三维立体适形放射治疗联合肝动脉化疗栓塞治疗肝细胞性肝癌的临床研究  

Three-dimensional conformal radiotherapy combined with transcatheter arterial chemoembolization for hepatocellular carcinoma

作　　者：武玉国[1] 杨玉斌 安金森 武永梅 

机构地区：[1]新泰市人民医院肿瘤科,山东新泰271200 [2]新泰市天宝中心卫生院,山东新泰271200

出　　处：《中华肿瘤防治杂志》2006年第21期1651-1654,共4页Chinese Journal of Cancer Prevention and Treatment

摘　　要：目的:观察三维立体适形放射治疗(3DCRT)联合肝动脉化疗栓塞(TACE)治疗肝细胞性肝癌(HCC)的疗效和患者的耐受性。方法:46例HCC患者,先采用TACE治疗1～3次,再进行3DCRT。2Gy/次,1次/d,5d/周。肿瘤剂量30～54Gy,总疗程3～6个周。结果:46例患者中,部分缓解8例,稳定35例,进展3例。全组患者中位生存时间16个月,1、2、3年生存率分别为60.9%、39.1%和28.3%。1、2、3年局部控制率分别为73.9%、56.5%和39.1%。1、2、3年远处转移率分别为15.2%、21.7%和34.8%。单因素分析表明,T分期、广州会议分期、门脉癌栓、放疗前肝硬化Child-Pugh分级和肿瘤照射剂量对生存率的影响差异有统计学意义。COX多因素分析显示,肿瘤照射剂量和肝硬化Child-Pugh分级是HCC患者预后的独立影响因素。5例患者发生急性肝脏毒副反应,1级2例,3级3例。3例出现1级上消化道急性损伤,其中1例出现轻度上消化道出血。10例出现1或2级外周血白细胞降低。2例出现放射性肝病。结论:3DCRT联合TACE综合治疗HCC安全、有效,值得进一步研究。OBJECTIVE： To evaluate the response and tolerance in hepatocellular carcinoma （HCC） patients treated by three-dimensional conformal radiotherapy （3DCRT） combined with transcatheter arterial chemoembolization（TACE）. METHODS： Fourty-six HCC patients confirmed by cytology or histology were studied. All patients underwent TACE 1 to 3 courses. Then they received 3DCRT after an interval of about one month. 3DCRT was given with the field covering the tumor with a generous margin 6 MV Xray. The total dose was 30-54 Gy,in 2 Gy fractions daily. RESULTS： Partial response was observed in 8 （17.4%） patients. Stable disease and progressive disease was observed in 35 （76.1%） patients and 3 （6.5%） patients, respectively. No complete response was observed at the time of the response evaluation. The overall survival rates at 1-,2-and 3-year were 60.9% ,39. 1%and 28.3% ,respectively,with a median survival period of 16 months. The 1-, 2-and 3-year local progression-free rates were 73.9%, 56.5% and 39.1%, respectively. The 1-,2- and 3-year distant metastasis rates were 15.2%, 21.7% and 34.8%. Univariate analysis showed that favorable prognostic predictors for survival were： T3 stage, CACA 2001 stage Ⅰ, absence of portal thrombosis,Child-Pugh grade A and irradiation does of 〉45 Gy. Irradia- tion dose and liver cirrhosis were identified by COX-regression analysis as independent predictors for survival. Two patients experienced CTC grade 1 acute hepatic toxicity and throe patients grade 3 acute hepatic toxicity. Two patients developed RILD. Three patients experienced RTOG grade Ⅰ acute gastrointestinal complication and one patient acute gastrointestinal bleeding. Five patients experienced RTOG grade 1 leucopenia, and five patients grade 2 leucopenia. CONCLUSION： 3DCRT combined with TACE is safe and effective for HCC. It is worthy of a further dose escalation study.

关 键 词：肝肿瘤/放射疗法 立体定位技术 化学栓塞 治疗性 

分 类 号：R735.7[医药卫生—肿瘤]