放射治疗转移性肝癌的临床预后因素研究

The research for clinical prognotic factors of metastatic liver cancer treated with radiotherapy

目的:分析转移性肝癌应用放疗的疗效及预后因子。方法:转移性肝癌患者38例,21例经肝动脉栓塞化疗药物灌注(TACE)2~3次后行外放疗,17例进行单纯放射治疗,38例患者总照射剂量TD2000Gy^6600CGy,分割剂量150Gy^200CGy/次,每周5次。结果:所有患者均完成治疗过程,总有效率(PR+CR)为86.8%,1年及2年生存率为55.3%,36.8%。应用SAS6.0软件单因素分析显示肝内转移数量、经动脉栓塞化疗(TACE)、适形放疗、Child-Pugh分级是对预后的影响有统计学意义的因素(P<0.001),COX回归分析上述因素也是独立的预后因子(P<0.05)。结论:经动脉栓塞化疗(TACE)、适形放疗、肝内转移数量和Child-Pugh分级对转移性肝癌放疗的生存率有显著影响,同时也是独立的预后因子。

Objective：To evaluate the efficacy of liver metastases cancer treated by radiotherapy, and investigate the prognostic factors. Methods ： From August 1997 to November 2003, 38 patients who have been diagnozed liver metastases cancer received radiotherapy,21 patients received transarterial chemoembolization （ TACE ） 2 - 4 weeks before radiotherapy, and 17 patients treated by radiotherapy alone. Radiotherapy include normal radiotherapy and 3 - dimensional conformal radiation therapy （3 - DCRT）. The total irradiation dose was 20Gy to 65 Gy in daily fraction of 150Gy -200CGy. Results： All patients could tolerate the side effect. The response rate （CR ＋ PR） was 86.8% , 1 -year and 2 -year survival rates were 55.3% ,36.8%. The number of metastases, TACE, 3 - DCRT, Child - Pugh Grade had significant role on the 1 - year overall survival （ P 〈 0.001 ）. The number of metastases, Child - Pugh Grade, TACE and 3 - DCRT were independent significant prognostic factors （ P 〈 0. 05 ）. Conclusion. The number of metastases, TACE, 3 - DCRT, Child - Pugh Grade have significant role on the overall survival in liver metastases cancer patients received radiotherapy, and these factors also are independent prognostic factors.