肝动脉化疗栓塞加三维适形放疗治疗原发性肝细胞癌

Combined transcatheter arterial chemoembolization and three dimensional conformal radiotherapy for primary hepatocellular carcinoma

目的探讨肝动脉化疗栓塞（TACE）加三维适形放射治疗（3D—CRT）治疗原发性肝细胞癌的疗效及患者的耐受性。方法38例患者先行TACE，阿霉素50mg／m^2、氟尿嘧啶600mg／m^2、顺铂60mg和碘油10～15ml，每4周重复，共3次。休息1～2个月后，针对肿瘤局部行3D-CRT，80％～90％等剂量线包绕计划靶区并以此为处方线，4～8Gy／次，3次／周，共7～11次，总剂量为44～56Gy。结果全部患者均能完成治疗计划，按WHO毒性分级标准：Ⅰ～Ⅱ级急性胃肠道反应占53%（20／38），Ⅰ～Ⅱ级骨髓抑制发生率占47％（18／38），对症治疗后均能缓解。CR为24％，PR为63％．总有效率（CR＋PR）为87％。1、2年生存率分别为74％和58％。结论TACE加3D-CRT综合治疗原发性肝细胞癌的毒副作用较轻，近期疗效好，是原发性肝细胞癌患者非手术治疗的一种较为满意的方法。

Objective To explore the curative effect and patient＇s tolerance with combined transcatheter arterial chemoembolization（TACE） and three dimensional conformal radiotherapy（3D-CRT） for primary hepatocellular carcinoma. Methods 38 patients were treated with combined TACE and 3D-CRT. The patient＇s characteristics were：27 male and 11 female,with median age of 52 years（range 35- 78） ; karnofsky performance score ≥70;stage Ⅰ 11, Ⅱ 19 and Ⅲ 8,Child-Pugh staging of liver function were 17 of grade A,15 of grade B and 6 of grade C.The treatment regimen consisted of TACE first, it took TACE of doxorubicin 50mg/m^2, fluorouracil 600mg/m^2, cisplatin 60mg and iodine oil 10-15 ml in once per four weeks, total three times. After resting one or two months, followed by 3D-CRT（44 - 56Gy/7 - 11f/3 - 4 weeks）, the planning target volume（PTV） was covered by the 80 % - 90 % isodose curve and the target dose was prescribed to PTV. Results All patients completed the planned treatment. Hematological and radiation-induced toxicities as shown by the WHO staging system were 53 % （20/38） of grade 1- 2 acute gastrointestinal tract reaction and 47 % （18/38） of grade 1 -2 bone marrow inhibition, but they were tolerable. The complete response（CR） and partial response（PR） rates were 24 % and 63 % , respectively, with a CR ＋ PR rate of 87 %. The 1- and 2- year survival rates were 74 % and 58 % , respectively. Conclusion Combined TACE and 3D-CRT is better to short-term curative effect,it has less toxicities and it is satisfactory therapy for unresectable primary hepatocellular carcinoma.