体部伽玛刀联合热化疗治疗中晚期肝癌25例临床观察  

Effect of combined body gamma-knife radiotherapy and thermotherapy on intermediate or advanced hepatocellular carcinoma in 25 patients

作　　者：刘永新[1] 张建宇[1] 山顺林[1] 

机构地区：[1]中国人民解放军第82医院肿瘤治疗中心,江苏淮安223001

出　　处：《军医进修学院学报》2010年第4期322-323,共2页Academic Journal of Pla Postgraduate Medical School

摘　　要：目的探讨利用体部伽玛刀联合全身热化疗和微量泵化疗对中晚期原发性肝癌进行综合治疗的疗效。方法入院后经检查无全身热疗及化疗禁忌症晚期肝癌患者25例,全身热疗时予氟尿嘧啶1g、羟基喜树碱10mg、奥沙利铂100mg;以后予奥沙利铂100mg/d,8d,静脉滴注;热化疗后第2d起予氟尿嘧啶0.25g/d,14d;羟基喜树碱2mg/d,9d。热化疗3d后进行体部伽玛刀治疗,50～65%的等剂量曲线包绕计划靶区PTV,单次剂量3.2～4.0Gy,10～12次,总剂量为36～44Gy。其中化疗泵治疗间隔2周重复,共4～6周期;全身热疗1～3次,于每次化疗第1天进行。热化疗及伽玛刀治疗结束后分别观察不良反应和近期疗效。结果部分缓解(PR)20例;1年局部病变无进展率为56%(14/25)。1年生存率为76%(19/25),2年生存率40%(10/25)。全身热疗中6例出现下肢或腹部局部皮肤红斑,2例出现小水泡;肝脏急性不良反应Ⅰ级1例。结论伽玛刀联合全身热化疗治疗肝细胞癌安全可靠,有利于提高疗效。Objective To study the curative effect of combined body gamma-knife radiotherapy and whole body thermotherapy and micro-infusion pump chemotherapy on intermediate or advanced hepatocellular carcinoma （HCC）. Methods Twenty-five intermediate or advanced HCC patients with no contraindications for thermotherapy were included in the study. The patients were given 5-fluorouracil （1.0g）, hydroxycamptothecin （10mg）, and oxaliplatin （100mg） during thermotherapy, followed by intravenous oxaliplatin （100mg） on day 8. Two days later, the patients were given 5-fluorouracil （0.25g a day for 14 days） and hydroxycamptothecin （2mg a day for 9 days） through a micro-infusion pump. Body gamma-knife radiotherapy was performed 3 days after thermotherapy at a single dosage of 3.2-4.0Gy and a total dose of 36-44Gy according to the 50%-65% isodose line covering planning target volume. Chemotherapy was performed every two weeks, 4-6 weeks as a cycle. Thermotherapy was performed 1-3 times, once a month, on day 1 after chemotherapy. The toxicity, adverse reaction and short-term curative effect were observed after thermotherapy and body gamma-knife radiotherapy. Results Improvement was achieved in 22 patients, and the 1-year local lesion progression-free rate was 56% （14/25）. The 1- and 2-year survival rate was 76% （19/25） and 40% （10/25）, respectively. Local skin erythema on the lower limbs and abdomen, vesicles on skin and grade 1 acute adverse reaction occurred in 6, 2, and 1 patient, respectively, during the whole body thermotherapy. Conclusion Combined Body gamma-knife radiotherapy in combination with whole body thermotherapy and chemotherapy for HCC is safe and effective.

关 键 词：肝肿瘤 抗肿瘤联合化疗方案 透热疗法 放射疗法 

分 类 号：R815[医药卫生—放射医学]