中晚期胆囊癌放疗疗效及预后影响因素分析

Efficacy of Radiotherapy of Patients with Middle-advanced Gallbladder Carcinoma and Analysis of Influen-tial Factor of Prognosis

【目的】回顾性分析中晚期胆囊癌放疗疗效及评价其安全性，以期改善其预后。【方法187例胆囊癌患者行三维适形放射治疗，可评价疗效81例，Nevin分期Ⅳ期23例、V期58例。其中男性35例，女性46例。单次照射剂量1．8～2．2Gy，每日1次，每周5次，总剂量38～65Gy。【结果lCox回归分析提示：CAl99值、近期疗效与预后有关。81例中晚期胆囊癌患者，完全缓解率12．3％（10例），部分缓解率42．0％（34例），有效率54．3％。3个月生存期为95．1％（77例），6个月生存期为69．1％（56例），1、2、3年生存率分别为24．7％、3．7％、1．2％，中位生存期为8．5个月。毒副作用主要表现为近期胃肠道反应，经对症处理恢复正常。消化道反应I级31例，Ⅱ级10例，发生率为50．6％；血液学毒性白细胞下降I度15例，Ⅱ度5例，发生率为24．7％，血小板下降I度8例，Ⅱ度3例，发生率为35．5％。无一例因严重放疗反应而终止治疗。【结论】三维适形放疗可延长中晚期胆囊癌患者生存期，减轻患者症状；且副作用大部分患者能耐受。

[ObjectivelTo retrospectively analyze the efficacy and evaluate the safety of radiotherapy of middle-ad- vanced gallbladder carcinoma in order to improve the prognosis. [Methods] Totally 87 patients with gallbladder carcinoma received three-dimensional conformal radiation therapy. The efficacy of 81 patients was evaluated. There were 23 patients with stage IV of Nevin staging and 58 patients with stage V. Among them 35 patients were male and 46 patients were fe- male. Single radiation dose was 1.8 to 2.2Gy once a day and five times a week. The total dose was 38 to 65Gy. [Results] Cox regression analysis showed that serum CA199 value and short-term efficacy were correlated with prognosis. Among 81 patients with middle-advanced gallbladder carcinoma, complete remission rate was 12.3% （10 cases）, and partial re- mission rate was 42.0%（34 cases）, and the effective rate was 54.3~. The 3-month survival rate was 95.1^（77 cases） and 6-month survival rate was 69.1 ~/00 （56 cases）. The 1-, 2- and 3 year survival rate were 24.7 %, 3.7 % and 1.2 ~, re- spectively. The median survival time was 8. 5 months. The main adverse reaction was recent gastrointestinal tract re- sponse which recovered the normal after symptomatic treatment. Digestive tract response with grade [ was found in 31 pa- tients and that with grade ]I was found in 10 patients, and the incidence rate was 50.6 %. The hematological toxicity leu- kopenia with degree I was found in 15 patients and that with degree ]I was found in 5 cases, and the incidence rate was 24. 7 %. The thrombocytopenia with degree I was found in 8 patients and that with degree 1I was found in 3 patients, and the incidence rate was 35.5 ~. No one ceased the treatment due to severe radiation reaction. [Conclusion]Three-dimensional conformal radiotherapy can prolong survival time of patients with middle-advanced gallbladder carcinoma, and alleviate the symptoms. Most patients can tolerate side effects.