三维适形放疗联合鸦胆子油乳介入治疗原发性肝癌临床研究

Clinical study of radiotherapy combined with brucea javanica oil emulsion TACE in patients with hepatocellular carcinoma

目的探讨三维适形放射治疗联合介入化疗治疗肝癌的临床效果。方法选取本院2007年9月至2009年3月收治的78例无法手术切除的肝癌患者,随机分为单纯介入治疗组38例(鸦胆子油乳10mg/m2,5-Fu 500mg/m2,顺铂40mg/m2,表阿霉素40mg/m2);介入治疗(同前)加三维适形放射治疗组40例,放射治疗肿瘤的平均剂量为56Gy(50～60Gy),观察两组患者1年无进展生存率、1.5年总体生存率与毒性反应情况。结果平均生存时间,单纯介入化疗组为(9.2±2.1)个月,介入化疗加放射治疗组为(13.5±1.9)个月,两组比较差异有统计学意义(P<0.05);单纯介入化疗组1年总体生存率为45.4%,而介入化疗加放射治疗组为58.5%,两组比较差异有统计学意义(P<0.05);1.5年总体生存率介入联合放射治疗组(28.4%)显著高于单纯介入治疗组(7.8%),差异有统计学意义(P<0.05);两组在发热、腹痛等不良反应发生率方面比较差异无统计学意义(P>0.05)。结论三维适形放射治疗联合鸦胆子油乳为基础的介入治疗让部分肝癌患者临床受益,三维适形放射治疗后尚需进一步的措施防止远处转移和肝功能恶化。

Objective Radiotherapy play an important role in multidisciplInary treatment of hepatic carcinoma. To prove that the combination of 3-dimensional conformal radiotherapy （RA） with transcatheter arterial chemoembolization （TACE） based on brucea javanica oil emulsion has clinical potential. Methods 78 eligible patients with unresectable HCC were enrolled in the study from September 2007 to March 2009. Group TACE （n= 38,Brucea Javanica Oil Emulsion 10 mg/m2＋5-Fu 500 mg/m2,cisplatinum 40 mg/m2 ,epi-adriamycin 40 mg/m2. Radiotherapy combined with TACE （Brucea Javanica Oil Emulsion 10 mg/m2 if- 5 Fu 500 mg/ m2 ,cisplatinum 40 mg/m2 ,epi-adriamycin 40 mg/m2 in group TACE＋Radiotherapy （n=40）. A median total tumor dose of 56 Gy （range 50-60 Gy） was delivered in radiotherapy group. Progression free survival and overal survival were analysied. Results The mean survival time（TACE： 9.2 ± 2. 1 months, TACE ＋ RA： 13.5 ! 1.9 months） was significantly different from each other （ P〈0.05）. The progression-free rate at 1 year was 32.4% in the TACE,58.5% in the TACE ＋RA group,the difference was statisti- cally significant（P〈0.05） ;The overal survival at 1.5 years was 7.8% in the TACE,28.4% in the TACE＋RA group,the difference was statistically significant（P〈0.05） ;There were no significant differences in side effects of fever and abdomen pain between TACE group and TACE＋ Radiotherapy group（P〈0.05）. Conclusion The results shows that the combination of TACE based on brucea javanica oil emulsion and radiotherapy has clinical potential for unresectable hepatocellular carcinoma patients. Additional treatments should be considered to prevent distant metastases and hepatic functional deterioration after radiotherapy.