三维适形放疗治疗胃肠道恶性肿瘤转移引起的梗阻性黄疸疗效观察

Efficacy of three-dimensional conformal radiotherapy in the treatment of obstructive jaundice caused by metastasis of gastrointestinal cancer

目的探讨三维适形放疗(3DCRT)治疗胃肠道恶性肿瘤转移引起的梗阻性黄疸的疗效。方法 28例胃肠道恶性肿瘤转移引起梗阻性黄疸患者采用3DCRT技术放疗,必要时行经皮肝穿刺外引流术或胆道内支架植入术完成后续放疗,分割剂量为2.5Gy/次,5次/周,总剂量55～65Gy。结果 28例患者中,8例完全缓解(CR),13例部分缓解(PR),2例稳定(NC),3例进展(PD)。2例放弃治疗。总有效率(CR+PR)75.0%(21/28)。黄疸、上腹部疼痛、腹部包块、白陶土样大便缓解率分别为64.3%、89.4%、81.8%和75.0%。0.5,1,2年生存率分别为82.1%(23/28)、53.6%(15/28)和14.3%(4/28)。结论 3DCRT治疗胃肠道恶性肿瘤转移引起的梗阻性黄疸是一种安全、有效的治疗方法,近期疗效好,症状改善满意,远期疗效有待进一步探讨。

Objective To explore the efficacy of three-dimensional conformal radiotherapy in the treatment of obstructive jaundice caused by metastasis of gastrointestinal malignant tumors. Methods Twenty-eight cases of obstructive jaundice caused by metastasis of gastrointestinal cancer were treated,with threedimensional conformal radiation therapy（ 3DCRT） ,if necessary,percutaneous transhepatic external drainage or biliary stenting was used to complete follow-up radiotherapy. The total dose of 3DCRT was 55-65 Gy（ 2. 5 Gy/f,5 f/w） . During radiotherapy,appropriate treatment was given according to the situation. Results In the 28 patients,the complete response rates was 28. 6% （ 8 /28） ,partial response rate 46. 4% （ 13 /28） ; no change rate 7. 1% （ 2 /28） and progress of disease 10. 7% （ 3 /28） ,abandonment of treatment rate 7. 1% （ 2 / 28） ,with a total response rate of 75. 0% （ 21 /28） . The remission rates of jaundice,upper abdominal pain, abdominal mass,white clay-like stool were 64. 3% ,89. 4% ,81. 8% and 75. 0% . The 0. 5,1-and 2-year survival rates were 82. 1% （ 23 /28） ,53. 6% （ 15 /28） and 14. 3% （ 4 /28） . Conclusion 3DCRT treatment of malignant obstructive jaundice is safe and effective,with good curative efficacy,symptom improvement, but the long-term effect needs further study.