体部伽玛刀治疗原发性肝癌的疗效分析

Application of body-γ-knife radiotherapy for patients with liver primarily cancer

目的:探讨体部伽玛刀放射治疗原发性肝癌的临床疗效和不良反应。方法:采用立体定向伽玛射线体部治疗系统治疗原发性肝癌27例。根据肿瘤的位置、临床靶体积、患者的身体状况与治疗目的,制定放射治疗计划及调整剂量分布。50%～80%的等剂量曲线包绕100%的肿瘤体积,照射剂量32～42Gy,中位剂量40Gy,分割处方剂量3.2～4.2Gy,重复治疗8～15次,每日1次,每周连续治疗5次。结果:肝区疼痛症状缓解率为83.3%。治疗后1～6个月复查CT或MRI,CR25.9%(7/27),PR55.6%(15/27),NR18.59%(5/27),总有效率为81.5%;半年局部无进展生存率75%,1年局部无进展生存率22%。无严重放射性肝炎、消化道穿孔等严重不良反应发生。结论:体部伽玛刀使肿瘤局部得到准确的高剂量照射,周围正常组织损伤较小,近期治疗效果较为理想,为肝癌患者提供了一种新的治疗方法。

Objective：To evaluate the therapeutic of hody-γ-knife radiotherapy for patients with primarily hepatic cancer. Methods： Twenty-seven patients with primarily hepatic cancer were treated by technique of body-γ-knife radiotherapy. Planning of treatment was made and the prescribed dose was adjusted depending on the site of the tumor ,clinical target volume（GTV） ,Kanofsky Performance and aim of treatment. Planning target volume received 50% - 80% of the prescribed dose for 3.2 - 4. 2Gy per-fraction. Treatment dose was 32 -42 Gy （median dose 40Gy） in daily fractions of 3.2 -4. 2Gy five fractions one week. Results：The tumor response rate was CR25.9%, PR55.6%, NR18.59% ; the response rate （CR ＋ PR） was 81.5%. Half-year local recurrence-free survival rate was 75% ; 1-year local recurrence-free survival rate was 22%. There were no serious complications during radiotherapy and follow-up. Pain relieve rate in liver region was 83.3%. Conclusion： Body-γ-knife radiotherapy can improve the local control on the treatment of primary hepatic neoplasm and does not increase the treatment complication.