原发巨大肝癌介入化疗栓塞合并三维适形放疗疗效观察

Three-dimensional conformal radiotherapy combined with transcatheter arterial chemoembolization for massive primary liver cancer

目的评价肝动脉化疗栓塞(TACE)合并三维适形放疗(3-DCRT)对晚期原发巨大肝癌的疗效。方法搜集2001年1月～2004年12月诊治病例,对84例无法进行手术的巨大(直径≥10cm)原发性肝癌进行TACE、3-DCRT序贯治疗。其中UICC/AJCC T3期49例,T4期35例,均为N0,合并有门脉癌栓30例。根据Child-Pugh肝硬化分级,A级64例,B级20例。可见肿瘤体积(GTV)为(705±430)cm3(170～2099cm3)。先行TACE:将氟尿嘧啶和羟喜树碱注入患者肝肿瘤的供血动脉(靶动脉),然后将卡铂和丝裂霉素(或吡柔比星)与超液化碘油充分混合成乳剂注入靶动脉,再用明胶海绵颗粒栓塞治疗,根据患者情况每1.5～2个月重复1次,1～3次治疗。后行3-DCRT,每次分割剂量4～6Gy,照射次数(11±2)次(7～15次),肿瘤剂量(53.6±6.6)Gy,每周3次,隔日1次。结果8例患者3-DCRT后3个月内死亡,未能评价疗效,总有效率(CR+PR)68.9%(51/74),1、2和3年累积生存率分别为55.4%、24.7%和15.4%,T分期、GTV、门脉癌栓和分割剂量对生存率的影响无显著差异,Child-Pugh肝硬化分级是独立的预后因子(P=0.035,相对危险度=2.440)。结论3-DCRT合并TACE对晚期巨大原发肝癌有一定疗效,Child-Pugh是独立预后因子。

Objective To evaluate the outcomes of patients with unresectable massive primary liver cancer （PLC） receiving three-dimensional conformal radiotherapy （3-DCRT） combined with transcatheter arterial chemoembolization （TACE）. Methods From January 2001 to December 2004, 84 patients with unresectable massive PLC （tumor size≥ 10 cm） received 3-DCRT combined with TACE, including 49 cases in UICC/AJCC T3 stage and 35 cases in T4 stages. Lymph node metastasis was found in none of the patients, and portal vein tumor thrombosis （PVTT） was detected in 30 cases. Child-Pugh grade A of liver cirrhosis was present in 64 cases and grade B in 20 cases. The mean value of GTV was 705±430 cm^3 （170-2099 cm^3）. Following injections offluorouracil and hydroxycamptothecine into the target artery of the tumor, the mixture ofcarboplatin, mitomycin （or pirarubicin） and super-liquefactive iodized oil was injected into the target artery. Gelatin sponge was used to embolize the artery. The procedure was repeated every 1.5-2 months according to the condition of the patients, and each patient received 1-3 such procedures. 3-DCRT was performed in all the patients, who received a total dose of 53.6±6.6 Gy （4-6 Gy per fraction at the interval of 48 h）, and 3 fractions were given every week. Results Eight patients died in 3 months after 3-DCRT and were not evaluated. The total response rate （CR＋PR） in these patients was 68.9% （51/74）. The overall survival rates at 1, 2 and 3 years were 55.4%, 24.7% and 15.4%, respectively. T stage, GTV, PVTT and fraction size had no significant impact on the overall survival. Child-Pugh grade was found to have significant impact on the patients＇ survival （P=0.035, RR=2.440）. Conclusions 3-DCRT combined with TACE has definite therapeutic effect on advanced massive PLC, and Child-Pugh grade is an independent prognostic factor in such cases. primary liver cancer; 3-dimensional conformal radiation