28例不能手术的肝外胆道系统肿瘤放化疗疗效分析

Radiochemotherapy for unresectable extra-hepatic bile duct carcinoma: analysis of 28 patients

目的 评价放疗晚期肝外胆道系统肿瘤的疗效。方法 对28例手术不可切除的肝外胆道系统肿瘤采用放化疗，其中胆囊癌13例，肝外胆管癌15例。15例采用常规放疗，中位照射剂量45Gy（30～60Gy），13例采用三维适形放疗（3DcRT）多野（3～5个野）照射或加量，中位照射剂量55Gy（50～70Gy）。12例单纯放疗，16例放化结合。化疗方案为氟尿嘧啶500mg，2次／周，或氟尿嘧啶500mg＋顺铂30mg，1次／周，疗程3～6个周期。结果 全部患者近期有效率14％。全组中位生存期9．4个月（2～28个月）。1、2年生存率分别为38％、15％；其中1年生存率胆囊癌为46％，肝外胆管癌为27％，3DCRT为42％，常规放疗为33％，单纯放疗为37％，放疗＋化疗为31％；〈50Gy的为29％，≥50Gy的为45％。只有照射剂量（≥50Gy）对1年生存率有影响（X^2=5．31，P=0．023）。急性消化道反应1～2级为57％，3级为18％，仅有25％的出现1～2级血液毒性反应。结论 对晚期肝外胆道系统肿瘤采用放化疗可取得一定疗效，且副作用可耐受。

Objective To evaluate the effect of radiochemotherapy for unresectable extra-hepatic bile duct eaneinoma. Methods Form June 1993 to August 2003, 28 unressctable extra-hepatic bile duct carcinoma treated by radiochemotherapy were analyzed. There were 13 gallbladder carcinoma and 15 bile duet carcinoma. The radiotherapy regimen consisted of conventional radiation therapy group（ 15 patients, with a median dose of 45 Gy, range 30-60Gy） and three-dimemional eonformal radiation therapy group（13 patients, with a median dose of 55 Gy, range 50-70 Gy）. Among these patients, 12 patients were treated by radiotherapy alone（RT）, 16 patients treated by radiochemotherapy（CRT）, with a chemotherapy regimen consisting of 5-Fu 500 nag twice weekly or 5-Fu 500mg ＋ DDP30mgoneeweekly for 3-6 cycles. Results The CR＋PR, SD and PD rate was 14%, 64%, and 21%, respectively. The overall 1-,2-year survival rate was 38% and 15%, with a median survival time of 9.4 months. The 1-year survival of gallbladder cancer and extra-hepatic bile duet cancer was 46% and 27% ;of 3DCRT and conventional radiotherapy was 42% and 33% ;of those radiation dose less than 50 Gy and more than 50 Gy was 29% and 45% ;of RT alone and radiochemotherapy was 37% and 31%, respectively. There was significance difference in overall survival between those RT dose less than 50 Gy and more than 50 Gy, （ P = 0. 023）. Grade 1-2 and Grade 3 acute gastrointestinal toxicity was 57% and 18%, respectively. Only 25% patients suffered grade 1-2 hematology toxicity. Conclusion Radiochemotherapy shows moderate effect for unressectable extra-hepatic bile duet cancer with acceptable side effects.