伽马刀或三维适形调强放疗联合经皮肝动脉插管化疗栓塞治疗原发性肝癌的疗效观察  

Evaluation and Adverse reaction of γ-Knife or 3D Intensity-modulated Radiation Therapy Combined with TACE for Patients with Liver Carcinoma

作　　者：黄慧[1] 谢从华[1] 龙志雄[1] 

机构地区：[1]武汉大学中南医院肿瘤科,武汉430000

出　　处：《中国肿瘤临床与康复》2013年第2期137-139,共3页Chinese Journal of Clinical Oncology and Rehabilitation

摘　　要：目的探讨γ刀或三维适形调强放疗联合经皮肝动脉插管化疗栓塞(TACE)治疗原发性肝癌的近期疗效和不良反应。方法对2008年4月至2010年9月间69例原发性肝癌患者进行随机分组治疗。69例患者随机分为A、B两组,A组35例患者接受深圳一体医疗科技有限公司生产的月亮神γ刀设计放疗联合TACE治疗,B组34例患者接受瑞典医柯达公司生产的医用电子直线加速器设计三维适形调强放疗联合TACE治疗。两组患者治疗结束后2个月复查肝脏增强CT,根据病灶大小评估疗效。所有患者均先行肝动脉化疗栓塞1次,4周后重复1次,休息2周后再根据分组情况分别行γ刀治疗或三维适形调强放疗。γ刀及三维适形调强放疗具体方法为:在各自的立体定向放疗定位系统下以5mm层厚行CT增强扫描靶区,对所获图像在TPS上进行三维重建,勾画靶区,GTV为影像学上所见肿瘤靶区,PTV在GTV基础上均外扩1cm,修饰解剖学边界。γ刀为50%等剂量曲线包绕病灶,照射剂量为每次3Gy,每周5次,共15次。三维适形调强放疗为90%等剂量曲线包绕肿瘤边缘,照射剂量为每次2.5Gy,每周5次,共28次。结果 A组患者完全缓解(CR)2例(5.7%),部分缓解(PR)20例(57.1%),稳定(SD)8例(22.9%),进展(PD)5例(14.3%),总有效率(RR)为62.9%。B组患者CR 0例(0),PR 19例(55.9%),SD 8例(23.5%),PD 7例(20.6%),RR为55.9%。A组患者6个月、1年生存率分别为82.3%和60.7%,B组患者6个月、1年生存率分别为79.6%和58.1%。两组患者主要不良反应均为骨髓抑制、消化道反应和轻度肝功能损伤,无与治疗相关死亡患者。结论γ刀联合TACE和三维适形调强放疗联合TACE均为治疗原发性肝癌安全、有效的方法。γ刀联合TACE治疗对患者骨髓抑制作用影响更小。Objective To evaluate the therapeutic effect and adverse reaction of γ-knife or 3D in- tensity-modulated radiation therapy combined with TACE for patients with early liver carcinoma. Methods From April 2008 to September 2010, 69 patients with early liver carcinoma were randomly divided into group A and group B. group A were treated with TACE plus γ-knife, group B were treated with TACE plus 3D intensity-modulated radiation therapy. All the patients were treated with TACE firstly, γ-knife or 3D in- tensity-modulated radiation therapy was performed according to the group condition after two times TACE was given. Results CR of group A and group B were 5.7% and 0 respectively, PR were 57.1% and 55.9% respectively, SD were 22.9% and 23.5% respectively, PD were 14. 3% and 20.6% respectively, RR were 62. 9% and 55.9% respectively. The survival rate was 82. 3% in 6 months and 60. 7% in 1 year in group A, 79. 6% and 58.1% in group B respectively. Two groups of major adverse reactions are the bone marrow suppression, reaction of disgestive tract and mild liver damage, no treatment related deaths. Conclusions γ-knife combined with TACE and 3D intensity-modulated radiation therapy combined with TACE for treatment of primary liver cancer was safe, effective. γ-knife combined with TACE on bone marrow suppres- sion effect was less.

关 键 词：Γ刀 三维适形调强放疗 原发性肝癌 经导管动脉化学栓塞 

分 类 号：R735.7[医药卫生—肿瘤]