伽马刀治疗22例巨块型原发性肝癌临床观察  

Gamma-knife treatment of 22 patients with huge hepatocellular carcinoma

作　　者：杨远游[1] 程海明[1] 宁健[1] 穆晓峰[1] 

机构地区：[1]武警总医院肿瘤放疗中心,北京100039

出　　处：《现代肿瘤医学》2015年第16期2344-2347,共4页Journal of Modern Oncology

摘　　要：目的:分析伽马刀治疗巨块型原发性肝癌的疗效及预后因素。方法:2005年8月至2012年4月22例巨块型肝癌行伽马刀治疗,以40%-60%等剂量曲线为处方剂量线,中位剂量42Gy(范围30-50Gy),3-5Gy/次,9-13次完成。靶区为肝内病灶包括或不包括门脉癌栓。治疗后每1-3个月行血液和影像学检查(CT或MRI)。随访时间3-36个月,2013年9月结束。结果:总生存期3-36个月,中位生存期6.5个月,1-3年生存率分别为31.8%、22.7%、4.5%,有效率68.2%(CR 3例,PR 12例,SD 6例,PD 1例)。5例出现RTOG标准III级晚期放射性肝损伤。Kanplan-meier单因素分析显示AFP(P=0.002)、等效生物剂量(P=0.002)的生存差异有统计学意义(AFP<1171ng/ml好于≥1171ng/ml,≥60Gy好于<60Gy);COX多因素分析显示等效生物剂量是有意义的预后影响因素(P=0.009)。结论:伽马刀治疗为巨块型肝癌可选方式之一,巨块型肝癌仍应给予足够剂量以改善肿瘤局控率和预后。Objective： To analyze the effectiveness and prognostic factor of Gamma-knife treatment huge hepatocellular carcinoma. Methods： From August 2005 to April 2012,22 patients with huge hepatocellular carcinoma were treated by Gamma-knife. A 42 Gy median dose（ range： 30-50Gy） were prescribed to 40%-60% isodose line and performed in 9-13 fraction of 3-5Gy each. The target included primary tumor with or without vien thrombosis. Blood and imaging（ CT or MRI） were tested every 1-3 months after treatment. Follow-up time was 3-36 months and ended in Sep. 2013. Results： Survival period was 3-36 months with a median survival time of 6. 5 months. Survival rate of 1-3 years were respectively 31. 8%,22. 7%,4. 5%. Response rate was 68. 2%（ CR 3 cases,PR 12 cases,SD 6cases,PD 1 case）. 5 cases appeared late RTOG standard grade III radioactive liver injury. Kanplan-meier univariate analysis showed that the difference of survival in AFP（ P = 0. 002） and equivalent biological dose（ P = 0. 002） were statistically significant（ AFP 1171 ng/ml is better than ≥1171ng/ml,≥60Gy is better than 60Gy）. The COX multivariate regression analysis showed that equivalent biological dose was significant prognostic factor（ P = 0. 009）.Conclusion： Gamma-knife treatment is one of optional treatment ways for huge hepatocellular carcinoma. Patients with huge hepatocellular carcinoma still need to be given adequate dose to improve local tumor control rate and prognosis.

关 键 词：巨块型原发性肝癌 伽马刀 疗效 预后因素 

分 类 号：R735.7[医药卫生—肿瘤]