原发性肝癌腹膜后转移立体适形放疗的疗效分析

Efficiency of stereotactic radiotherapy for the treatment of retroperitoneal metastasis of liver cancer

目的:探讨分析立体适形放疗技术治疗原发性肝癌腹膜后转移的疗效。方法:1999年4月～2003年4月,共收治41例原发性肝癌腹膜后转移患者,其中11例为原发性肝癌术后(有1例为肝移植术后)发生转移,有12例合并肺、骨、脾转移。采用立体适形放疗技术治疗,分割剂量视病情为2.81～7Gy/次,6～20次,80%～90%以上的等剂量线包绕靶区,总的肿瘤生物剂量40～70Gy。结果:CR16例(39%),PR12例(29.3%),NC3例(7.3%),PD10例(24.4%),总有效率(CR+PR)68.3%。1、2、3年生存率分别为56.1%、19.6%、9.8%。中位生存时间为15.1个月。近期疗效与病灶体积有显著关系,病灶体积越小,疗效越好,统计学有显著性意义(P<0.05)。当总剂量≥56Gy时,CR与PR值明显升高,统计学有显著性意义(P<0.05)。结论:采用立体适形放疗技术治疗原发性肝癌腹膜后转移,疗效好,损伤小,易耐受,不失为腹膜后转移癌首选的治疗方法之一。建议原发性肝癌患者应定期进行腹部CT、MRI或PET-CT检查,腹膜后转移癌发现越早,病灶体积越小,放疗效果越好。

Objective.To analyse the effects of stereotactic radiotherapy in the treatment of retroperitoneal metastasis of primary liver cancer. Methods：From April 1999 to April 2003, 41 patients with retroperitoneal metastasis of liver cancer were treated with stereotactic radiotherapy in our department. The planned target volume was encompassed by more than 80% to 90% isodose line, tumor dose was 2.81Gy to 7Gy per fraction, with total number of 6 to 20 fractions and total dose ranging from 40Gy to 70Gy. Results： The overall response rate （CR ＋ PR） was 68.3%. The 1 year and 2 years survival rates were 56.1% （24/41） and 19.6% （6/41）, respectively. The median survival time was 15.1 months. The early response rate was in accordance with the tumor volume irradiated, better response rate was seen in smaller tumor （P 〈0. 05）. When total tumor dose was ≥56Gy,tbe CR and PR rate was significantly increased （P 〈 0. 05 ）. Conclusion： Stereotactic radiotherapy is an effective treatment method for retroperitoneal metastasis of liver cancer, with less damage and less toxicity. The patients with liver cancer shoule be examined with CT, MRI or PET-CT regularly to find retroperitoneal metastasis earlier. The less tumor volume, the better response rate with stereotactic radiotherapy.