射波刀治疗80例原发性肝癌的临床观察

Clinical observation of 80 patients with primary hepatic carcinoma treated by Cyber Knife

目的:评价采用射波刀(立体定向放射手术平台Cyber Knife)治疗原发性肝癌的疗效和近期毒副反应。方法:80例原发性肝癌患者接受了射波刀治疗,T1期5例,T2期31例,T3期37例,T4期7例。根据肝硬化Child-Pugh分级标准,A级45例,B级29例,C级6例。50例为首程治疗,30例曾接受过手术、介入治疗、氩氦刀等至少一种治疗手段后失败。GTV为CT和MRI增强影像显示的病灶,PTV为GTV外放3-5mm。肝脏病灶治疗均采用金标追踪与呼吸同步追踪技术(synchrony),CT定位前1周经B超或CT引导下穿刺植入金标2-4粒到肿瘤内或肿瘤旁3cm内。处方剂量:总剂量38-45Gy分割3-5次。处方剂量线范围为70%-82%。结果:完全缓解(CR)15例(18.7%),部分缓解(PR)51例(63.8%),稳定(NC)8例(10.0%),进展(PD)6例(7.5%)。随诊2年,6个月、12个月、24个月生存率分别是96.3%(77/80)、82.5%(66/80)和45.0%(36/80),所有患者对治疗耐受良好,毒副作用较轻。结论:射波刀治疗原发性肝癌使肿瘤局部得到精准的高剂量照射,疗效确切,毒副作用小,为肝癌患者提供了一种安全有效的治疗方法。

Objective：To evaluate the efficiency and the toxicity of primary hepatic carcinoma treated with Cyber Knife therapy （ stereotactic radiosurgery platform Cyber Knife ）. Methods： Total of 80 patients with primary hepatic carcinoma patients underwent Cyber Knife treatment,5 patients in stage 1,31 stage T2 ,37 stage T3 ,7 stage T4 ,45 ca-ses in grade A ,29 grade B ,6 grade C. 50 cases had accepted primary process treatment. 30 patients had received sur-gery, interventional therapy and cryosurgical treatment, one was failed. Before CT positioning 1 week,2-4 gold parti-cles were implanted into the tumor or tumor within 3cm guided by B ultrasound or CT. Prescription dose：The total dose was 38-45 Gy splitted by 3 to 5 times. The range of prescription dose line was 70% to 82%. Results：Response rates were complete remission （CR） 11.9% ;partial remission （PR） 64.2% ;NR 18.3% ;PD 5.5%, respectively. The 6 months,12 months and 24 months survival rates were 96.3% （77/80） ,82.5% （66/80） and 45.0% （36/ 80）. All patients tolerated the treatment better,with less side effects. ConcLusion：Along with its prominent curative effect and little side effects, Cyber Knife will become a safe and effective therapeutic method to treat primary hepatic carcinoma.