TACE联合TOMO治疗原发性肝癌下腔静脉、右心房癌栓的疗效及安全性  

Efficacy of TACE combined with TOMO in the treatment of liver tumor thrombus in the inferior vena cava and right atrium

作　　者：肖静 欧阳兵 吴毅 郑文涛 李庆东 XIAO Jing;OUYANG Bing;WU Yi;ZHENG Wen-tao;LI Qing-dong(Department of Vascular and Interventional,Chongqing Key Laboratory of Translational Research for Cancer Metastasis and Individualized Treatment,Chongqing University Cancer Hospital,Chongqing 400030,China)

机构地区：[1]重庆大学附属肿瘤医院血管与介入科、肿瘤转移与个体化诊治转化研究重庆市重点实验室,重庆400030

出　　处：《影像诊断与介入放射学》2022年第6期403-410,共8页Diagnostic Imaging & Interventional Radiology

基　　金：重庆市2020年科卫联合医学科研项目(2020MSXM071);北京医学奖励基金会“肿瘤介入科研基金”(YXJL-2020-0972-0434);2022年度重庆市医药生物技术协会科研育苗项目(cmba2022kyym-zkxmQ0010)。

摘　　要：目的评价肝动脉化疗栓塞术(TACE)联合螺旋断层放射治疗系统(TOMO)与单独使用TACE相比,治疗原发性肝癌下腔静脉(IVC)和/或右心房(RA)癌栓的疗效和安全性。方法前瞻性收集2020年8月31日~2021年8月31日诊断为原发性肝癌IVC和/或RA癌栓的84例患者,采用随机数字表法随机分为2组。实验组行TACE联合TOMO放疗治疗(TACE同时栓塞肝脏病灶及癌栓,放疗仅针对癌栓),对照组行TACE治疗(TACE同时栓塞肝脏病灶及癌栓)。对比分析两组治疗原发性肝癌IVC和/或RA癌栓,1个月、3个月客观缓解率(ORR)、疾病控制率(DCR),疾病无进展生存时间(PFS),总生存(OS)率及主要并发症发生率。结果两组的基线特征相似(P均>0.05)。术后1个月ORR(69%比38.1%)、DCR(90.5%比73.8%),3个月ORR(78.6%比21.4%)、DCR(95.2%比59.5%),TACE+TOMO组均明显高于单纯TACE组(P均<0.05)。中位PFS时间TACE+TOMO组高于TACE组(9.9个月比5.0个月,P=0.013)。OS率9个月(90.5%比69.0%,P=0.0021)、12个月(61.9%比23.8%,P<0.0001),TACE+TOMO组显著高于TACE组的患者。两组并发症无明显差别(P>0.05)。结论TACE联合TOMO在治疗原发性肝癌IVC和/或RA癌栓与单独TACE相比,具有更好的短期和长期疗效,安全性可靠。Objective To compare the efficacy of transcatheter arterial chemoembolization(TACE)with and without tomotherapy system(TOMO)in the treatment of inferior vena cava(IVC)and/or right atrium(RA)tumor thrombus in patients with primary hepatocellular carcinoma(HCC).Methods From August 31,2020 to August 31,2021,84 patients with HCC emboli in the IVC and/or RA were randomly divided into 2 groups using the random number table method.Both groups were treated with TACE of the liver lesion and tumor emboli while the experimental group also received TOMO radiotherapy of the emboli.The objective remission rate(ORR)at 1 month and 3 months,disease control rate(DCR),progression-free survival time(PFS),overall survival(OS)rate,and major complication rate were compared and analyzed between the two groups for the treatment of IVC and/or RA tumor emboli.Results Baseline characteristics were similar in both groups(all P>0.05).The TACE+TOMO group had significantly(all P<0.05)higher ORR and DCR at 1 month(69%,90.5%)and 3 months(78.6%,95.2%)than the control group with TACE alone group at 1 month(38.1%,73.8%)and 3 months(21.4%,59.5%)after treatment.The median PFS time(9.9 months)was significantly longer(P=0.013)in the TACE+TOMO group than in the TACE group(5.0 months).OS rates at 9 months(90.5%)and 12 months(61.9%)were also significantly higher(P=0.0021,P<0.0001)in the TACE+TOMO group than that of TACE group(69.0%,23.8%).There was no significant difference in complication rates between the two groups(P>0.05).Conclusion TACE combined with TOMO has better short-term and long-term efficacy than TACE alone in the treatment of IVC and/or RA tumor thrombus in patients with HCC.

关 键 词：原发性肝癌 癌栓 肝动脉化疗栓塞术 放射治疗 

分 类 号：R735.7[医药卫生—肿瘤] R815[医药卫生—临床医学]