肝癌术后放疗的临床意义（附104例分析）

Clinical significance of postoperative radiotherapy with primary liver caner （104 cases of analysis）

目的探讨原发性肝癌术后给予辅助放疗的临床意义。方法1999年5月至2007年1月，我院肿瘤科对61例原发性肝癌病人施行手术治疗加术后辅助放疗。放疗方案主要采用先予全肝放疗，靶区包括全肝、第一肝门区、部分腹主动脉、下腔静脉旁淋巴结，DT16～20Gy，1．5～1．8Gy／次。再予瘤床15-20Gy。与同期根治术后未行放射治疗的43例肝癌病人相比较，分析治疗效果及治疗相关并发症。结果术后放疗组1a、3a，5a总生存率为88．5％、70．9％、48．9％；1a、3a、5a局部复发率为18．0％、25．5％、37．8％。术后放疗组1a、3a、5a复发率均较单纯手术组为优，差异有显著的统计学意义；总生存率仅1年生存率术后放疗组优于单纯手术组。未见肝功能进行性恶化、黄疸、腹水等放射性肝炎症状发生。结论放射治疗作为肝癌切除术后的辅助治疗手段，可获得较好疗效。不良反应可耐受。

Objective To evaluate the value of postoperative radiotherapy with primary liver cancer. Methods From May 1999 to January 2007, there were 61 patients with primary liver caner underwent postoperative radiotherapy after bepatectomy in our hospital. The whole liver, the first hepatic hilar region and part of abdominal lymph nodes were irradiated, and the tumor dose ranged from 16 to 20 Grays in daily 1.5-1.8 Grays every fraction, 5 times a week, followed by tumor bed boost for all patients, tumor dose 15-20Gy. There were 43 patients received operation only in our hospital in the same period. The efficacy and procedure-related complications were compared between the two groups. Results The 1-, 3-, and 5-year survival rates were 88.5%, 70.9%, and 48.9%, and the 1-, 3-, and 5-year relapse rates were 18.0%, 25.5%, and 37.8% respectively in the group of postoperative radiotherapy. The 1-, 3-, and 5-year relapse rates and the l-year relapse rates in the postoperative radiotherapy group was significantly higher than that in the surgery group （P〈0.05）. No serious complications occurred in all patients. Conclusions External irradiation after hepatectomy may improve the survival rate and reduce the relapse rate, and the toxicity might be endurable.