A comparative study of high-dose hepatic arterial infusion chemotherapy and transarterial chemoembolization using doxorubicin for intractable, advanced hepatocellular carcinoma.
A comparative study of high-dose hepatic arterial infusion chemotherapy and transarterial chemoembolization using doxorubicin for intractable, advanced hepatocellular carcinoma.
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DOI：
10.3350/kjhep.2010.16.4.355
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发表时间：
2010-12
期刊：
影响因子：
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通讯作者：
Korean Liver Cancer Study Group
中科院分区：
文献类型：
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作者：
Kim HY;Kim JD;Bae SH;Park JY;Han KH;Woo HY;Choi JY;Yoon SK;Jang BK;Hwang JS;Kim SG;Kim YS;Seo YS;Yim HJ;Um SH;Korean Liver Cancer Study Group
经动脉化疗栓塞（TACE）长期以来一直被用作不可切除的肝细胞癌（HCC）的姑息治疗。高剂量肝动脉灌注化疗 (HAIC) 在顽固性晚期 HCC 患者中显示出良好的疗效。本研究的目的是比较高剂量 HAIC 和使用阿霉素的传统 TACE 治疗晚期 HCC 的有效性和安全性。高剂量 HAIC 组由来自 6 个机构的 36 名患者组成。入组标准为良好的肝功能、主要门静脉侵犯（包括血管分流）、浸润型、双叶受累和/或先前常规治疗（TACE、射频消融或经皮乙醇注射）难治性，以及有记录的进展性疾病。患者通过植入式端口系统接受 5-氟尿嘧啶（第 1~3 天 500 mg/m2）和顺铂（每 4 周第 2 天 60 mg/m2）。在TACE组中，从单一中心回顾性招募了31名与高剂量HAIC组特征相似的患者。患者每4~8周接受一次阿霉素经动脉输注。总体而言，6 名患者（8.9%）获得部分缓解，20 名患者（29.8%）病情稳定。高剂量HAIC组的客观缓解率（完全缓解+部分缓解）明显优于TACE组（16.7% vs. 0%，P=0.030）。高剂量 HAIC 组的总生存期比 TACE 组长（中位生存期，193 天 vs. 119 天；P=0.026）。高剂量HAIC组没有出现严重不良反应，而TACE组则更常发生肝脏并发症。与使用阿霉素的传统 TACE 相比，高剂量 HAIC 似乎可以改善顽固性晚期 HCC 患者的肿瘤反应和生存结果。
Transarterial chemoembolization (TACE) has long been used as a palliative therapy for unresectable hepatocellular carcinoma (HCC). High-dose hepatic arterial infusion chemotherapy (HAIC) has showed favorable outcomes in patients with intractable, advanced HCC. The aim of this study was to compare the effectiveness and safety of high-dose HAIC and conventional TACE using doxorubicin for advanced HCC. The high-dose HAIC group comprised 36 patients who were enrolled prospectively from six institutions. The enrollment criteria were good liver function, main portal vein invasion (including vascular shunt), infiltrative type, bilobar involvement, and/or refractory to prior conventional treatment (TACE, radiofrequency ablation, or percutaneous ethanol injection), and documented progressive disease. Patients received 5-fluorouracil (500 mg/m2 on days 1~3) and cisplatin (60 mg/m2 on day 2 every 4 weeks) via an implantable port system. In the TACE group, 31 patients with characteristics similar to those in the high-dose HAIC group were recruited retrospectively from a single center. Patients underwent a transarterial infusion of doxorubicin every 4~8 weeks. Overall, 6 patients (8.9%) achieved a partial response and 20 patients (29.8%) had stable disease. The objective response rate (complete response+partial response) was significantly better in the high-dose HAIC group than in the TACE group (16.7% vs. 0%, P=0.030). Overall survival was longer in the high-dose HAIC group than in the TACE group (median survival, 193 vs. 119 days; P=0.026). There were no serious adverse effects in the high-dose HAIC group, while hepatic complications occurred more often in the TACE group. High-dose HAIC appears to improve the tumor response and survival outcome compared to conventional TACE using doxorubicin in patients with intractable, advanced HCC.