三维适形放疗联合超声聚焦刀治疗肝癌42例疗效观察

3 Dimensional Conformal Radiotherapy Combined with High Intensity Focused Ultrasound for Primary Hepatic Carcinoma

目的评价三维适形放疗(3DCRT)联合超声聚焦刀(HIFU)治疗肝癌的疗效。方法应用三维适形放疗联合声像图引导定位、实时监控超声聚焦刀治疗原发性肝癌42例。3DCRT采用15MVX射线,计划靶体积(PTV)<125cm3者单次剂量4～6Gy,5次/周,总DT45～56Gy;PTV≥125cm3者单次剂量2～4Gy,每周5次,总DT45～60Gy。超声聚焦刀治疗每周2次,两次中间隔72h。结果治疗后超声显示回声增强,随后中心回声减低,边缘回声增强,血供消失或明显减少,最终回声不均匀增强是疗效显著的特征性表现。CR9例(21.4%),PR26例(61.9%),NC4例(9.5%),PD3例(7.1%),总有效率(CR+PR)为83.3%,1、2、3年生存率分别为88.1%、66.7%、40.4%。结论应用三维适形放疗联合超声聚焦刀治疗早期肝癌及部分不能手术切除的晚期原发性肝癌疗效较好,超声能准确有效地引导焦点定位、实时疗效监控及治疗后的疗效评价。

Objective The purpose of this trial was to evaluate the effects of 3 dimensional conformal radiotherapy （3DCRT） combined with high intensity focused ultrasound（HIFU） for primary hepatic carcinoma. Methods Forty-two cases with primary hepatic carcinoma were treated by 3DCRT combined with HIFU. 3DCRT was given by 15MV X-rays. The patients with planned target volume （PTV） less than 125 cm^3 received a total dose of 45 -56 Gy,4 -6 Gy per fraction,and the patients with PTV larger than 125 cm^3 received a total dose of 45-60 Gy,2 -4Gy per fraction,5 times every week. HIFU treated with 2 times every week,72 hours between 2 treatments. Results Immediately after treatment, the tumor had intensified echo. The echo was gradually reduced with only the intensified edge echoes left. Irregular intensified echoes is the typical evidence for treatment efficacy. 9 patients had CR 9（21.4% ） and 26 patients had PR 26（61.9% ）. NC was seen in 4 cases （9.5%） and PD in 3 cases （7.1%）. The total response rate （ CR ＋ PR） was 83.3%. The 1- ,2-,and 3-year survival rates were 88.1% ,66.7% and 40.4% ,respectively. Conclusion Combined 3DCRT and HIFU have good efficacy in patients with early or late stage primary hepatic carcinoma. Uhrasonography can exactly direct focal fields, and CDFI real-time is reliable for surveillance.