原发性肝癌三维适形放疗后放射性肝病的相关因素分析

Risk factors of radiation-induced liver disease after three-dimensional conformal radiotherapy for primary liver carcinoma

目的分析原发性肝癌常规分割三维适形放疗后发生放射性肝病的相关因素,以指导原发性肝癌放疗计划的制定,减少或避免放射性肝病的发生。方法对88例原发性肝癌患者采用常规分割三维适形放疗(1.8～2.2 Gy/次,15～33次,30～66 Gy,中位剂量46 Gy)。对性别、年龄、病理类型、病理分型、肿瘤最大直径、肿瘤部位、肝动脉栓塞化疗、门静脉癌栓、肝门淋巴结、HBV、腹水、疗效、肝硬化、Child-Pugh肝功能分级、PTV体积、PTV边缘剂量、正常肝脏平均剂量以及肝脏受照射的体积剂量(包括V_5、V_(10)、V_(15)、V_(20)、V_(25)、V_(30)、V_(35)、V_(40)、V_(45))与放射性肝病之间的关系进行分析。结果88例原发性肝癌发生放射性肝病16例,其中死亡9例。单因素分析发现年龄、HBV、腹水、Child-Pugh肝功能分级、门静脉癌栓、肿瘤最大直径、PTV体积与放射性肝病的发生有关。Logistic回归分析发现HBV和Child-Pugh肝功能分级是影响放射性肝病发生的独立预后因素。结论放射性肝病的病死率较高,在制定原发性肝癌三维适形放疗计划时,应充分考虑患者的HBV状况和Child-Pugh肝功能分级,以减少放射性肝病的发生。

Objective To identify the risk factors of radiation-induced liver disease after three-dimensional conformal radiotherapy （3DCRT） for primary liver carcinoma in conventional fractions. Methods Eighty-eight patients with primary liver carcinoma were treated by 3DCRT to a total dose of 30-66 Gy and 1.8-2.2 Gy per fraction. The relation between radiation-induced liver disease and the possible clinical factors were analyzed, such as the gender, age, pathology, tumor size, tumor site, TACE, portal vein carcinomatous thrombus, hepatic-hilar lymph node, HBV, ascites, curative effect, hepatic cirrhosis, hepatic function, PTV, total dose, mean dose to normal liver and dosimetric parameters （ including V5 , V10, V15, V20, V25, V30, V35, V40 and V45）. Results Sixteen patients （ 18.2% ） developed radiation-induced liver disease and 9 died. It was found that the age, ascites, HBV, hepatic function, portal vein carcinomatous thrombus, tumor size and PTV were correlated with radiation-induced liver disease. Logistic regression analysis showed that only the HBV and hepatic function were independent factors. Conclusions As radiationinduced liver disease possesses a very high mortality rate（9/16）, when planning three-dimensional conformal radiotherapy for primary liver carcinoma, comprehensive consideration of HBV and hepatic function may lower the incidence of radiation-induced liver disease.