肝动脉化疗栓塞联合三维适形放射治疗对肝癌并门静脉癌栓近期疗效

Observation on efficacy of transcatheter arterial chemoembolization combined with three-dimensional conformal radiotherapy in treatment of hepatocellular carcinoma with portal vein tumor thrombus

目的研究肝动脉化疗栓塞(TACE)联合三维适形放射治疗(3DCRT)对原发性肝癌(PHC)合并门静脉癌栓(PVTT)的近期疗效及不良反应。方法 72例晚期肝癌患者随机分为A、B两组,A组单纯行TACE,B组行TACE联合3DCRT,观察两组近期疗效及毒性和不良反应情况。结果 A组原发肿瘤有效率为55.6%(20/36),门静脉癌栓(PVTT)消失率为25.0%,1、2年生存率分别为27.8%(10/36)、13.9%(5/36),B组原发肿瘤有效率为77.8%(28/36),PVTT消失率为50.0%(18/36),1、2年生存率分别为52.8%(19/36)、44.4%(16/36)。两组差异有统计学意义(P<0.05或<0.01)。放射性肝脏毒性反应是最常见的并发症,两组发生率差异无统计学意义(P>0.05)。结论 TACE联合3DCRT治疗PHC并PVTT近期疗效显著,不良反应可耐受,是PHC并PVTT治疗有效可行的手段。

Objective To evaluate the efficacy and toxicity of transcatheter arterial chemoembolization（TACE） combined with three-dimensional conformal radiotherapy（3DCRT） in treatment of primary hepatic cancer（PHC） with portal vein tumor thrombus.Methods Seventy-two cases of advanced PHC were randomly assigned to receive only TACE（group A,n=36） or TACE＋3D CRT（group B,n=36）.The short-term effectiveness and radiation side reaction were evaluated.The survival rate was followed up.Results The effective rate of group A was 55.6%,the disappearance rate of cancerous thrombus in the portal vein was 25.0%,the 1-and 2-year survival rate was 27.8%,13.9%,respectively.The effective rate of group B was 77.8%,the disappearance rate of cancerous thrombus in the portal vein was 50.0%,the 1-and 2-year survival rate was 52.8%,44.4%,respectively.There were significant difference between two groups（P0.05 or 0.01）.Radiation-induced hepatotoxicity was the most common treatment-related complication,the incidence had no significant difference（P0.05）.Conclusion TACE combined with 3DCRT is safe and effective for PHC with portal vein tumor thrombus,its side reaction is bearable,it is a practicable approach for the disease.