- 期刊
全身性合併化學療法對一例肝癌轉移之治療
Systemic Combination Chemotherapy in a Case with Metastatic Hepatocellular Carcinoma
摘要
肝癌為世界上最常見的惡性腫瘤之一，在疾病早期對小型的腫瘤以手術切除為唯一可能提供治癒希望的方法。然而，僅有少數病患適合進行手術切除，無法進行手術的常見原因爲腫瘤位于肝臟兩葉、侵犯或造成主肝門靜脉栓塞，或是出現肝臟以外之癌細胞轉移；當病患出現肝癌轉移時，全身性化學療法（化療）爲唯一的治療選擇。我們將報告一復發性肝癌伴隨左側腎上腺轉移，進行合幷全身性化療之病例，病患使用之療程主要是修改自合幷cisplatin、interferon α-2b、epirubicin、5-fluorouracil之療法，簡稱PIAF療程。經過六次化療之後，病患得到部分緩解(partial response)、胎兒蛋白(α-fetoprotein)回到正常值，電腦斷層婦描亦顯示肝腫瘤壞死率約90%。經文獻回顧，關於PIAF合幷治療之臨床效益，雖然治療反應率幷不高，但是少數在化療後達到部分緩解之病患，隨即進行手術切除，其切除下來之腫瘤檢體，經病理檢查幷無發現癌細胞；這些病例報告顯示此種合幷全身性化療，有可能使病患達到完全病理緩解，且化療之效益較可能出現在肝功能較佳之病患。最後，我們也將討論病患此次使用之化療療程和PIAF之不同處。
並列摘要
Hepatocellular carcinoma (HCC) is one of the most common malignant tumors in the world. Surgical resection is the only way to provide hope of cure in the early stage that the tumor size was still small. However, only few patients are suitable for resection. Usually, reasons of the unoperable cases are the presence of bilobar liver tumors, invasion or thrombosis of the main portal vein, or extrahepatic metastases. Systemic chemotherapy is the only treatment option as soon as the extrahepatic metastasis appeared. We presented a case of recurrent HCC with left adrenal gland metastases, who was treated with systemic combination chemotherapy. The regimen of chemotherapy for this patient was modified from the combination of cisplatin, interferon α-2b, doxorubicin, and 5-fluorouracil, the PIAF regimen. After six courses of chemotherapy, partial response was achieved and the α-fetoprotein level returned to normal (5.6ng/mL) under the modified PIAF regimen. Also, the computed tomography scan demonstrated about 90% central necrosis of the hepatic mass. Furthermore, we reviewed the literature about treatment response and clinical benefit of the PIAF combination therapy. Although the response rate was low, the pathologic examination of the resected specimen from few patients who achieved partial response and subsequently underwent surgical resection after chemotherapy revealed no visible tumor cells. These reports provide evidence to show that complete pathological remission is possible with this systemic combination chemotherapy. The chemotherapy is most likely to benefit patients with the better liver function.