肝动脉化疗栓塞、射频消融联合^(125)Ⅰ粒子植入治疗原发性肝癌的临床应用

The clinical application of TACE together with RFA and ^(125)Ⅰ seed implantation in treating hepatocellular carcinoma

目的探讨肝动脉药物栓塞(TACE)、射频消融(RFA)联合125Ⅰ粒子植入治疗肝细胞肝癌(HCC)的临床应用价值。方法 2008年3月至2010年12月收治15例HCC患者(共25个肿瘤灶),病灶大小1～8 cm。对所有患者均先进行TACE,然后在CT引导下进行RFA及125Ⅰ粒子植入治疗。125Ⅰ粒子植入通过TPS计划,对肝内同一病灶,在RFA结束时植入粒子进行补充治疗,或对多发病例中RFA受限的病灶直接植入粒子进行治疗。放疗剂量为60～100 Gy,随访观察疗效及相关并发症。结果随访时间3～28个月(平均10.6个月),全组肿瘤完全坏死率为96%,除1例粒子游走外,未出现其他严重并发症。结论 TACE、RFA联合125Ⅰ粒子植入治疗HCC,近期疗效明显,可望成为HCC更有效的治疗新模式。

Objective To assess the clinical value of the combined treatment of transcatheter arterial chemoembolization（TACE）,CT-guided radiofrequency ablation（RFA） and radioactive 125Ⅰ seed implantation for hepatocellular carcinoma（HCC）.Methods During the period from March 2008 to Dec.2010,15 patients with HCC were admitted to the hospital.A total of 25 hepatic lesions were detected with the size of 1-8 cm.TACE was carried out first,which was followed by CT-guided RFA and radioactive 125Ⅰ seed implantation.With the help of treat plan system（TPS）,the radioactive 125Ⅰ seed implantation was conducted to make additional management for the same lesion when RFA was finished,or the radioactive 125Ⅰ seeds were directly implanted into the areas where RFA could not reach.The radioactive dose was 60-100 Gy.All the patients were followed up and were kept under observation for the signs of related complications.The therapeutic results were evaluated.Results The combined treatment was successfully accomplished in all patients.All patients were followed up for 3-28 months（mean of 10.6 months）.The complete necrosis rate of the tumor was 96%.No serious complications occurred except the immigration of 125Ⅰ seeds in 1 case.Conclusion The combined treatment of TACE and CT-guided RFA together with 125Ⅰ seed implantation is a safe,reliable and effective therapy for HCC with excellent short-term result.