肝动脉栓塞化疗、三维适形放疗与斯普林联合治疗中晚期肝癌的临床探索  

Clinical investigation of transcatheter arterial chemoembolization,3-Dimension conformal radiation therapy and sipulin for the middle and advanced-stage liver cancer

作　　者：王文玲[1] 文小平[1] 杨晓峰[1] 黄韵红[1] 

机构地区：[1]贵阳医学院附属医院肿瘤科,贵阳550004

出　　处：《肿瘤》2006年第5期480-483,共4页Tumor

摘　　要：目的：评价肝动脉栓塞化疗、三维适形放疗及联合斯普林治疗中晚期肝癌的安全性及疗效。方法：35例不能手术的原发性肝癌先行肝动脉栓塞化疗1～2次，在此基础上行病灶的三维适形放疗（3-dimension comformal radiation therapy，3DCRT），单次剂量2Gy，每日1次，总剂量40～56Gy（平均50．5Gy）。上述治疗开始即配合斯普林注射液10mL／d静脉滴注，连续治疗6～8周。结果：随访6～45个月（中位随访期24个月），随访率97．1％；35例患者中CR5例（14．3％），PR20例（57．1％），NC8例（22．9％），PD2例（5．7％），总有效率（CR＋PR）为71．4％。1、2、3年生存率分别为65．7％、48．6％、31．4%；43．3％（13／30）患者的血清肿瘤标志物（AFP）降至正常；85．7％的患者治疗后生活质量较治疗前明显改善；本组治疗后比治疗前CD3^＋、CD4^＋、CD4^＋／CD8^＋比值升高，CD8^＋明显下降（P〈0．01）。主要毒性反应为胃肠道反应和发热，按WHO的不良反应分级标准均为Ⅰ、Ⅱ级，患者均能顺利完成全部治疗。结论：肝动脉栓塞化疗、三维适形放疗及联合斯普林治疗无手术机会的肝癌患者具有创伤小，安全性高的特点，能提高生活质量，改善自身细胞免疫功能。Objective：To evaluate the safety and effectiveness of transcatheter arterial chemoembolization （TACE） combined with three-dimensional conformal radiotherapy （3DCRT） and Sipulin for the middle and advanced hepatocellular carcinoma. Method：Thirty-five patients with primary hepatocellular carcinoma who were unsuited for the surgery were first given TACE therapy 1 or 2 times. Then the patients were treated with 3 DCRT once daily at 2 Gy/time with total dosage of 40-56 Gy （average 50.5 Gy）. Sipulin was injected ivdrip to these patients simultaneously at 10 mL/day. The combined treatment lasted for about 6-8 weeks. Results： Follow-up lasted for 6 45 months（median follow-up period 24 months） and follow-up ratio was 97.1%. Out of 35 patients,5 patients（14.3%） had complete response（CR）,20 patients （57. 1%） had partial response（PR）,8 patients （22.9%） had no change, and 2 patients （5.7 %） had progressive disease, respectively. The effective rate （CR＋PR） was 71.4%. The overall survival rates were 65.7 %,48.6%,and 31.4 % at 1, 2, and 3 years, respectively. The level of alpha-fetoprotein（AFP） in 13 out of 30 patients （43.3%） decreased to the normal level. Qualities of life of 85.7% patients were obviously improved after treatment. The number of CD3^＋ cells,CD4^＋ cells,and CD4^＋/CD8^＋ ratio markedly increased and the number of CD8^＋ cells markedly decreased after treatment （P〈0.01）. Gastrointestinal reaction and fever were the main treatment-related toxic reactions. Adverse reactions were at Ⅰ and Ⅱ grade according to the standard of WHO. All of the patients completed the whole therapies. Conelusion：TACE combined with 3DCRT and Sipulin caused small lesions and had higher safety in the treatment of patients with primary hepatocellular carcinoma who were unsuited for the surgery. They can increase the qualities of life and improve cell immunity of the patients.

关 键 词：肝肿瘤 抗肿瘤联合化疗方案 化学栓塞 治疗性 放射治疗计划 计算机辅助 受体 抗原 T细胞 肝动脉栓塞化疗 三维适形放疗 斯普林 

分 类 号：R735.7[医药卫生—肿瘤] R730.58[医药卫生—临床医学]