原发性肝癌切除术前应用立体定向适形放疗的价值

THE VALUE OF PREOPERATIVE STEREOTACTIC CONFORMAL RADIOTHERAPY IN TREATMENT OF PRIMARY LIVER CANCER

目的 探讨立体定向适形放疗对原发性肝癌的治疗效果及其术前应用的价值。方法 1 998年 5月至 2 0 0 1年 1 0月 ,2 5例肝癌行术前短程大剂量立体定向适形放疗 2周后手术切除 ,与同期单纯手术切除的病例对照 ,进行病理、肝功能、血常规、AFP、术中出血量、术后复发率及生存率的分析研究。结果 立体定向适形放疗能有效杀灭肿瘤细胞 ,导致癌周小血管、淋巴管闭塞及纤维机化带形成 ,显著缩小肿瘤体积 (P<0 .0 1 ) ,减少术中出血量 (P<0 .0 5 ) ,提高术后近期 AFP转阴率 (P<0 .0 1 ) ,降低术后 1年复发率 (P<0 .0 1 ) ,提高术后 2年生存率 (P<0 .0 1 )。同时 ,没有严重副作用。 结论 立体定向适形放疗是治疗肝癌的有效手段 ,术前短程大剂量冲击放疗可以提高手术切除率 ,改善预后 。

Objective To discuss the therapeutical effect of stereotactic conformal radiotherapy on primary liver cancer and its value in preoperative application.Methods From May 1998 to October 2001,25 PLC patients were performed hepatectomy two weeks after preoperative short time high dose stereotactic conformal radiotherapy,contrasted with 25 patients only performed hepatectomy in the corresponding period.The data including postoperative pathology,liver function,blood routine,AFP,intraoperative bleeding volume,postoperative recurrence rate and survival rate were analysed.Result Sterotactic conformal radiotherapy can destroied tumor cells effectively,resulted in the formation of fiber organixation zone and obliteration of small blood vessel and lymphatic vessel surrounding tumor tissue.It also reduced tumor volume( P <0.01) and intraoperative blood loss ( P <0.05),increased postoperative AFP trans negative rate in a short time( P <0.01),decreased postoperative one year recurrence rate( P <0.01)and increased postoperative tow year survival rate( P <0.01)significantly.Simultaneously,there was no severe side effect.Conclusion Stereotactic conformal radiotherapy is an effective approach for the treatment of PLC.Preoperative short time high dose radiotherapy can increase the resection rate,prognosis and the opportumity of second period resection.