不能手术的肝门区胆管癌支架置入结合三维适形放疗疗效初步评价

Evaluation of the efficacy of three-dimensional conformal radiotherapy(3DCRT)combined with stenting in treatment of non-resectable hilar cholangiocarcinoma

目的探讨胆管支架置入结合三维适形放疗(three-d im ensional conform al rad iotherapy,3DCRT)治疗不能手术的肝门区胆管癌(K latsk in tumor)的疗效。方法回顾分析了23例不能手术切除的肝门区胆管癌患者的临床资料,其中综合治疗组(胆管支架置入结合三维适形放射治疗)15例,对照组(单胆管支架置入)8例。用Kap lan-M e ier法分析比较两组患者生存率和支架开通率。结果两组患者支架置入术后总胆红素均逐渐下降。综合治疗组获得了60.0%(9/15)的肿瘤局部缓解率。综合治疗组和对照组1,2年生存率分别为53.3%(8/15)、13.3%(2/15)和25%(2/8)、0;1,2年支架开通率分别为40.0%(6/15)、13.3%(2/15)和12.5%(1/8)、0。中位生存期分别为13.4和7.5个月(P=0.04);支架中位开通时间分别为12.0和5.1个月(P=0.00)。结论3DCRT对肝门区胆管癌有较好的局部治疗效果,结合胆管支架置入明显提高了不能手术的肝门区胆管癌患者的生存率及支架开通率。

Objective To explore the efficacy of three-dimensional conforrnal radiotherapy （3DCRT） combined with stenting in treatment of non-resectable hilar eholangioeareinoma. Methods A retrospective analysis of the patients treated either with stenting followed by 3DCRT（ n = 15 ） or with stenting alone （ control group; n =8 ） was made. By using Kaplan-Meier analysis, both the survival rate and stent patency rate in the two groups were compared. Results After stenting, gradual decrease in total bilirubin blood levels was observed in two groups. The overall response rate of the radiotherapy group was 60.0%. The 1- year,2-year survival rates in radiotherapy group and control group were 53.3%, 13.3% and 25% ,0 respectively. The 1-year,2-year stent pateney rates were 40.0%, 13.3% and 12.5% ,0 respectively. The median survival period and stent patency period in the radiotherapy group （ 13.4 and 12.0 months, respectively） were markedly longer than those in control group（7.5 and 5.1 months, respectively） ,with the P 〈 0.05. Conclusions The local efficacy of 3DCRT in treatment of hilar cholangiocarcinomas was satisfactory. Combining with stenting can improve markedly the survival rate and stent patency rate in treatment of non-resectable hilar cholangiocarcinoma.