肝动脉化疗栓塞联合三维适形放疗治疗原发性肝癌合并门静脉瘤栓的临床对照研究

Pilot study on combination of three-dimensional conformal radiotherapy and transcatheter arterial chemoembolization for portal vein tumor thrombus in patients with unresectable hepatocellular carcinoma

目的:研究肝动脉化疗栓塞(TACE)联合三维适形放疗(3-DCRT)治疗肝癌合并门静脉瘤栓(PVTT)的疗效。方法:228例原发性肝癌合并门静脉瘤栓患者随机分为2组:A组(102例)单纯行TACE;B组(126例)行TACE结合3-DCRT。大体肿瘤靶区(GTV)只包括瘤栓,不包括原发灶,使85%～90%等剂量曲线覆盖100%PTV,照射总量为40～65Gy,单次照射剂量2～4Gy。结果:A、B两组治疗总有效率(CR+PR)分别为39.2%、83.3%;1、1.5、2年生存率分别为12.7%、9.4%、3.9%和54.0%、40.1%、27.4%,中位生存期分别为7.2、18.6个月。两组比较,差异有统计学意义(P<0.05)。结论:TACE联合3-DCRT能明显提高合并门静脉瘤栓的肝癌的治疗效果。

Objective： To study clinical therapeutic effctiveness of combined 3-dimensional conformal radiotherapy （3-DCRT） and transcatheter arterial chemoembolization for portal vein tumor thrombus （PVTT） in unresectable hepatocellular carcinoma（HCC）. Methods： 228 HCC patients with tumor thrombus in the portal vein were divided into two groups randomly.Group A（102 cases）was treated with TACE only; while group B （126 cases） with 3-DCRT combined with TACE. The gross tumor volume （GTV）was defined as only PVTT. RT was started 1.2 fractions following TACE.A total dose of 45-60 Gy was given as daily 2-4 Gy fractions, with the gross tumor volume （CTV）defined as only PVTT, 85%-90% isodose line covering 100% PTV. Results： Survival rates of group A at 1,1.5 and 2 years were 12.7%, 9.4% and 3.9% respectively with the mean survival time （MST） of 7.2 months,while those of group B were 54.0%, 40.1% and 27.4%, median survival time were 7.2 months and 18.6 months. The total effective rates of group A and B were 39.2%（40/102） and 83.3%（105/ 126） respectively. There was significant difference between the two groups （P〈0.05）. Conclusion： 3-DCRT combined with TACE can elevate the therapeutic effect of portal vein tumor thrombus in hepatocellular carcinoma.