460例巨大肝癌放射治疗的技术改进

460 cases of radiotherapy for primary massive liver cancer

目的总结改良的全肝移动条野放射+缩野技术+分段放射治疗技术,探讨在巨大肝癌放射治疗中的意义。方法收集1987～2001年本院460例巨大肝癌放射治疗资料进行回顾性分析。按放疗剂量分为3组。结果1组全肝移动条野照射2轮,mTD16～19Gy共260例,临床受益率81.5%,中位生存期8个月。2组全肝移动条野照射3～4轮,mTD24～35Gy共127例,临床受益率90.5%,中位生存期11个月。3组全肝移动条野照射+缩野技术+分段放疗,mTD50～60Gy共73例,肿瘤明显缩小40.0%～50.0%以上,临床受益率100.0%,1、3和5年生存率分别为95.8%、47.9%和10.9%,其中10例肿瘤缩小后二步切除,5年生存率为40.0%,10年生存率30.0%,最长生存者18年仍健在。结论全肝移动条野放射+缩野技术+分段放疗是安全、有效的肝癌治疗技术,临床受益率高,少数患者可获根治。

Objective：To summarize the improvement of technology by radiotherapy with moving split fields radiation （MSFR） of the whole liver and diminution field technology and split course to explore the significance by radiotherapy for Primary Liver Cancer （PLC）. Methods ：460 patients with PLC underwent in our hospital between 1987 and 2001 were carried out for retrospective analysis. There were three groups defined by the irradiation doses. Results：（ 1 ） 260 patients treated with moving split fields radiation （MSFR） of the whole liver twice, mTD 16 - 19Gy. Clinical Benefit Response （CBR） was 81.5% with a median survival duration of 8 months. （ 2 ） 127 patients treated with MSFR of the whole liver for 3 - 4 times, mTD 24 - 35 Gy, CBR was 90. 5 %, with a median survival duration of 11 months. （3） 73 patients treated with moving split radiation of the whole liver and diminution field technology and split course,mTD 50 -60Gy obviously reduced more than 40. 0% -50. 0% ,CBR was 100.0% ,1-,3-,5-year survival rate 95.8% ,47.9% and 10. 9%. 10 patients of them ,whose median tumor diameter reduced from 14cm to 7cm, accepted operation after radiotherapy, and the 5-year and 10-year survival rate were 40. 0% and 30.0% ,with the longest survival duration of more than 18 years. Conclusion：It has been proved that the new radiotherapy, the MSPR of the whole liver, diminution field technology and split course,is safe and effective for the treatment of primary massive liver cancer, and has a high clinical benefit response. Partial patients have been base cure.