介入治疗结合大分割三维适形放射治疗原发性肝癌的疗效评价

Evaluating the efficacy of transcatheter arterial chemoembolization combined with hypofractionated 3- dimensional conformal radiotherapy for hepatocellular carcinoma

目的 评价肝动脉化疗栓塞 (TACE)结合大分割三维适形放射治疗 (3 DCRT)肝细胞癌(HCC)的疗效。方法 1 998年 5月至 1 999年 1 2月 ,81例不能手术切除的HCC患者 ,采用非随机分组方法 ,综合治疗组 4 1例采用TACE结合大分割 3 DCRT ,对照组 4 0例单独行TACE治疗 ,观察近期疗效 ,生存分析用Kaplan Meier法 ,两组生存率比较采用Log rank检验 ,综合治疗组多因素分析采用Cox比例风险模型。结果 综合治疗组和对照组肿瘤缓解率分别为 85 .4 %和 6 5 .0 % (P <0 .0 5 ) ,1、2、3年生存率分别为 90 .2 %、75 .6 %、4 4 .6 %和 89.7%、5 8.7%、2 4 .0 % ,两组生存率比较差异有显著性 (P=0 .0 4 39)。两组中位生存期分别为 36和 2 7个月。综合治疗组中 ,Child分级、临床分期及肿瘤直径是影响预后的主要因素 (P <0 .0 5 )。结论 综合治疗组较对照组有较好的疗效。综合治疗组中Child分级、临床分期。

Objective To evaluate the efficacy of transcatheter arterial chemoembolization (TACE) combined with hypofractionated 3 dimensional conformal radiotherapy for hepatocellular carcinoma (HCC). Methods During May 1998 and Dec. 1999, 81 unresectable HCC patients were divided into two groups. Forty one patients in group A were treated with TACE and hypofractionated 3 dimensional conformal radiotherapy and 40 patients in group B were treated with TACE alone. Acute effects were analyzed and survival rates were assessed from the date of the beginning of treatment using the Kaplan Meier method. The survival rates of two groups were compared using Log rank. The Cox proportional hazards model was used to analyze the prognostic factors in group A. Results The objective response rate in group A was higher than that in group B (85.4% vs. 65.0% , P <0.05). The overall survival rates in group A (90.2%, 75.6% and 44.6% at 1, 2 and 3 years, respectively) were significantly higher than those in group B (89.7%, 58.7% and 24.0%, respectively, P =0.0439). The median survival was 36 and 27 months in group A and group B. Cox proportional hazards model analysis showed that the diameter of tumor, Child Pugh classification and Okuda stage were the most important prognostic factors for patient's survival probability and had statistic significance( P <0.05)in group A. Conclusions Hypofractionated 3 dimensional conformal radiotherapy combined with TACE is more effective than TACE alone and can be considered an effective and feasible approach to unresectabe HCC patients. In group A, the diameter of tumor, Child Pugh classification and Okuda stage could be identified as unresectabe HCC predictors.