Clinical Study Of Hepatic Arterial Infusion Different Drugs Combined Embolization In The Treatment Of Advanced Hepatocellular Carcinoma

Objective : In order to explore better treatment method and chemotherapeutic drugs for the advanced HCC patients, we study the safety and efficacy of hepatic arterial infusion Raltitrexed or Tegafur combined Pirarubicin and Oxaliplatin iodized oil emulsion embolization in the treatment of advanced hepatocellular carcinoma.Methods: A total of 89 advanced HCC cases were treated with TACE in the Affiliated Hospital of Hebei University from December of 2011 to January of 2014. All patients were divided into three groups: Raltitrexed group(group A, n=27) were treated with hepatic arterial Raltitrexed infusion combined Pirarubicin and Oxaliplatin iodized oil emulsion embolization; Tegafur group(group B, n=30) were treated with hepatic arterial Tegafur infusion combined Pirarubicin and Oxaliplatin iodized oil emulsion embolization; Control group(group C, n=32) were treated with Pirarubicin and Oxaliplatin iodized oil emulsion embolization alone without hepatic arterial chemotherapeutic infusion. No difference were observed in age, gender, liver function, tumor size, Portal vein tumor thrombus,the level of AFP in these three groups(Table 1).The degree of tumor necrosis, changes of AFP level, recent survival rate and metastasis rate, liver function, postoperative complications, clinical symptom remission, side effects of intra-arterial injection of chemotherapy were observed, compared and assessed.Results:1 Clinical therapeutic effect of interventional therapy in HCC patientsTumor size and necrosis areas were assessed by dynamic conventional and/or intensify CT scan. For tumor size changes, no significant difference were found in Raltitrexed group(A group) and Tegafur group checked by conventional CT scan in 1 month after the procedure. While the degree of the effective intra-tumor necrosis in the group A and B was higher than that of group C.(Table 4)2 Change of liver function and AFP levels in HCC patients before and after interventional therapyLiver function of HCC patients were detected before and after interventional therapy, the results suggests that no significant difference were found among the three groups before and 4 weeks after the procedure(P> 0.05). The AFP levels were detected, the results suggest that in group A, AFP levels in 21 cases were higher than normal level, while, 4 weeks after interventional therapy, AFP level of 4 cases dropped to normal levels, down more than 50 percent in 6 cases, fell less than 50 percent in 8 cases and increased slightly in 3 cases. In group B, AFP level of 22 cases were higher than normal level, 4 weeks after the interventional therapy, AFP level of 6 cases dropped to normal levels, down more than 50 percent in 5 cases, fell less than 50 percent in 8cases and increased slightly in 3 cases. The degree of AFP levels decrease in group A and B was lower significantly than that of in group C(P<0.05).(Table 5, Table 6)3 The postoperative complication and adverse reactions in HCC patientsThere were 21 cases with fever in group A, the incidence was 77.8%(21/27), in group B and group C, the incidence was 46.9%(25/30)、46.9%(15/32) respectively, no significant difference could be observed between the group A and B(P>0.05), while the incidence of the fever in group C were lower than that in group A and B(P<0.05). As for nausea, vomiting, there were 6 cases in group A, the incidence was 22.2 %. There were 17 cases and 14 cases in group B and C, the incidence was 56.7% 43.8% respectively, no significant difference could be observed between the group B and group C(P>0.05), while the incidence in group A were lower than that in group B and C(P>0.05). The degree of nausea, vomiting in three groups were mainly the first degree adverse reactions, the symptoms were improved after given omeprazole.(Table 7)4 Cumulatived metastasis rate in HCC patients after interventional therapyThe cumulative metastasis rates in theses HCC patients were as follows: 3.70%, 7.40%, 14.8% in group A; 3.33%, 10%, 16.7 % in group B; 9.3%, 15.6%, 25.0% in group C. At 3, 6 and 9 months, the metastasis rate in group A and group B were lower than that of group C(P<0.05). No significant difference could be seen between group A and B(P>0.05).(Table 8)5 Clinical symptoms and efficacy evaluationIn group A and B, the symptoms of fatigue and bloating improved significantly after the procedure compared to that of group C(P<0.05), while no significant difference could be seen between the group A and B. The symptoms of pain and poor appetite could not be improved after the procedure in group A and B, no significant difference could be seen compared to that of group C. In group C, the symptoms of fatigue and abdominal distension became more serious after the procedure(P<0.05), while as for the symptoms of pain and poor appetite, no significant changes could be seen after the procedure.(Table 9)6 Human functional status scoreKPS scores, which were calculated after the last interventional procedure, were used to estimate human functional state before and after treatment. After the procedure, KPS scores in group A and B were significantly higher than before treatment(P<0.05), no statistical difference could be seen between group A and B. As for the KPS scores in group C, no significant difference could be seen(P>0.05).(Table 10)7 Survival rate of HCC patients in different groupThe recently survival rate in theses HCC patients were as follows: 100%, 96.3%, 77.8% in group A; 96.7%, 86.7%, 76.7% in group B; 87.5%, 75.0%, 53.1% in group C. The survival rate in group A and group B were higher than that of group C(P<0.05). No significant difference could be seen between group A and B(P>0.05).(Table 11)Conclusions:1 Hepatic arterial infusion Raltitrexed or Tegafur combined Pirarubicin and Oxaliplatin iodized oil emulsion embolization was more effective than pirarubicin and Oxaliplatin iodized oil emulsion embolization alone for advanced HCC patients. The tumor metastasis rate, survival rate and KPS scores were better than control group.2 The bloating, poor appetite had been improved and corrected more significantly after the procedure of hepatic arterial Raltitrexed or Tegafur infusion combined Pirarubicin and Oxaliplatin iodized oil emulsion embolization. The safety of hepatic arterial infusion Raltitrexed was higher and the incidence of side effects of Raltitrexed was lower than that of tegafur infusion combined Pirarubicin and Oxaliplatin iodized oil emulsion embolization and embolization alone.