肿瘤热化疗中化疗药物的选择

目的：肿瘤治疗进入综合治疗时代，临床已应用热疗联合化疗和／或放疗治疗多种肿瘤，但热化疗中还有许多问题需要明确，如最佳的温度和作用时间，热化疗是药物的选择等。方法：通过总结许多国内外的基础试验研究和临床应用结果，评价肿瘤热化疗的协同作用。结果：体外细胞试验表明化疗药物的毒性与治疗温度和时间相关，温度37．0～41．0℃（41．5℃）合并药物时，细胞生存率急剧下降，而除ADR外，41．0～43．0℃时细胞生存率下降不明显。体内实验表明9种药物中，除BIN外热增长比例（TER）在41．5℃和43．0℃无明显区别，其中马法兰的TER最高。热化疗的临床研究还处于初期，但用马法兰和TNF进行隔离肢体热灌注治疗黑色素瘤和软组织肉瘤效果确切。结论：热疗联合化疗有协同抗肿瘤作用，应进一步深入研究。

Selection of Chemotherapeutics in Thermochemotherapy of Tumor

Objective: To discuss the optimal temperature(OT) and action time(AT),selection of chemotherapeutics in the thermochemotherapy(TCT) of tumor.Methods: The synergistic action in the TCT of tumor was evaluated by summarizing the basal experimental investigation and clinical application of the internal and external.Results: Exosomatic cell test showed that the toxicity of chemotherapeutics was relative to treating temperature and time.When the temperature was 37.0-41.00C(41.50C) with medication,cell survival rates decreased suddenly except Adr;the test in vivo showed that out of the 9 drugs,L-Sarcolysinum's(L-PAM) TER(=Thermal Enhancement Ratio) was the highest at 41.50C and 43.00C,except BLM without significant difference.Although the clinical study on TCT is still in the initial stage,hyperthermic isolated limb perfusion with L-PAM and TNF in the treatment of melanoma and soft-tissue sarcoma has got good effects.Conclusion: Thermotherapy combined with chemotherapy has synergistic action against tumor,which should be further studied.