原发性肝癌三维适形放疗加介入治疗的疗效

The efficacy of three-dimensional conformal radiotherapy plus transcatheter arterial chemoembolization for treatment of primary liver cancer

目的评价三维适形放疗结合经皮肝动脉化疗栓塞术治疗不能手术的原发性肝癌的疗效。方法1999年4月至2007年7月,对83例不能手术的原发性肝癌患者进行肝动脉化疗栓塞术及三维适形放疗。放疗分割剂量2～8Gy(中位4.6Gy),照射次数为6～30次(中位11次),每周3～5次,肿瘤剂量33.6～70Gy(中位52Gy)。肝动脉化疗栓塞术采用超液态碘油、顺铂、吡喃阿霉素、丝裂霉素、健择、羟基喜树碱和明胶海绵颗粒经肝动脉化疗栓塞。治疗结束后评价患者生存情况及应用WHO分度标准评价不良反应。结果患者近期有效率为42.2%,其中CR 11例,PR 24例,NC 25例,PD 23例。1、3、5年生存率分别为65.9%、32.5%、25.5%。肝功能异常1例,上消化道出血3例,Ⅰ～Ⅱ度骨髓功能抑制16例,发热1例。结论肝动脉介入化疗结合三维适形放疗对不能手术的原发性肝癌有一定的疗效,是安全、有效的治疗方法。

Objective To evaluate the therapeutic effects of three-dimensional conformal radiation （3DCRT） combined with transcatheter arterial chemoembolization （TACE） on the unresectable primary liver cancer （PLC）. Methods From April 1999 to July 2007, a total of 83 patients who could not receive surgical therapy were treated with TACE plus 3DCRT. Fraetionated radiotherapy dose was 2 - 8Gy （ median 4.6Gy）, irradiation times were 6 - 30 （ median 11 ）, 3 - 5 times/week, tumor dose was 33. 6-70Gy （median 52Gy）. TACE was performed by using lipiedol, cisplatin, perarubicin, mitomycin, gemcitabine hydrochloride, hydroxycamptotheein and gelatin sponge cubes. Results The short-term efficacy rate was 42. 2%. The 1-, 2- and 3- year survival rates were 65.9% , 32.5% and 25.5% , respectively. The liver function tests showed abnomality in one patient, upper gastrointestinal hemorrhage in three patients,Ⅰ-Ⅱ level inhibitory effect on marrow function in 16 patients and fever in one patient. Conclusion The 3DCRT is effective, feasible and can be applied as one of the first-line means for treating uuresectable PLC.