晚期肝癌调强适形放射治疗的疗效及预后分析

Therapeutic effect and prognostic factors of intensity modulated radiation treatment for advanced primary hepatocellular carcinoma

目的评价调强适形放射治疗（intensity modulated radiation treatment,IMRT）应用于晚期肝癌患者的疗效及预后。方法对22例不能手术切除的晚期肝癌患者进行调强适形放射治疗,每次分割剂量为3-6 Gy,每日1次或隔日1次,照射次数为6-15次,总治疗时间为2-5周,相当于生物效应剂量（biological effective dose,BED）56-80Gy,中位剂量66 Gy。观察近期疗效及预后影响因素。结果 22例患者中完全缓解（CR）3例,部分缓解（PR）10例,病情稳定（NC）8例,病情进展（PD）1例,中位生存时间18个月（2-75个月）。单因素分析显示大体肿瘤体积（GTV）、放疗分次剂量、放疗总剂量对近期疗效的影响均有统计学意义（P〈0.05）。结论调强适形放射治疗（IMRT）应用于晚期肝癌患者时有较好的疗效,不良反应较轻,患者易于耐受。大体肿瘤体积（GTV）、放疗分次剂量、放疗总剂量对患者的疗效有显著影响。

Objective To evaluate therapeutic effect and prognostic factors of intensity modulated radiation treatment for advanced primary hepatocellular carcinoma.Methods22 patients with advanced primary hepatocellular carcinoma were treated with intensity modulated radiation（IMRT） treatment with a daily or alternate day fractional dose of 3-6 Gy in 6-15 fractions in 2-5 weeks,with a biological effective dose,BED of 56-76 Gy.The median biological effective dose,BED was 66 Gy in 10 fractions in 4 weeks.Then the therapeutic outcome was evaluated.ResultsCR,PR,NC,PD for the whole 22 patient were 3,10,8,1 respectively,and the complete remission（CR） rate was 13.6%,remission rate was 59.1%,and median survival time was 18 months（2-75 months）.The univariate analyses showed gross tumor volume（GTV）,fractional dose,and total dose were prognostic factors（P〈0.05）.ConclusionThe application of intensity modulated radiation treatment IMRT reveals a better therapeutic effect,a minor adverse reaction and a better tolerance in patient with advanced primary hepatocellular carcinoma.GTV,fractional dose and total dose are prognostic factors.