体部伽玛刀与高强度聚焦超声治疗原发性肝癌门静脉癌栓的临床观察  

Body gamma knife and high intensity focused ultrasound (HIFU) for the treatment of portal vein tumor thrombosis of hepatocellular carcinoma

作　　者：党亚正[1] 张学成 陆婉玲[1] 吴发伟[1] 雷续虎[1] 蔡永胜[1] 刘军[1] 李明月[1] 

机构地区：[1]中国人民解放军第323医院肿瘤中心,陕西西安710054 [2]长安医院肿瘤中心,陕西西安710016

出　　处：《现代肿瘤医学》2010年第1期114-117,共4页Journal of Modern Oncology

摘　　要：目的:比较体部伽玛刀与高强度聚焦超声(high intensity focused ultrasound HIFU)治疗门静脉癌栓(portal vein tumor thrombosis PVTT)的有效性,探讨其临床应用价值。方法:2006年6月至2008年6月的原发性晚期肝癌合并门静脉癌栓的患者分为两组,38例采用体部伽玛刀治疗,计划设计3-10个靶点,单次剂量3-6Gy,2-5F/wk,照射总量30-50Gy。治疗计划中≥50%的等剂量曲线包绕计划靶区(PTV)。40例采用高强度聚焦超声治疗,对门静脉主干或(和)第1级分支内癌栓进行HIFU治疗3-7次,观察治疗后门静脉癌栓的变化、肝功能腹水的改善及患者的生存情况。结果:治疗后1月评价疗效,伽玛刀组癌栓完全消失(CR)8例(21.1%),部分缓解(PR)10例(26.3%),无变化(NC)20例(52.6%);HIFU组完全消失7例(17.5%),部分缓解14例(35.0%),无变化19例(47.5%)。两组总有效率(CR+PR)比较无显著差异性(P=0.702)。治疗后两组患者肝功能和腹水均有不同程度的改善。随访时间6-30个月,伽玛刀组死亡19例,中位生存期11个月;HIFU组死亡22例,中位生存期10个月。结论:体部伽玛刀与HIFU治疗门静脉癌栓疗效相似,均安全、无创伤、痛苦小。Objective： To evaluate the efficacy and clinical value of body gamma knife or high intensity focused ultrasound for the treatment of patients with hepatocellular carcinoma who have portal vein tumor thrombosis （PVTT）. Methods： Between June,2006 and June,2008,78 patients with PvTr in hepatocellular carcinoma were treated in our department. They were divided into 2 groups, one was treated with body gamma knife （ Gamma knife group） （38 cases）, another was treated with high intensity focused ultrasound （HIFU group） （40 cases）. For Gamma knife group, planning of treatment from 3 to 10 dots ,3 -6Gy per -fraction ,2 -5 times per week, and the total treatment doses was 30 -50Gy. ≥50% isodose include PTV. Average dose of liver 〈 25Gy, V30Gy 〈 30%. For HIFU group,51 PVTT portal veins and main branches ,were treated with HIFU, and the changes in the blood flow of PVTT embolized portal vein, echo and the size of tumor thrombi, function of liver, ascites and survive were observed. Results： Of the 38 patients who received gamma knife ,8 （21.1%） showed complete disappearance of tumor thrombi, 10 （26.3%） were in partial remission ,and 20 （52.6%） were no change after 1 month from the end of the therapy. In the HIFU group, 7 （17.5%） were in complete disappearance, 14 （35.0%） were in partial remission, and 19 （47.5%） were no change. There was no significant difference between two groups （P = 0. 702）for response rates. The median followed - up was 15 months,19 cases died in Gamma knife group and 22 cases in HIFU group. The median survival were 11 and 10 months, respectively. The improvements of liver function and ascites in varying degrees were observed in all patients. Conclusion： Body gamma knife and HIFU are same effective in treatment of patients with PVTT and they are all safe,less painful and noninvasive.

关 键 词：原发性肝癌 门静脉癌栓 体部伽玛刀 高强度聚焦超声 

分 类 号：R735.7[医药卫生—肿瘤]