立体定向放疗治疗不能手术原发性肝癌的临床研究  

Clinical Outcomes of Stereotactic Radiotherapy for Inoperable Primary Ilcpatoccllular Carcinoma

作　　者：肖作平[1] 王春刚[1] 居小萍[1] 刘永明[1] 

机构地区：[1]第二军医大学长海医院放疗科,上海200433

出　　处：《中华临床医学杂志》2006年第3期13-15,共3页Chinese Journal of Clinical Practical Medicine

摘　　要：目的 评价立体定向放疗（SRT）治疗不能手术原发性肝癌的疗效和毒副作用。方法 对52例原发性肝癌行SRT，≥90％等剂量面包绕PTV，单次剂量3.54-6.31Gy，照射次数7～15次。采用SPSS10.0统计软件，生存率以Laplan-Meier法计算，近期疗效和放射反应评价采用卡方检验，相关因素对预后的影响采用Cox回归。结果 1，2年生存率分别为64.1％和12．6％，中位生存期13个月。临床有效率（CR＋PR）55.8％。肿块小于6cm及大于6cm者有效率分别为91．7％和45．0％（P=0．007，〈0．05）。肝脏急性不良反应1级5例，1例发生严重放射性肝损伤，1级、2级上消化道反应分别为23（44.2％）、15（28．8％）。肿块较大和合并门静脉癌栓为影响生存率的危险因素（P值分别为0．042和0．001）。结论 SRT治疗不能手术原发性肝癌在可接受的毒副作用前提下获得了一定的疗效，肿块较大和合并门静脉癌栓为影响生存率的危险因素。Objective To evaluate the efficacy and toxicity of stereotactic radiotherapy for inoperable primary hepatocellular carcinoma. Methods Fifty two patients with histopathologically proven hepatocellular carcinom were treated with stereotactic radiotherapy. We prescribed single dose 3.54 Gy to 6.31Gy in 7 to 15 fractions at 90% isodose line at the planning target volume. The objective responses were analyzed and the survival rates were assessed from the date of the beginning of treatment using the Kaplan-Meier method. The Cox proportional hazards model was used to analyze the prognostic factors. Results Survival rates at 1 and 2 years were 64.1% and 12.6 %, respectively. The median survival time was 13.0 months. An objective response rate was observed in 29 of 52 cases（55.8 %）. The objective response for turn ors 〈 6cm or ≥6cm in diameter was 91.7% and 45.0%, respectively （P = 0.007, 〈0,05） .Five patients developed Grade 1 acute liver toxicity and one patient experienced radiation-induced liver disease. For gastrointestinal complications, 23 cases were scored as Grade 1 （44.2%） and 15 cases were scored as Grade 2 （28.8%） . Mutivariate analysis revealed tumor size and PVTT were the independent and statistically significant factors affecting the patient＇s survival （P〈 0.05） . Conclusion stereotactic radiotherapy is effective and feasible for unresectable primary hepatocellular carcinoma and tumor size and PVTT are the major factors affecting survival of primary hepatocellular carcinoma patients.

关 键 词：肝肿瘤 放射疗法 立体定向放射治疗 因素分析 统计学 

分 类 号：R735.7[医药卫生—肿瘤] R730.55[医药卫生—临床医学]