| 摘要 |
<p>Background: Between 1991 and 1997 sixty-seven patients with non-resectable hepatoma were treated with hepatic artery infusions (HAI) of cisplatinum. Patients were divided into groups for analysis based on alpha-fetoprotein elevation (AFP+) or no elevation (AFP-), hepatitis B/C status, the presence or absence of extra-hepatic metastases and primary treatment at our facility or initial therapy elsewhere. Methods: Forty-four patients received an initial course of 21-24 Gy whole liver external radiation with cisplatinum 50 mg/m2 IV on days 1 and 8 of radiation. Twenty-three patients did not receive external radiation and received HAI cisplatinum only. All patients were then treated with HAI cisplatinum at 50 mg/m2 on a monthly basis. The rationale for the advantage to HAI cisplatinum was evaluated by giving a tracer dose of radioactive 195mcisplatinum for quantitative determinations by the intra-arterial route in six patients. Results: A 50% overall response rate was seen, as judged by a 50% reduction in tumor diameter or a 50% reduction in AFP titer. Monthly HAI cisplatinum at 50 mg/m2 was well tolerated and could be repeated indefinitely without significant toxicity. Median survival for primarily treated non-resectable hepatomas AFP(+) and AFP(-) was 12 months and 17.5 months, respectively. Statistical analysis of all patients AFP(+) versus AFP(-) revealed a log rank statistical difference in survival of P=0.007. For patients with hepatitis B or C median survival was 10.7 months regardless of AFP status. Radioactive cisplatinum given by hepatic arterial infusion provided 34-55% tumor uptake of cisplatinum. Conclusions: Intra-arterial delivery of 50 mg/m2 cisplatinum on a monthly basis is a well-tolerated regimen for patients with non-resectable hepatoma. These data suggest a baseline chemotherapy regimen against which randomized trials could be evaluated. Further, the selective uptake of cisplatinum delivered intra-arterially suggests other selective intra-arterial protocols would be of use in regional cancers treated with cisplatinum. Keywords: Hepatoma, hepatocellular, carcinoma, cisplatin, cisplatinum, 195mcisplatinum, radioisotopes, intra-arterial.</p> |
