常规分割三维适形放疗对不可切除的原发性肝细胞癌的疗效分析

Effects of conventional fractionated three dimensional conformal radiotherapy on unresectable hepatocelluar carcinoma

目的探讨常规分割三维适形放疗对不可切除的原发性肝细胞癌的疗效。方法用8MVX射线对52例不可切除的原发性肝细胞癌患者进行三维适形放疗，单次剂量2Gy，每周5次，3．6～5．6周，总剂量36～66Gy。CT扫描肿瘤最大直径、评价疗效、记录生存期及评估不良反应。结果52例不可切除的原发性肝细胞癌患者中，完全缓解2例，部分缓解34例，总有效率为69．2％；放射性肝病发生率为1．92％。50Gy以上和50Gy以下剂量组缓解率分别为76．9％与46．2％（X^2=10．72，P〈0．05）。中位生存时间为10．5个月，1、2、3和4年生存率为57．7％、34．6％、23．1％和9．61％；未出现3或4级急性放射性损伤。结论常规分割三维适形放疗治疗不可切除的肝细胞癌有效率高，不良反应轻。

Objective To investigate the efficacy and toxicity of conventional fractionated three- dimensional conformal radiotherapy （3D-CRT） on unresectable hepatocelluar carcinoma（HCC）. Methods Fifty two patients with unresectable HCC, all without extrahepatic metastases, were treated by 3D-CRT conducted 5 times a week with the total radiation dose of 36-66 Gy and a daily dose of 2 Gy. The curative effect was evaluated by CT scan to observe the maximum tumor size. Survival rates, survival time, and adverse responses were recorded. Results The total effective rate of the 52 patients was 69.2% with complete response （CR） in 2 patients and partial response （PR） in 34 patients. The incidence rate of radioactive hepatitis was 1.92%. The 1-, 2-, 3-, and 4-year survival rates were 57.7%, 34.6%, 23.1% , and 9.61% respectively, and the median survival time was 10. 5 months. The 1-,2-,3-, and 4- year local control rates were 67% , 51.5% , 32. 3% , and 2. 24% , and the 1-, 2-, 3-, and 4-year distant metastasis rate were 17.2% , 23.5% , 36.7% , and 76.9% respectively. The intrahepatic metastases rate was 62. 5% and 37.5% of the patients suffered from extrahepatic metastasis, including metastases of lung, bone, and retroperitoneal lymph nodes. The remission rate of the≥〉50 Gy group was 76.9% , significantly higher than that of the ≤50 Gy group （46.2% , X^2 = 10. 72,P 〈0. 05）. There was no grade 3 or 4 acute toxicity, and two patients （3.84%） developed gastric or duodenal ulcer. Conclusions Conventional fractionated 3D-CRT evokes a rather effective response for unresectable HCC with acceptable toxicity. Radiation dose seems to be a significant prognostic factor in RT response for HCC.