合并门静脉癌栓的原发性肝癌的综合介入治疗

Combination therapy of primary liver cancer with portal vein tumor thrombus

目的评价CT引导下经皮射频消融(RFA)+经导管肝动脉化疗栓塞术(TACE)为主,必要时联合经皮无水乙醇注射(PEI)及三维适形放疗(3D-CRT)治疗合并门静脉癌栓(PVTT)的原发性肝癌的疗效。方法对38例侵犯门静脉的原发性肝癌患者先行TACE治疗,再行CT引导下RFA治疗,根据肿瘤位置以及是否侵犯门静脉主干,联合应用PEI或3D-CRT治疗。以mRECIST标准为评价指标。结果联合治疗侵犯门静脉的原发性肝癌总体完全缓解(CR)率为42.11%(16/38),部分缓解(PR)率为15.79%(6/38),稳定(SD)率为2.63%(1/38),进展(PD)率为39.47%(15/38)。结论以TACE+RFA治疗为主,必要时联合PEI和3D-CRT治疗侵犯门静脉的原发性肝癌,方法安全,疗效显著。

Objective To evaluate the clinical curative effect of transcatheter hepatic arterial chemoembolization（TACE）,radiofrequency ablation（RFA） and,when necessary,combined with percutaneous ethanol injection（PEI） or three dimensional conformal radiotherapy（3D-CRT） in the treatment of primary liver cancer patients with portal vein tumor thrombus（PVTT）.Methods Thirty-eight patients with primary liver cancer invading portal vein were treated with TACE and RFA guided by CT as well as combined with PEI and/or 3D-CRT when necessary.The clinical effect was evaluated through the standard of mRECIST.Results The rate of complete response（CR）,partial response（PR）,stable disease（SD） and progressive disease（PD） of the combination therapy was 42.11%（16/38）,15.79%（6/38）,2.63%（1/38） and 39.47%（15/38）,respectively.Conclusion TACE＋RFA and,when necessary,combined with PEI or 3D-CRT is safe and effective in the treatment of primary liver cancer patients with PVTT.