伽玛刀联合肝动脉栓塞化疗治疗原发性肝癌的疗效观察  

Effects of gamma knife stereotaxis radiation therapy combined with transcatheter arterial chemoembolization on patients with advanced unresectable hepatocellular carcinoma

作　　者：吴发伟[1] 张学成 党亚正[1] 李明月[1] 雷续虎[1] 程才[1] 王孝明[1] 

机构地区：[1]解放军第三二三医院肿瘤治疗中心,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119-122,共4页Journal of Modern Oncology

摘　　要：目的:观察全身伽玛刀联合肝动脉栓塞化疗(TACE)治疗原发性肝癌的疗效及不良反应。方法:32例原发性肝癌患者,16例行全身伽玛刀联合TACE治疗(综合组)。TACE灌注化疗药物为:丝裂霉素(MMC)10-20mg,氟尿嘧啶(5-FU)1000-1500mg,表阿霉素(E-ADM)30-50mg,栓塞剂为40%超液态碘化油5-20ml。经TACE1-2次治疗后,应用SGS-I型立体定向伽玛射线旋转聚焦全身放射治疗系统放疗,40%-60%等剂量线包绕PTV,单次剂量3-6Gy,3-5次/wk,照射总量30-50Gy。16例单行全身伽玛刀治疗(观察组)。结果:综合组总有效率(CR+PR)75.0%(12/16),观察组为56.3%(9/16)。两组差异有显著性意义(P<0.005)。综合组1年、2年生存率分别为70.2%和41.6%,观察组为58.6%和27.3%,1年、2年生存率差异均有显著性(P<0.05)。两组患者均未见到放射诱发的肝病。结论:伽玛刀联合TACE治疗原发性肝癌安全可靠,并能提高疗效,不增加不良反应。Objective：To eveluate effects of body gamma knife stereotaxis radiation therapy combined with transcatheter arterial chemoembolization （TACE） on patients with advanced unresectable hepatocellular carcinoma. Methods： Sixteen patients were treated by gamma knife and TACE （Combined group）. For gamma knife stereotaxis radiation therapy, planning of treatment from 3 to 10 dots, 3 - 6Gy per - fraction, 2 - 5 times per week, and the total treatment dose was 30 -50Gy. ≥50% isodose include PTV. Average dose of liver 〈 25Gy, V30Gy 〈 30%. For TACE, 20 mg mitomycin C, 1000 - 1500 mg 5 - fluorouracil and 60 - 80 mg cisplatin were perfused into the hepatic arteries, 10 -20 ml iodized oil were given to emobolized the hepatic arteries, and each patient was treated with 1 -2 sessions. Sixteen patients were treated only by gamma knife （ Gamma knife group）. Results： The response rates （ CR ＋ PR） were 75.0% （12/16） and 56.3% for Combined group and Gamma knife group,the difference of the response rate was statistically significant（P 〈 0.005）. For Combined group , the 1 and 2 year survival rates were 70.2% and 41.6% respectively, and for Gamma knife group, they were 58.6% and 27.3% respectively. The differences were statistically significant for 1 and 2 year survival rates（P 〈 0.05 ）. Conclusion： Gamma knife combined with TACE is an effective approach in the treatment of advanced unresectable hepatocellular carcinoma.

关 键 词：原发性肝癌 全身伽玛刀 介入栓塞化疗 

分 类 号：R735.7[医药卫生—肿瘤]