放射性肝病影响因素及肝脏放射耐受剂量的研究  

Radiation-induced liver disease:Risk factors and liver irradiation tolerance

作　　者：梁世雄[1] 蒋国梁[2] 朱小东[1] 傅小龙[2] 杨云利[1] 徐志勇[2] 朱骥[2] 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,上海200031

出　　处：《癌症进展》2006年第4期308-313,共6页Oncology Progress

基　　金：卫生部临床学科重点科研项目资助(2004-826);广西医科大学博士启动基金(304153)

摘　　要：目的探讨PLC三维适形放射治疗(3DCRT)后放射性肝病(RILD)的影响因素,以指导PLC的3DCRT,避免和减少RILD的发生。方法采用8MVX线直线加速器对109例原发性肝癌(PLC)患者进行3DCRT。UICCAJCCT3期65例,T4期44例。B超或CT提示有门脉癌栓者28例。根据肝硬化Child-Pugh分级,A级93例,B级16例。肿瘤剂量54Gy(38～68Gy),每次分割剂量4.6Gy(4～6Gy),每周3次,隔日1次。肝脏耐受剂量应用Logistic模型和ROC曲线进行估计。结果所有患者3DCRT治疗后中位随访时间12个月(1～52个月),RILD发生率为16%(17109)。T分期、GTV、门脉癌栓(PVT)、肝硬化分级和肝动脉化疗栓塞治疗(TACE)与RILD的发生有关(P=0.006、0.036、0.037、0.000和0.017),肝硬化分级是独立的影响因子(P=0.000)。16例肝硬化Child-PughB级患者中发生RILD9例,发生率916(56%),无法找出与RILD发生相关的剂量学因素。93例Child-PughA患者中,发生RILD的正常肝平均剂量(MDTNL)(24.9Gy±3.9Gy)和不发生RILD患者(19.9Gy±5.4Gy),有显著性差异(P=0.008)。经剂量学分析,23Gy可能是MDTNL的耐受剂量。V586%,V1068%,V1559%,V2049%,V2535%,V3028%,V3525%,和V4020%可能是DVH中的耐受剂量。结论肝硬化Child-Pugh分级是影响RILD的主要因素,Child-PughA级患者比B级患者有更好的放射耐受性。MDTNL23Gy。对于肝硬化,上述3DCRT方法需改进,以减少RILD的发生。Background ＆ Objective Radiation- induced liver disease （BILD） has been considered the most severe complication in liver irradiation. The purpose of the current study was to identify the risk factors relevant to RILD and to find out hepatic radiation tolerance in 3 - dimensional conformal radiation therapy （3DCRT） for primary liver carcinoma （PLC）. Methods Between August 2000 and November 2004, 109 PLC patients treated with 3DCRT were accrued in this study. There were 65 cases of T3 and 44 cases of T4 without lymph node or distant metastases. The median age was 47 years （23 - 72）, and males predominated, with a ratio of 99 men to 10 women. Portal vein thrombosis （PVT） was detected in 28 patients （26%）. The liver cancer in 93 patients （85%） was associated with hepatic cirrhosis of Child- Pugh grade A, and 16 patients （15%）, grade B. A median dose of 54Gy （38 - 68） was delivered to the PLC by hypofractionated irradiation （three fractions per week） with a median fraction size of 4.6Gy （4- 6）. Liver radiation tolerance was estimated by Logistic model and receiver operating characteristic （ROC） curve. Results The median follow- up time was 14 months （ 1 - 52） after the completion of 3DCRT. 17 （ 16% ） patients were diagnosed as RILD. By univariate analysis of clinical characteristics, T stage, gross tumor volume （GTV）, PVT, cirrhosis of Child - Pugh grade B and TACE showed significant correlation with RILD （ P = 0.006, 0.036, 0.037, 0.000 and 0.017, respectively）. Multivariate analyses demonstrated that severity of hepatic cirrhosis was a unique independent predictor （ P = 0.000）. Because of the small number of patients with Child - Pugh B, analyses for liver radiation tolerance were carried out only for 93 Child - Pugh grade A patients. Moreover, patients with RILl） received a higher mean dose to normal liver （MDTNL） （24.9Gy ± 3.9Gy）, compared to patients with no RILD （ 19.9Gy ± 5.4Gy） （ P = 0.008）. From dosimetric studies, MDTN

关 键 词：肝肿瘤/放射疗法 三维适形放射治疗 放射性肝病 LOGISTIC回归 

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