消化道肿瘤腹膜后淋巴结转移行介入化疗加立体定向放疗的价值

目的 探讨消化道肿瘤术后腹膜后淋巴结转移行介入化疗加立体定向放疗的价值。方法 自1997年8月至2001年2月，在我院采用立体定向加介入治疗腹腔转移瘤46例，采用先腹脸动脉化疗（ATAI），Seldinger技术穿刺股动脉，插入1.22-1.83m长的导管，行腹腔动脉肿瘤供血支插管药物灌注化疗，鳞癌给予顺铂60－80mg，丝裂霉素10－20mg，阿霉素60－80mg，腺癌给予甲酰四氢叶酸钙300mg，氟尿嘧啶1000－1500mg，顺铂60－80mg，阿霉素60－80mg(或丝裂霉素10－20mg)。TAI后或2次TAI间歇期给予立体定向放疗，根据病变大小和部位选用不同大小的准直器，80％以上的等剂量线包绕靶区，边缘剂量2－6Gy/次不等，隔日1次，常规外照射后补量4－6次；未行外照射者行8－15次。疗效评价采用国际抗癌联盟制定的标准；（1）完全缓解（complete response,CR)，所见肿瘤病变完全消失并至少维持4周以上；（2）部分缓解（partial resonse,PR)，肿瘤病灶的最大径及其最大垂直径的乘积减少50％以上，并维持4周以上，无新的病变出现；（3）无变化（no change,NC)，肿瘤病灶的两径乘积缩小50％以下或增大25％以上，无新的病变出现；（4）进展（progressive disease,PD)，肿瘤病灶的两径乘积增大25％以上或出现新病灶。结果 46例中CR达20例，PR20例，总有效率（CR＋PR）为87％，1，2，3年生存率分别为54％（25／46），44％（17／39），24％（5／21）。结论 采用介入化疗结合立体定向放疗治疗腹膜后转移瘤，疗效高，缓解期长，副作用小，不失为腹膜后转移瘤首选的治疗方案之一。

Value of interventional chemotherapy combined with stereotactic radiotherapy for retroperitoneal metastatic tumor

Objective To study the combined therapy of stereotactic radiotherapy and interventional chemotherapy in the treatment of retroperitoneal metastatic tumors Methods From August, 1997 to February, 2001, 46 cases of retroperitoneal metastatic tumors were treated The first step was interventional chemotherapy (TAI). Following Seldinger technique, the specific needle was penetrated into the femoral artery, and the tumor supplying artery branch was selected, and then the chemotherapy drugs were infused. For squamous carcinoma: Cisplatin 60-80 mg, Mitomycin C 10- 20 mg, Adriamycin 60-80 mg; For adenocarcinoma: Citrovorum factor 300 mg, Fluorouracil 1 000-1 500 mg, Cisplatin 60-80 mg, Adriamycin 60-80 mg (or Mitomycin C 10- 20 mg) After the first TAI therapy, the stereotactic radiotherapy was carried on The size of the collimator depended on the location and size of the tumors, and the planning target volume was encompassed by more than 80% isodose line, DT was from 2 Gy to 6 Gy per fraction Results The whole effective rate was 87% (CR 20 and PR 20) The survival rates of 1, 2, and 3 year were 54%(25/46), 44%(17/39), and 24%(5/21), respectively Conclusion Compared with the radiotherapy alone and interventional chemotherapy alone, the combined therapy has higher therapeutic effect, longer remission time, and little side effects We consider that it is an effective treatment method of choice for the retroperitoneal metastatic tumors