肝动脉栓塞化疗联合三维适形放疗治疗局部晚期原发性肝癌的影像学观察

A study of transcatheter arterial chemoembolization (TACE) combined with three-dimensional conformal radiotherapy (3DCRT) in local advanced primary liver cancer (PLC)

目的结合影像学观察肝动脉栓塞化疗(TACE)联合三维适形放疗(3DCRT)治疗局部晚期原发性肝癌的疗效,探讨与预后相关的因素。方法 60例不能手术切除的局部晚期原发性肝癌(PLC)患者随机分为TACE组联合3DCRT(实验组)及单纯TACE(对照组);实验组行TACE2～3次后,再予三维适形放疗,靶区剂量范围36～54Gy;对照组仅给予TACE3次。术后1月随访复查CT,确定肿块的退缩情况,评价肿瘤近期有效率及1、2、3年生存率。结果客观缓解率(CR+PR)实验组为66.7%好于对照组的36.7%,两组差异有统计学意义(P<0.05);实验组治疗结束后100.0%AFP下降,对照组TACE后76.0%下降,两组差异有统计学意义,P﹤0.05;1、2、3年生存率实验组分别是76.7%、43.3%、26.7%,中位生存时间21个月;对照组分别是60.0%、30.0%、13.3%,中位生存时间13个月。结论 TACE联合3DCRT疗效优于单纯TACE,TACE联合3DCRT副反应小,绝大多数病人能耐受,可作为局部晚期原发性肝癌非手术治疗的有效治疗方法。

Objective To evaluate the therapeutic effect of 3-dimentional conformalradiotherapy (3DCRT)combined with transcather arterial chemoembolization (TACE) and investigate the factors affecting prognosis in patients with late stage primary liver cancer (PLC).Methods 60 cases of unresectable PLC were divided into 2 groups.The former group were treated with TACE for 2～3 times,and then sequentially with 3DCRT,received a total dose of 36～54 Gy.The other group only treated with TACE.By computed tomography (CT) or type-B ultrasonic (BU)T,the therapeutic effects and overall survival rate were studied as the adverse reactions and the cause of death were analysied.Results The (CR+PR)response rate were 66.7% in the former group and 36.7% in the latter group (P<0.025).The percentage of AFP declined was 100% in the former,76.0% in the latter(P<0.05).The overall 1-,2-,3-year survival rate was 76.7%,43.3%,26.7% in former and 60.0%,30.0%,13.3% in the latter respectively.The median survival time was 21 months as 13months.Conclusion The total effective rate of treatment of late stage PLC with TACE combined with 3DCRT is significantly higher than the group only received TACE.3DCRT Combinaton of TACE is an more effective,safeted and favored approach for unresettable liver carcinoma.