[Epirubicin in the treatment of malignant obstructive jaundice].
OBJECTIVE
To evaluate the safety and efficiency of epirubicin in the treatment of malignant obstructive jaundice (MOJ).


METHODS
Thirty-nine patients with diagnosis of MOJ, whose serum total bilirubin (TB) had not dropped to normal level after stent placement or percutaneous transhepatic biliary drainage, received trans-arterial chemoembolization (TACE). During TACE, epirubicin emulsion containing pharmorubicin at dose of 30 mg/m(2) was used. The toxicity and hepatic injury was observed according to WHO anticancer drug toxicity criterion and Child-Pugh classification criterion, respectively. The time of jaundice recurrence and survival were also observed during follow-up.


RESULTS
Median total serum bilirubin in 39 patients was 72.7 micromol/L (range: 52.1 - 91.4 micromol/L) before TACE. The dose of pharmorubicin was 40 - 60 mg with a median of 55.0 mg and the amount of lipiodol was 2 - 25 ml. Decrease in white blood cell count was observed: grade I in 41.0% of patients, grade II in 35.9% and grade III - IV in 15.4%. Grade III - IV nausea and vomiting developed in 100% of the patients. Hepatic injury became aggravated in 8 from A to B class patients, in one from A to C class, and in 3 from B to C class according to Child-Pugh classification criterion. No cardiac toxicity was observed in this series. The median survival time was 6.0 months with a range of 2 to 72 months. Jaundice recurred in 19 patients (48.7%) with a medium jaundice recurrence time of 9.0 months (range: 2 - 20 months).


CONCLUSIONS
Epirubicin-lipiodol emulsion at a dose of 30 mg/m(2) is safe and efficient in the management of patients with malignant obstructive jaundice with total serum bilirubin between 51 and 100 micromol/L after biliary drainage.
Chen
Yi
Y
Department of Diagnostic Radiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China.
Yan
Zhi-ping
ZP
Wang
Jian-hua
JH
Wang
Xiao-lin
XL
Cheng
Jie-min
JM
Gong
Gao-quan
GQ
Liu
Qing-xin
QX
Qian
Sheng
S
Liu
Rong
R
Luo
Jian-jun
JJ
D000328:Adult; D000368:Aged; D000903:Antibiotics, Antineoplastic / Q000008:administration & dosage; D001650:Bile Duct Neoplasms / Q000150:complications; D001663:Bilirubin / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000150:complications; D016461:Chemoembolization, Therapeutic; D015251:Epirubicin / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007459:Iodized Oil / Q000008:administration & dosage; D041781:Jaundice, Obstructive / Q000209:etiology / Q000628:therapy*; D008113:Liver Neoplasms / Q000150:complications; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D015996:Survival Rate
D000903:Antibiotics, Antineoplastic; D015251:Epirubicin; D007459:Iodized Oil; D001663:Bilirubin