立体定向适形放疗治疗原发性肝癌的近期疗效分析

Analysis of short-term therapeutic effects for patients with primary liver cancer treated with three-dimensional stereotactic conformal radiotherapy

目的观察立体定向适形放疗治疗原发性肝癌的近期疗效。方法28例原发性肝癌患者经Elscint twinflash螺旋CT机定位后,用Leibinger三维放疗计划系统拟制放疗计划,在Varian直线加速器上实施治疗。平均随访时间为12个月。分析肿瘤反应率、放疗后无肝内肿瘤进展率及放疗后12个月生存率,观察治疗毒副作用。结果放疗后肿瘤体积反应率为85·7%,放疗后12个月无肝内肿瘤进展率为38·4%,放疗后12个月生存率为70·5%。存活患者无晚期肝损伤。结论立体定向适形放疗治疗肝癌的毒性较小,对提高肝内肿瘤的局部控制率有一定意义。

Objective To evaluate the short-term therapeutic effects for patients with priruary liver cancer using three-dimensional stereotaetie conformal radiotherapy （3D-CRT）. Methods Twenty-eight patients with primary hepatic cancer were treated with 3D-CRT （the average overall dose was 38Gy, localized by Elscint twin flash slice CT, radiotherapy plan was designed by Leibinger three-dimensional radiotherapy planning system and operated on Varian 600C/D liner accelerator）. The average follow-up time was 12 months （5-17mon. ）. Tumor volume response rate, rate of free from tumor progression and survival rate were analyzed. The adverse effects were studied simultaneously. Results According to follow-up CT results 3 months after radiotherapy, 2 eases had full responses with disappearance of the tumors, while partial responses with decreased tumors re, ass were seen in 22 eases, and no response in 4 eases. Tumor volume response rate was 85. 7%. The last follow-up CT results showed that in 5 patients there was tumor progression in planning target volume （PTV）, in 10 cases there was intrahepatie progression but not in PTV, and in 4 cases extrahepatie tumor growth. Intrahepatie tumor free rates 6 months and 12 months after radiotherapy were 66. 5% and 38. 4%, respectively. 6-month survival rate after radiotherapy was 88. 6%, 12- month survival rate was 70. 5% after radiotherapy. During 3 months of radiotherapy, manifestations of subacute radiation injuries occurred in six patients： gastrointestinal hemorrhage in 2 eases, jaundice in 3 eases and subacute radiation hepatitis in 1 patient. No survivors suffered from long-term liver injury. Conclusions With little adverse effect, 3D-CRT could raise the control rate of the hepatic tumor, and also short-term survival rate. There fore, 3D-CRT is a valuable treatment for patients with primary liver cancer.