动脉内持续输注治疗胰腺癌和胆道癌。

C Zanon, O Alabiso, M Grosso, R Buosi, I Chiappino, R Clara, A Satolli, S Zai, M Bortolini, M Botta, A Mussa
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引用次数: 15

摘要

背景:对于不能切除或转移到肝脏的胰腺和胆道肿瘤,全身化疗不能令人满意地改善其不良预后。动脉内输注抗肿瘤药物可使肿瘤得到较高的浓度,全身得到较低的浓度,由于肝脏清除,具有潜在的疗效和较低的毒性。方法:基于安全、动态的经皮动脉移植技术,评价5-氟尿嘧啶(5-FU)动脉持续输注联合全身吉西他滨剂量递增的可行性和毒性。17例胰腺癌(14例)或胆道癌(3例)患者接受了长达6个周期的治疗。治疗包括在第1和第8天静脉注射吉西他滨,在第1-14天动脉内连续输注5-FU,每21天一次。吉西他滨的剂量递增水平为900和1000 mg/m2, 5-FU的剂量递增水平为8、10、12、15和17 mg/kg/d。计划在每个剂量水平下连续队列3名患者。结果:胃肠道毒性(呕吐、腹泻[3 ~ 4度]和胃炎)构成剂量限制性毒性,吉西他滨最大耐受剂量为1000 mg/m2, 5-FU最大耐受剂量为15 mg/kg/d。少数患者出现血液学毒性。没有患者出现与植入动脉端口相关的动脉血栓形成、硬化性胆管炎或化学性胆囊炎等急性或晚期并发症。结论:5-氟尿嘧啶动脉持续输注联合全身吉西他滨似乎是一种可行且安全的治疗胰腺癌的方案,可能会产生有趣的结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Intra-arterial continuous infusion for treatment of pancreatic and biliary tract cancer.

Background: Systemic chemotherapy does not satisfactorily improve the poor prognosis of pancreas and biliary tract cancer unresectable or metastatic to the liver. Intra-arterial infusion of antineoplastic agents can give higher concentrations to the tumor and slighter concentrations to the whole body, with a potential of efficacy and lower toxicity, due to the hepatic clearance.

Methods: Based on a safe and ambulatorial technique of transcutaneous arterial port implantation, this study was designed to evaluate feasibility and toxicity of 5-fluorouracil (5-FU) intra-arterial continuous infusion combined with systemic gemcitabine with dose escalation. Seventeen patients affected by pancreatic (14) or biliary tract (3) cancer received up to six cycles of treatment. Treatment consisted of intravenous gemcitabine on d 1 and 8 and intra-arterial 5-FU continuous infusion on d 1-14 every 21 d. Dose-escalation levels were 900 and 1000 mg/m2 for gemcitabine and 8, 10, 12, 15, and 17 mg/kg/d for 5-FU. Consecutive cohorts of three patients were planned at each dose level.

Results: Gastrointestinal toxicity (vomiting and diarrhea [3rd-4th degree] and gastritis), constituted the dose-limiting toxicity, with a maximum-tolerated dose of 1000 mg/m2 for gemcitabine and 15 mg/kg/d for 5-FU. Hematological toxicity was present in a minority of patients. No patient had acute or later complications such as arterial thrombosis related to the implanted arterial port, sclerosis cholangitis, or chemical cholecistitis.

Conclusion: 5-Fluorouracil intra-arterial continuous infusion, combined with systemic gemcitabine, seems to be a feasible and safe regimen that could give interesting results in pancreatic cancer.

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