沙利度胺联合TACE序贯适形放疗治疗原发性肝癌的疗效  

Effect of advanced hepatocellular carcinoma treated by conformal radiotherapy after thalidomide combined with trancather arterial chemoembolization

作　　者：叶祯开[1] 卢耀振[1] 龙江珍[1] 陈艳[1] 

机构地区：[1]广西壮族自治区民族医院放疗科,广西南宁530001

出　　处：《现代肿瘤医学》2013年第10期2276-2279,共4页Journal of Modern Oncology

摘　　要：目的:评价沙利度胺联合肝动脉栓塞化疗(trancather arterial chemoembolization,TACE)序贯适形放疗治疗原发性肝癌的疗效。方法:符合入组条件的中晚期肝癌患者77例随机分为治疗组(A组)38例和对照组(B组)39例,A组为沙利度胺联合TACE序贯适形放疗。沙利度胺:口服剂量为200mg/d,同时联合TACE,TACE用药选用吉西他滨0.8-1.4g,栓塞剂选用碘化油、明胶海绵。4周后如无放疗禁忌症,行肝部肿瘤立体定向适形放疗,分割剂量为3.0-5.0Gy,50%等剂量线包绕P-GTV,边缘剂量30-40Gy。放疗结束后继续予沙利度胺维持治疗,维持量达(200-300)mg/d,服药至少3个月以上。B组单纯行TACE序贯适形放疗,方案及剂量同上。结果:近期疗效两组无完全缓解(CR)病例。A组有效率为51.6%;B组有效率为43.8%,两组差异无显著性(P>0.05)。A组和B组患者的中位生存期分别为17个月、14个月,A组半年、1年、2年生存率分别为93.5%、61.3%、22.6%;B组半年、1年、2年生存率分别为87.5%、59.3%、15.6%。口服沙利度胺3个月以上患者与对照组病例相比,生存期有显著性差异(P<0.05)。放疗联合TACE、口服沙利度胺组,与未接受放疗患者相比,其生存期有显著性差异(P<0.05)。治疗组严重皮疹发生率为5.3%,严重嗜睡、头晕发生率为10.5%。结论:沙利度胺联合TACE序贯适形放疗治疗原发性肝癌能延长患者生存期,适形放疗有可能在综合治疗肝癌中发挥重要作用。Objective：To evaluate the efficacy of advanced hepatocellular carcinoma（HCC） treated by conformal radiotherapy after thalidomide combined with traneather arterial chemoembolization （ TACE ）. Methods ： All 77 paiients with unreseetable primary HCC were randomized into treatment group （eonformal radiotherapy after thalidomide plus TACE：A group） and control group （conformal radiotherapy after TACE：B group）. Treatment group received oral ad- ministration of thalidomide （ 200 - 300） mg/d for over 3 months. At the same time, TACE was treated with 0.8 - 1.4g gemcitabine as chemotherapeutic drugs, and iodolipol as ambolic agent. If no contraindication of radiotherapy,the pa- tients received stereotactie eonformal radiotherapy with margin dose of 30 - 40Gy, at （ 3 - 5 ） Gy/F, after passed 4 week. Results ： The overall response rate was 51.6 percent （ no complete response case） in the treatment group and 43.8 per- cent（ no complete response ease）in the control group（ P 〉0.05 ）. The median survival period was 17 months in the treatment group and 14 months in the control group. The 6 - month, 1 - year and 2 - year survival rates were 93.5% , 61.3% and 22.6% respectively in the treatment group,and 87.5% ,59.3% and 15.6% respectively in the control group. Excluding the patients who took thalidomide for less than 3 months, the median survival period was significantly longer in the treatment group than in the control group（21 months vs 14 months ,P 〈0.05 ）. The median survival peri- od of the patients who did not received stereotactic conformal radiotherapy was significantly shorter than received one （7 months vs 16 months, P 〈 0.05 ）. The occurrence rate of serious rashes was 5.3 % and that of serious both somno- lency and dizziness was 10.5%. Conclusion：Compared with eonformal radiotherapy after TACE,eonformal radiother- apy after thalidomide plus TACE can obviously prolong survival of HCC patients,it was more important for conformal radiotherapy in HCC patients who

关 键 词：肝肿瘤 化疗栓塞 适形放疗 沙利度胺 疗效 

分 类 号：R735.7[医药卫生—肿瘤]