巨大原发性肝癌69例的三维适形放射治疗  

Three-dimensional conformal radiotherapy(3-DCRT) for 69 cases of massive primary liver cancer

作　　者：梁世雄[1] 朱小东[1] 蒋国梁[2] 陈龙[1] 杨云利[1] 

机构地区：[1]广西医科大学附属肿瘤医院放射治疗科,广西南宁530021 [2]复旦大学附属肿瘤医院放射治疗科,复旦大学上海医学院肿瘤学系,上海200032

出　　处：《中国癌症杂志》2006年第6期478-480,491,共4页China Oncology

基　　金：广西医疗卫生重点科研课题(No.重200532)

摘　　要：背景与目的：巨大肝癌手术难度大，一般采用非手术疗法，但效果差。本研究旨在评价无法手术切除巨大肝癌的三维适形放射治疗（3-DCRT）疗效。方法：1999年4月-2003年8月，对69例无法手术切除的巨大（直径≥10cm）原发性肝癌进行3-DCRT，其中UICC／AJCC T3期36例，T4期33例，均为N0，合并有门脉癌栓（PVTT）29例。根据Child—Pugh肝硬化分级，A级54例，B级15例。可见肿瘤体积（GTV）为（710±436）cm^3（169～2097cm^3），每次分割剂量4～8Gy，照射次数为（11±2）次（7～15次），肿瘤剂量（53．6±6．6）Gy，每周3次，隔日1次。结果：7例患者3-DCRT后3个月内死亡，未能评价即期疗效，总有效（CR＋PR）率47％（29／62），1、2和3年生存率分别为41％、20％和17％。T分期、GTV、门脉癌栓（PVTT）和分割剂量对生存率的影响差异无显著性，Child—Pugh分级是独立的预后因子（P=0．047，相对危险度=2．402）：结论：3-DCRT对于无法手术切除巨大肝癌有一定的疗效，Child—Pugh分级是独立预后因子.Background and purpose： The majority of massive primary liver cancer（PLC） patients are technically unreseetable or medically inoperable, there have not been any really effective treatment modalities and the non-surgical modalities have resulted in very poor survivals. Our objective was to evaluate the efficacy of unresectable massive PLC patients receiving 3-DCRT. Methods： From April 1999 to August 2003, 69 unresectable massive PLC（ tumor size ≥ 10era） patients received 3-DCRT. U1CC/AJCC T3 stage 36 cases, T4 33 cases, none of the patients had lymph node metastasis, Portal vein tumor thrombosis （PVTF） was present in 29 patients. Child-Pugh Grade A of liver cirrhosis was present in 54 cases, Child- Pugh Grade B 15 cases, The mean value of GTV was （710 ±436）era3（ 169-2097 cm^3）. All patients received a total dose of （ 53.6 ± 6.6） Gy at 4-SGy per fraction, interfraction interval was 48 hours and irradiation 3 times every week. Results： 7 eases died in 3 months after 3-DCRT, were nnt evaluated. The response rate （ CR ＋ PR） was 47% （29/69）. The overall survival rate at 1, 2, and 3 years was41%, 20%, and 17%, respectively. T stage, GTV, PVT and fraction size had no significant impact on the overall survival. Chihl-Pugh Grade had significant impact on survival （P = 0.047, RR = 2. 402）. Conclusions： 3-DCRT had definitive impact on the overall survival of massive PLC, Child-Pugh Grade were independent prngnostic factor.

关 键 词：肝肿瘤 放射治疗 三维适形放射治疗 预后 

分 类 号：R735.2[医药卫生—肿瘤]