介入化疗及栓塞术联合放射治疗原发性中晚期肝癌

Combined Therapy of Interventional Chemotherapy, Embolism and Radiotherapy in the Treatment of Primary Medium and Late Stage Carcinoma of Liver

目的:为观察介入化疗及栓塞术联合放射治疗中晚期肝癌的近期疗效及副作用。方法:本文采用64例确诊的无手术指征的中晚期肝癌,随机分为介入加放疗组与单纯放疗组各32例。介入法采用动脉插管至肝固有动脉,灌注5-氟脲嘧啶1000 mg+卡铂300 mg+表阿霉素30 mg,栓塞剂为40％碘化油或明胶海绵。放疗采用高能X线(18mV),肿块10 cm以下采用局野外照射,10 cm以上采用全肝移动条照射。结果:介入加放疗组总有效率(CR+PR)为59.3％(19/32),单纯放疗组总有效率(CR+PR)为31.3％(10/32),两组比较有显著性差异(P<0.05)。介入加放疗组平均生存期为14.7个月,单纯放疗组平均生存期为11.8个月。1年生存率介入加放疗组为60.8％,单纯放疗组为44.1％,前者明显高于后者。结论:采用介入加放射综合治疗原发性肝癌较单纯放射治疗可明显地提高治疗的有效率、生存期及生存率,是中晚期肝癌理想的有效治疗手段之一。

Purpose: To observe near time therapeutic effect and side reaction in the combined therapy of interventional chemotherapy, embolism and radiotherapy. Methods: 64 patients had been diagnosed with medium and late stage carcinoma of liver without operation indecation. They are randomly allocated into combined interventional therapy and radiotherapy group, and simple radiotherapy group (32 cases in each group). In the interventional therapy group, catheters were catheterized into proper hepatic artery. Then we perfused 5-FU l000mg, carboplatin 300 mg, mitomycin 30mg and suppository (40% iodized oil or gelfoam). In the radiotherapy, we used high-energy radiation. If the tumor was smaller than 10 cm, we gave local extemal irradiation. Otherwise, we gave mobile irradiation of the whole liver. Results: In the combined therapy group, the effective rate(CR+PR) was 59% (19/32) and it was 31.3% (10/32) in the controlled group. Compared the two, there were significant difference (P<0. 05). The average vital stage was 14.7 months in combined interventional therapy and radiotherapy group, and 11.8 months in simple radiotherapy group. The survival rate of a year was 60. 8% in the combined therapy, 44.1% in the con-trolled grop. The former is distinctly higher than the latter. Conclusions: Combined treatment of interven-tional therapy and radiotherapy can significantly raised the effective rate, vital stage and survival rate, com-pared with simple radiotherapy group. So it was an ideal and effective treatment in the medium and late stage carcinoma of liver.