肝动脉栓塞联合三维放射治疗肝癌的疗效评价

Three - dimensional conformal radiotherapy for patients with unresectable hepatocellular carcinoma after incomplete transcatheter arterial chemoembolization

目的评估经首次导管化疗栓塞（TACE）后，碘油栓塞不完全的中晚期肝细胞癌患者序贯适形外放射治疗的疗效及毒副作用。方法 2008年1月—2010年1月，纳入首次栓塞不完全的50例中晚期肝细胞癌患者，随机分两组，25例患者依据病情进行2-3次单纯TACE，25例序贯采用三维适型外放射补充治疗。测量肿瘤大小变化评价肿瘤的反应，评估治疗毒副作用。结果单纯TACE组治疗前后平均肿瘤直径分别为（8．37±9．15）cm和（4．22±5．66）cm；TACE放疗组治疗前后平均肿瘤直径分别为（8．65±6．89）cm和（3．86±4．32）cm。两组治疗前后比较差异具有统计学意义，两组间比较无统计学意义。TACE放疗组总有效率为52％，完全反应16％，部分反应36％。两组患者12个月生存率分别为48％和64．0％，差异具有统计学意义（P〈0．05）。没有出现三级及更高级别的毒副作用。结论对首次栓塞不完全的肝细胞癌患者，序贯采用三维适型外放射补充治疗能有效的提高患者的生存率，且毒副作用可以耐受。

Objective We prospectively evaluated the efficacy and toxicity of 3 -dimensional conformal radiotherapy （ 3 D - CRT） for patients with unreseetable hepatocellular carcinoma （ HCC ） after first incomplete transcatheter arterial chemoembolization （ TACE ）. Methods Between January 2008 and January 2010,50 patients with unreseetable HCC with incomplete uptake of iodized oil were randomly divided into two groups. TACE group （25 patients）was performed 2 -3 cycles by using Lipiodol and adriamycin embolization according to disease. TA-CE ＋3D- CRT group（25 patients）was added three -dimensional eonformal radiotherapy. Tumor response was evaluated by changes in tumor size on serial computed tomography scans, and toxicity was evaluated by the Common Terminology Criteria for Adverse Events v3.0. Results The average diameter of tumor before and after treatment were （ 8.37 ± 9.15 ） cm and （ 4.22 ± 5.66 ） cm in TACE group, respectively. The tumor diameter before and after treatment were （ 8.65 ± 6.89 ） cm and （ 3.86 ± 4.32 ） cm in TACE ＋ 3 D - CRT group, respectively. There was significant decrease in tumor size in both TACE group（P 〈0.05 ）and TACE ＋ 3D -CRT group B （P 〈 0.05 ）. There was no significant differences between the two groups in tumor response （ P 〉 0.05 ）. An objective response was achieved in 13 of 25 lesions（52.0% ） ,with a complete response in 4 lesions（ 16.0% ）and partial response in 9 lesions（36.0% ）. The overall survival rate was 64.0% at 1 year. There was no grade III or greater acute toxicity. Conclusion This study shows that the application of 3D - CRT could be more considered for pa- tients with incomplete uptake of iodized oil than single TACE.