大分割三维适形放疗治疗不能手术原发性肝癌

Clinical outcomes of 3-D conformal hypofractionated radiotherapy for inoperable primary hepatocellular carcinoma

背景与目的：在原发性肝癌患者中，大部分失去手术机会，三维适形放疗（3-DCRT）因为具有物理剂量分布优势而被越来越多应用于本类病例治疗。本研究着眼于评价大分割3-DCRT治疗不能手术原发性肝癌的疗效和毒副作用。方法：对52例原发性肝癌行3-DCRT，≥90％等剂量面包括计划肿瘤区域（PTV），单次剂量3．54～6．31Gy，照射次数7～15次。采用SPSS10．0统计软件，生存率以Kaplan—Meier法计算，近期疗效和放射反应评价采用x^2检验，相关因素对预后的影响采用Cox回归。结果：1、2年生存率分别为64．1％和12．6％，中位生存期13个月。近期有效率（CR＋PR）55．8％，肿块小于6cm及大于6cm者有效率分别为91．7％和45．0％（P=0．007）。肝脏急性不良反应Ⅰ级5例，1例发生严重放射性肝损伤，Ⅰ／Ⅱ级上消化道反应分别为23例（44．2％）和15例（28．8％）。肿块较大和合并门静脉痛栓（PVTT）为影响生存率的危险冈素（P值分别为0．042和0．001）。结论：3-DCRT治疗不能手术原发性肝癌在可接受的毒副作用前提下可获得一定的疗效，肿块较大和合并门静脉癌栓为影响生存率的危险因素。

Background and purpose： Primary hepatocellular carcinoma（HCC） is a major malignant disease in parts of Asia. However, the number of resectable （rases is still limited. Although radiotherapy for the treatment of HCC has been attempted for more than 4 decades, no satisfactory resuhs were obtained. Recently, part liver RT has been attempted by several investigators, who have shown that high doses of radiation can be safely delivered to a portion of the liver alone or in combination with other nonsurgical modalities. In this retrospective study, we analyzed the treatment results and prognostic factors affecting survival to evaluate the efficacy and toxicity of 3-D conformal hypofractionated radiotherapy for inoperable primary hepatocellular carcinoma. Methods： Fifty two patients with histopathologically proven hepatocellular carcinoma were treated with stereotactic radiotherapy. 3.54 Gy to 6.31Gy/fx, 7 to 15fractions would be given at the planning target volume covered by 90% isodose line . The objective responses and the survival rates were assessed from the first （lay of treatment. Kaplan-Meier method was used for the analysis of survival and Cox proportional hazards model was used to analyze the prognostic factors. Results： Survival rates at 1 and 2 years were 64. 1% and 12.6%, respectively. The median survival time was 13.0 months. An objective response rate was observed in 29 of 52 cases（55.8% ）. The objective responses for tumors 〈6cm or ≥6cm in diameter were 91.7% and 45.0%, respectively（ P = 0. 007, 〈 0.05） . Five patients developed grade 1 acute liver toxicity and one patient experienced radiatlon-induced liver disease. For gastrointestinal complications, 23 cases were scored as grade 1（44.2%） and 15 cases were scored as grade 2（28.8%）. Mutivariate analysis revealed tumor size and PVTT were the independent and statistically significant factors that it impacted on the patient＇s survival（ P 〈 0.05）. Conclusions： Stereotactic radintherapy is effective and feasible for unresectable primary hepatocellular carcinoma, and tumor size and PVTT are the major factors affecting survival.