局部晚期肝门部胆管癌根治术后放疗的价值

Value of postoperative radiotherapy in locally advanced hepatic hilar cholangiocarcinoma

目的 回顾性分析及评价肝门部胆管癌根治性术后放疗的结果。方法 对接受根治术的肝门部胆管癌术后病理切缘阳性的47例进行分组研究，其中28例接受术后放疗（S＋RT组），19例未进行术后放疗（S组）。S＋RT组放疗采用6、15MVX线外照射，靶区剂量45～62Gy，中位剂量52Gy。术后中位随访期30个月（4～113个月）。结果 全组5年生存率为28％，中位生存期19．6个月。S＋RT组5年生存率、中位生存期显著高于S组，分别为34％、29个月和14％、10个月（P=0．015）。并发症发生率S组与S＋RT组分别为11％和11％，差异无统计学意义（P〉0．05）。结论 根治术结合放疗可明显延长切缘阳性患者的生存期，早、晚期放射反应可以接受。

Objective To evaluate the outcome of postoperative radiotherapy（RT） in locally advanced hepatic hilar cholangiocarcinoma. Methods From March 1992 to December 1997, 47 patients who had positive margin after surgery were treated by postoperative radiotherapy（S ＋ RT, 28 patients, with a median dose of 50 Gy, range 45-62 Gy） and surgery alone （S, 19 patients）. The median follow-up was 30 months （range 4-113）. Resuits The overall 5-year survival rate was 28%, with a median survival time of 19.6 months for the whole group. The 5-year survival rate of S＋ RT group and S group was 34% and 14% , with a median survival time of 29 and 10 months, respectively（ P = 0.015）. The complication rate was 11% in either group. Conclusion Postoperative radiotherapy obviously prolongs the survival in hepatic hilar cholangiocarcinoma patients with positive microscopic surgical margins. Radiation toxicities are well tolerated.