤位置以及造影所示的肿瘤供血情况选择介入治疗所用动脉 ,并相应分配化疗药物用量。介入治疗 1～ 3次后 ,对于疗效较好的大肠肿瘤原发灶未切除的病人如无禁忌可进一步行根治性切除术。对于局部动脉介入治疗疗效不佳或估计肿瘤切除有困难的患者继续施以放射治疗及 (或 )全身化疗。结果 :在可评价的 35例病人中 ,随诊时间范围为 1～ 139个月 ,平均 2 4个月。经综合治疗 (介入治疗 +手术及 /或放、化疗 )后总的临床有效率 (完全缓解 9例 +部分缓解 9例 )为 5 1.4 %。全部病例平均生存期为 2 4 .11个月 ,中位生存期为 12个月 ,其半年、一年、二年、三年、以及五年累积生存率分别为 :6 8.6 %、5 1.4 %、34.3%、14 .3%、以及 14 .3% ,一例患者的生存时间已达 139个月。综合治疗有效者中位生存期 (82个月 )显著长于无效者 (9个月 )。治疗后最常出现的毒副反应有发热、恶心、呕吐、腹痛。
Purpose:To evaluate the clinical efficacy of regional intra arterial chemoembolization in patients with Dukes stage B～D colorectal cancer. Methods:From January 1990 to April 2001, 50 patients with pathologically confirmed Dukes stage B～D colorectal cancer were treated with regional intra arterial chemoembolization in our hospital. Of the 50 patients entered, 15 have been lost to follow up. Of 35 evaluable patients, 21 were male, and 14 were female, with a median age of 48 years (range, 27～76). The regional intra-arterial chemoembolization was administered for 1～3 courses every 1～3 months for each patient. The Seldinger's technique was used in all patients. The catheter was introduced via the femoral artery on one side (usually on the right side), and the combined antineoplastic agents and (or) embolic materials were infused into the selected arterial branches supplying the tumor. 11 patients had received no prior therapy before initiating regional intra arterial chemoembolization; while as 24 patients had received prior treatment of pelvic surgery, and (or) radiotherapy, with or without systematic chemotherapy. If the results of the evaluation indicated that surgery was feasible, radical surgery was performed. The patients whose tumors were inoperable received radiation therapy, with or without systematic chemotherapy. Survival was computed by Kaplan Meier estimate and the difference in the treatment efficacy was evaluated by the Log rank method. Results:The mean follow up was 24 months (range, 1 to 139 months). Nine patients had a complete response, and nine had a partial response. Minor response in 6, no change in 5, and disease progressed in 6. The overall response rate was 51.4% (18/35). Prolonged survival was observed in the responders (with a median survival time of 82 months, vs. 9 months for nonresponders), and the difference was significant. For the patients had received no prior therapy before initiating regional intra arterial chemoembolization, the response rate was 54.5% with a median survival duration of 42 months, while as for the patients who had received prior treatment of pelvic surgery, and / or radiotherapy, with or without systematic chemotherapy, the response rate was 50% with a median survival duration of 15 months, but the difference was not statistically significant. The clinical response correlates to the clinical stage and whether the primary tumor had been surgically resected completely. The most frequently observed adverse effects were fever, nausea and vomiting, temporary pelvic pain, and short term diarrhea, etc. No severe complications were observed. Conclusions:Regional intra arterial chemoembolization was found beneficial for the patients with late stage colorectal cancer, and improved the quality of life in these patients lives.
出处
《中国癌症杂志》
CAS
CSCD
2002年第4期330-335,共6页
China Oncology
