三维适形放疗联合介入治疗原发性肝细胞癌

Three-dimensional conformal radiotherapy combined with interventional therapy in treatment of primary hepatocellular carcinoma

目的探讨失去手术机会的原发性肝细胞癌采用肝动脉化疗栓塞（TACE）后采用三维适形放疗（3DCRT）的疗效和毒副反应。方法对48例原发性肝细胞癌中24例患者采用TACE＋3DCRT（综合组）治疗。24例患者单纯TACE（对照组）治疗。TACE采用肝动脉灌注5-FU、DDP、ADM加碘油栓塞治疗。3DCRT采用6MV-X线,PTV 40-66 Gy/20-33 F,分割次剂量2-2.5 Gy。结果综合组近期有效率（CR＋PR）为82.6%,对照组为54.5%,两组差异有统计学意义（P=0.042）。1、3年生存率综合组74.0%、30.0%,对照组50.0%、14.0%,两组差异有统计学意义（P=0.036）。不良反应发生率差异无统计学意义。结论三维适形放疗联合介入治疗原发性肝细胞癌有一定的疗效,是安全有效的治疗方法 。

Objective To evaluate the therapeutic efficacy and adverse effects of three dimensional conformal radiotherapy（3-DCRT） for patients with primary hepatocellular carcinoma after transcatheter arterial chemoembolization（TACE） treatment.Methods From November 2005 to November 2007,48 patients with primary hepatocellular carcinoma entered this trial.Among those patients,24 cases in combined group were treated by TACE plus 3-DCRT;other 24 cases were treated by TACE alone as control group.TACE was administered via hepatic arterial infusion of 5-FU,DDP,ADM and iodized oil,while 3-DCRT applied 6MV X-ray for PTV 40~66 Gy/20~33 F with a single dose of 2 Gy.Results The early response rate（CR＋PR） for combined group was 82.6%,significantly higher than that of control group（54.5%,P=0.042）.The one-year and three-year survival rates were 74.0% and 30.0% for combined group,50.0% and 14.0% for control group,respectively（P=0.036）.There were no significant differences in adverse effects between two groups.Conclusion TACE combined with 3-DCRT is a safe and effective strategy for treatment of patients with primary hepatocellular carcinoma.