肝动脉化疗栓塞联合索拉非尼治疗肝细胞癌合并肺转移的临床观察

目的 评价肝动脉化疗栓塞(TACE)联合索拉非尼治疗肝细胞癌(HCC)合并肺转移的疗效和安伞性.方法 30例伴有肺转移的晚期HCC患者,于TACE治疗后3周复查,如无禁忌证即开始服用索拉非尼,400 mg/次,2次/d;不能耐受时减至200 mg/次,2次/d.每4周进行疗效评估.结果 肺部转移病灶缩小6例,病灶稳定8例;肝脏病灶稳定22例,进展8例,在服药期问行TACE1～3次.不良反应包括手足皮肤反应7例,疲乏无力18例,脱发6例,腹泻6例,贫血和骨髓抑制5例,高血压2例,消化道出血1例.结论 HCC合并肺转移时,TACE联合索拉非尼治疗可有效控制疾病进展,安伞性及患者耐受性良好.

Clinical observation of the treatment with combination of transcatheter arterial chemoembolization and sorafenib for hepatocelluar carcinoma with lung metastasis

Objective To evaluate the safety and efficacy of the combination of transcatheter arterial chemoembolization(TACE)and sorafenib in treatment of hepatocellular carcinoma(HCC)with lung metastasis.Methods Thirty HCC patients with lung metastasis were treated by the combination of TACE and sorafenib between Oct 2006 and May 2008,including 27 men and 3 women.The age of the patients ranged 32 to 73 years old.Sorafenib was administrated orally at 400 mg,twice daily(the less tolerant patients received 200 mg,bid.),if there was no counterindication,at 3-4 weeks after TACE,with every 4 weeks as a course of treatment.The efficacy was evaluated at the end of every course of treatment.Results The metastatic lesions in the lung were diminished in 6 cases and stable diseases achieved in 8 cases.The primary liver tumors were stable in 22 cases,including 10 cases achieved by TACE before sorafenib treatment.Eight cases had slightly progressed liver tumors and were treated with 1-3 times of TACE in combination with sorafenib.Side effects included skin lesions in 7 cases,hair loss in 6 cases,fatigue in 18 cases,diarrhea in 6 cases,anemia and bone marrow suppression in 5 cases,high blood pressure in 2 cases,and gastrointestinal bleeding in 1 case.Conclusion The combination of TACE and sorafenib can be used as an effective treatment for hepatocellular carcinoma patients with lung metastasis,which may stabilize the disease in some patients.