肝动脉栓塞化疗联合放疗治疗不能手术的原发性肝癌的临床观察

Effects of radiotherapy combined with transcatheter arterial chemoembolization on patients with advanced unresectable primary hepatocellular carcinoma

目的观察肝动脉栓塞化疗（TACE）联合直线加速器或全身伽玛刀治疗不能手术的原发性肝癌（PHC）的疗效及毒副反应。方法 2005年7月至2008年6月,108例不能手术的PHC患者中50例行TACE联合直线加速器放疗（加速器组）,58例行TACE联合全身伽玛刀放疗（伽玛刀组）。TACE灌注化疗药物包括丝裂霉素（MMC）10~20mg、氟尿嘧啶（5-FU）1000~1500mg、表阿霉素（E-ADM）30~50mg,栓塞剂为40%超液态碘化油5~20ml。直线加速器治疗用6MV-X,95%等剂量线包绕PTV,40~60Gy/15~25f,3~5f/周;伽玛刀治疗用月亮神立体定向伽玛射线旋转聚焦全身放射治疗系统（LUNA-TM-260）,40%~60%等剂量线包绕PTV,单次剂量3~6Gy,3~5f/周,照射总量30~50Gy。联合应用TACE为1~3个疗程。结果加速器组及伽玛刀组的中位生存期分别为14个月和16个月,中位肿瘤进展时间（TTP）分别为7.6个月和8.1个月;2年局部控制率分别为45.4%和43.6%（χ2=0.020,P=0.887）,3年局部控制率分别为36.5%和37.9%（χ2=0.040,P=0.841）;2年生存率分别为41.1%和39.6%（χ2=0.021,P=0.885）,3年生存率分别为34.3%和30.2%（χ2=0.368,P=0.544）。加速器组中出现1例放射诱发的肝病,伽玛刀组未见相关病例。结论直线加速器和伽玛刀联合TACE治疗PHC均安全可靠,疗效相当。

Objective To evaluate the effects of transcatheter arterial chemoembolization（TACE） combined with radiation therapy on patients with advanced unresectable primary hepatocellular carcinoma（PHC）.Methods From July 2005 to June 2008,108 patients with advanced unresectable PHC were divided into 2 groups.Fifty patients were treated with linear accelerator combined with TACE（accelerator group）,and 58 patients were treated with body gamma knife combined with TACE（gamma knife group）.For accelerator group,6MV-X ray was used,≥95% isodose included PTV,and the total treatment dosage was 40-60Gy with 3-5 times per week.For gamma knife stereotaxis radiation therapy,the planning of treatment was 3-6Gy per-fraction,3-5 times per week and the total treatment dosage was 30-50Gy.For TACE,10-20mg mitomycin,1000-1500mg fluorouracil and 30-50mg epirubicine were perfused into the hepatic arteries,5-20ml mioldized oil were given to emobolized the hepatic arteries,and each patient was treated with 1-3 sessions.Results For accelerator group and gamma knife group,the median survival time were 14 months and 16 months,and the median time-to-progression were 7.6 months and 8.1 months.The 2-year local control rates were 45.4% and 43.6%,and the 3-year local control rates were 36.5% and 37.9% respectively.There was no statistical significant difference between 2 groups（χ2=0.020,P=0.887;χ2=0.040,P=0.841）.For accelerator group,2-and 3-year overall survival rates were 41.1% and 39.6%,respectively.For gamma knife group,they were 34.3% and 30.2%,respectively.There was not significant difference in 2-and 3-year survival rates between 2 groups（χ2=0.021,P=0.885;χ2=0.368,P=0.544）.Accelerator group was found 1 case with radiation induced liver disease（RILD）,while RILD in gamma knife group was not found.Conclusion The efficacy and toxicity of TACE combined with linear accelerator or gamma knife for advanced unresectable PHC were similar.