全反式维甲酸联合三氧化二砷行肝动脉插管化疗栓塞治疗原发性肝癌的临床研究

目的]评价全反式维甲酸（ATRA）联合三氧化二砷（As2O3）行肝动脉插管化疗栓塞（TACE）治疗肝癌患者的临床疗效。方法]将40例肝癌患者随机分为2组，均接受超选择性TACE术，治疗组（19例）给予ATRA 60mg，As2O3注射液10mg；对照组（21例）采用常规化疗药物（5-氟尿嘧啶1000mg，顺铂50-70mg，阿霉素40-50mg，丝裂霉素8～16mg），经导管向供血动脉内注入碘油-化疗药物乳化剂，随后用明胶海绵（GS）或聚乙烯醇（PVA）微球栓塞该动脉。2组均每4周1个疗程，共4个疗程。结果]治疗组19例中，完全缓解（CR）5例，部分缓解（PR）9例，无变化（SD）3例，恶化（PD）1例，死亡1例，总有效率为73．7％，甲胎蛋白（AFP）下降率为80．0％，肿瘤缩小率为84．2％，中位生存期为15个月。对照组21例中，CR3例，PR5例；SD6例，PD5例，死亡2例，总有效率为38．1％，AFP下降率为47．1％，肿瘤缩小率为57．1％，中位生存期为8．5个月。2组中度以上不良反应率分别为10．5％和38．1％。结论]ATRA联合As2O3行TACE是一种安全、有效的治疗原发性肝癌的方法。

Clinical study on combination treatment using all-trans-retinoic acid and arsenic trioxide by TACE in patients with primary liver cancer

Objective]To evaluate the clinical efficacy of all-trans-retinoic acid （ATRA） combined with arsenic trioxide （As3O3） by transcatheter arterial chemoembolization （TACE） for primary liver cancer. Methods]Forty patients with liver cancer were retrospectively divided into two groups：nineteen in treatment group and twenty one in control group. All of forty patients underwent superselective TACE. Nineteen cases （treatment group） received ATRA 10mg and As3O3 60mg ;twenty one cases （control group） received conventional chemotherapeutic agents（5-fluorouracil 1000 mg,cisplatin 50 to 70 mg,doxorubicin 40-50 mg,mitomycin 8 to 16 mg）. Lipiodol-chemotherapeutic agents emulsion was injected into the feeding arteries of tumors followed by gelatin sponge （GS） or polyvinyl alcohol （PVA） particles embolization. Involving 51 patients with primary liver cancer in a four-course treatment by receiving TACE,and the intermission was four weeks of each course treatment. Results]In the treatment group： there were 5 CR ,9 PR , 3 SD and 1 PD; the overall response rate was 73. 7 %; the AFP and tumor reduction rates were 80% and 84. 2%; the median survival time was 15 months. In the control group ：there were 3 CR , 5 PR ,6 SD and 5 PD; the overall response rate was 38. 1%; the AFP and tumor reduction rates were 47.1% and 57.1 % ; the median survival time was 8. 5 months. The severe adverse reactionincidence was 10. 5% （ treatment group ）and 38. 1% （ control group）. Conclusion]All-trans-retinoic acid （ATRA） combined with arsenic trioxide （As2O3） by transcatheter arterial chemoembolization （TACE） for primary liver cancer is safe and effective for primary liver cancer.