原发性肝癌大分割三维适形放疗的预后因素分析  

Prognostic factor of primary liver cancer treated by hypofractionated three-dimensional conformal radiotherapy

作　　者：梁世雄[1] 蒋国梁[2] 朱小东[1] 傅小龙[2] 黎福祥[1] 黄启芳[1] 王安宇[1] 陈龙[1] 陆海杰[1] 

机构地区：[1]广西医科大学附属肿瘤医院放射治疗科,南宁530021 [2]复旦大学附属肿瘤医院放射治疗科

出　　处：《中华肿瘤杂志》2005年第10期613-615,共3页Chinese Journal of Oncology

基　　金：广西医科大学博士启动基金资助项目(304153);卫生部临床学科重点科研项目(20011626)

摘　　要：目的评价大分割三维适形放射治疗(3DCRT)对原发性肝癌的疗效,探讨其预后影响因素.方法对128例原发性肝癌进行大分割3DCRT.按UICC/AJCC分期,T3期 83例,T4期 45例,均为N0.合并有门脉癌栓(PVTT) 34例,无PVTT 94例.根据肝硬化Child-Pugh分级,A级108例,B级20例.大体肿瘤体积(GTV)为(458.92±429.8) cm3,中位值304.5 cm3;每次分割剂量4～8 Gy,照射次数7～15次;肿瘤剂量38～74 Gy,每周3次,隔日一次.结果 7例患者大分割3DCRT后3个月内死亡,诊断为放射性肝病,未能评价疗效.总有效(CR+PR)率为55.4%(67/121), 1,2,3年生存率分别为65.0%、43.3%和33.1%.T分期、GTV、PVTT和Child-Pugh分级对预后的影响有统计学意义(P均<0.01),GTV和Child-Pugh分级是独立的预后因子(P=0.044和0.015,RR=1.001和2.528).结论 UICC/AJCC T分期和PVTT对肝癌大分割3DCRT的生存率有影响,GTV和Child-Pugh分级是独立预后因子.Objective To evaluate the toxicity and efficacy of primary liver cancer （PLC） treated by hypofractionated three-dimensional conformal radiotherapy （3DCRT）and investigate the prognostic factors. Methods Between April 1999 and Augusl 2003, 128 PLC patients received hypofractionated 3DCRT. According to UICC/AJCC slaging syslem, there were 83 T3 patients, 45 T4, with none of them having lymph node metastasis. The mean value of gross tumor volume （ GTV ） was （458.92±429, 8 ） cm^3 （6.2-2097 cm^3）. Thirty-four patients had portal vein tumor thrombosis （PVTT）, 108 patients had Child-Pugh Grade A liver cirrhosis and 20 Child-Pugh Grade B liver cirrhosis, All patients received a total dose of （53.6±6.6） Gy/4-8 Gy per fraction/3 fractions per week. Forty-eight of these patients received 3DCRT combined with transarterial chemoembollzation（TACE）, Results Seven patients died within 3 months after the treatment were dismissed from the series. The response rate （CR ＋ PR） was 55% （67/121）. The overall 1-, 2-, and 3-year survival rate was 65.0% , 43.3% , and 33, 1% , respectively. T stage（ P =0.001 ）, GTV （P =0.0001 ）, PVTT（ P =0.0001 ） and Child-Pugh Grade （P = 0. 0001 ） had significant impact on the overall survival. However, only GTV and Child-Pugh Grade were independent significant prognostic factors by Coxregression analysis, （P =0,044 and P =0.015）, Conclusion T stage, GTV, PVTF and Child-Pugh Grade have significant impact on the overall survival in primary liver cancer patients treated by three-dimensional eonformal radiotherapy. But only GTV and Child-Pugh Grade are independent prognostic factors,

关 键 词：大分割三维适形放射治疗 肝肿瘤 预后 

分 类 号：R735.7[医药卫生—肿瘤] R692.507[医药卫生—临床医学]