光放射立体定向治疗联合肝动脉灌注化疗栓塞治疗大肝癌的临床研究

A Clinical Study on Laser Radiation Stereotactic Treament Combined with Transarterial Chemoembolization for Huge Hepatocellular Carcinomas

探讨光放射立体定向治疗联合肝动脉化疗栓塞(TACE)治疗大肝癌(≥10cm)的安全性和有效性。2006年5月至2013年6月我院收治的不能手术的77例大肝癌患者,患者均在行不完全的肝动脉化疗栓塞术后给予光放射立体定向治疗。平均照射总剂量35.6Gy,50%至55%等剂量曲线覆盖靶区,分次剂量2.6至3.0Gy,每日治疗1次,连续治疗6天后休息1天,总疗程12至14次结束。患者分组方式:肿瘤有包膜的为A组,35例,肿瘤无包膜的为B组42例。治疗结束后4周复查CT或MRI评价近期疗效,其后每1至3个月复查1次评估远期疗效及不良反应。77例患者中达到完全缓解(CR)7例(9.1%),部分缓解(PR)54例(70.1%),稳定(SD)10例(13.0%),进展(PD)6例(7.8%),总反应率(CR+PR)79.2%,中位平均随访17个月。总的1年、3年、5年生存率分别为39.0%、13.0%、2.6%,中位生存时间11.6个月(A组分别为57.1%,22.9%,5.7%,中位生存时间18.3个月;B组分别为23.8%、4.8%、0%,中位生存时间10.8个月(P=0.023))。治疗耐受良好,没有严重的放射诱发的肝病和3级以上的不良反应。肿瘤是否具有包膜是影响生存的预后因素。光放射立体定向治疗联合肝动脉化疗栓塞治疗不可手术切除的大肝癌是一种安全有效的治疗手段,值得临床推广。

To evaluate the safety and efficacy of Laser radiation stereotactic treament combined with transarterial chemoembolization( TACE) for huge( ≥10cm) hepatocellular carcinomas( HCCs). Between May,2006 and Jun,2013,77 patients with unresectable huge HCCs were treated by Laser radiation stereotactic treament following incomplete TACE. The median total dose of 35. 6Gy was delivered over 12-14 days with a fractional dose of 2. 6-3. 0Gy and6 fractions per week. Dose prescription was normalized at 50% or 55% isodose curve. The patients were classified into those with tumor encapsulation( group A,n = 35) and those without tumor encapsulation( group B,n = 42). Tumor response within the radiotherapy field was based on CT and / or MRI scans 4 weeks after the completion of the treatment and at 1- to 3-month intervals thereafter. Among the 77 patients,CR,PR,SD and PD were achieved in 7( 9. 1%),54( 70. 1%),10( 13. 0%) and 6 patients( 7. 8%),respectively,within a median follow-up of 17 months. The objective response rate was 79. 2%. The overall cumulative 1-,3- and 5-year survival rates and the median survival time were 39. 0, 13. 0 and 2. 6% and 11. 6 months,respectively. In group A,the overall cumulative 1-,3-and 5-year survival rates were 57. 1,22. 9 and 5. 7%,respectively,with a median survival of 18. 3 months; In group B,the overall cumulative 1-,3- and 5-year survival rates were 23. 8,4. 8 and 0%,respectively,with a median survival of 10. 8 months( P = 0. 023). The treatment was well tolerated,with no severe radiation-induced liver disease and no reported > grade 3 toxicity. Tumor encapsulation was found to be a significant prognostic factor for survival. The combination of Laser radiation stereotactic treament and TACE was shown to be a safe and effective treatment option for patients with unresectable huge HCC.