伴门静脉癌栓肝癌的不同靶区适形放疗临床分析  

Therapeutic effects of the different gross tumor volume three-dimensional conformal radiotherapy for portal vein tumor thrombus in patients with hepatocellular carcinoma

作　　者：房彤[1] 高宏[1] 封国生[1] 陈力[1] 孙保锦[1] 刘丽[2] 

机构地区：[1]北京世纪坛医院肿瘤中心,100038 [2]内蒙古医学院附属人民医院

出　　处：《中华放射医学与防护杂志》2007年第4期343-345,共3页Chinese Journal of Radiological Medicine and Protection

摘　　要：目的比较原发性肝癌伴门静脉癌栓不同肿瘤靶区三维适形放射治疗联合介入的临床疗效。方法30例原发性肝癌伴门静脉癌栓患者，采用三维适形放射治疗联合肝动脉化疗栓塞（TACE）进行治疗，根据肿瘤靶区分为2组：肿瘤靶区包括肝内原发肿瘤＋静脉癌栓者为A组（15例），肿瘤靶区只包括静脉癌栓而不包括肝原发灶者为B组（15例）。2组病例均于TACE 1～2次后开始放疗。结果A、B两组治疗有效率分别为33．3％和53．3％，1、2年生存率分别为26．7％、6．7％和40．0％、13．3％，两组差异均无统计学意义（P〉0．05）。A组放射反应发生率明显高于B组（P〈0．05）。结论对于晚期肝癌伴门静脉癌栓，特别是肝内多发或大病灶、肝功能差的患者，在联合TACE有效治疗下，对静脉癌栓的局部放射治疗仍能取得较好疗效。Objective To analyze the clinical efficacy of 3-dimensional conformal radiotherapy（3DCRT） combined with intervention of the different gross tumor volume （GTV） and transcatheter arterial chemoembolization （TACE） for portal vein tumor thrombus（PVTT） in hepatocellular carcinoma. Methods 30 patients with unresectable hepatocellular carcinoma complicated with tumor thrombus in the portal vein were enrolled into the study from March 2002 to January 2005. All patients were randomly divided into two groups ： group A including 15 cases with the gross tumor volume included intrahepatic tumor and portal vein tumor thrombus, Group B including 15 cases with the gross tumor volume defined as only PVTT. Intrahepatic tumor was not involved in the GTV. RT was started 1-2 factions following TACE. Results The effective rates in group A and group B were 33.3% and 53.3%, respectively （P 〉 0.05）. Survival rates at 1st and 2nd years were 26.7% , 6.7% in group A and 40.0%, 13.3% in group B, respectively （ P 〉 0.05）. Radiation toxicity was significantly more frequent in group A than that of group B （ P 〈 0.05）. Conclusions 3DCRT combined with TACE is an effective method for treatment of portal vein tumor thrombus in hepatocellular carcinoma, especially those patients with intrahepatic tumor of multiple or massive and poor liver function. The combined therapy may improve the quality of patient＇ s life and lower the incidence of toxicity.

关 键 词：原发性肝癌 门静脉癌栓 三维适形放疗 肝动脉化疗栓塞 

分 类 号：R735[医药卫生—肿瘤]