对不能切除的原发性肝癌综合治疗的临床研究

Clinical study of unresectable liver cancer treated by intraoperative hepatic arterial embolization and postoperative hyperfractionation radiotherapy.

目的 比较术中肝动脉栓塞化疗加超分割放射治疗与单纯肝动脉栓塞治疗不能切除的原发性肝癌的疗效。方法 对 91例手术探查不能切除的原发性肝癌随机分为 2个组 :术中肝动脉栓塞加超分割放射治疗组 (IHAE +HR) 4 3例 ,单纯术中肝动脉栓塞组 (IHAE) 4 8例。肝动脉化疗选用40 %碘化油≤ 2 0mL +顺铂 2 0～ 40mg、阿霉素 40～ 80mg、丝裂霉素 10～ 2 0mg、氟尿嘧啶 10 0 0～15 0 0mg。栓塞选用注入明胶海绵碎粒及结扎肝动脉方法。超分割放射治疗方法为 12 0cGy/次 ,2次/d ,间隔 6h ,总剂量 40 0 0～ 5 0 0 0cGy ,3～ 4周。 结果 IHAE +HR组和IHAE组的 1,3,5年生存率分别为 72 .9% ,35 .6 % ,2 8.5 %和 5 2 .0 % ,11.8% ,4.6 % ,2个组差异有显著意义 (P <0 .0 5 )。结论 术中肝动脉栓塞化疗加超分割放射治疗能有效地控制不能切除的原发性肝癌发展 ,提高了生存率 ,是一种比较好的综合治疗方法。

Objective To evaluate the treatment effects of intraoperative hepatic arterial embolization (IHAE) postoperative hyperfractionation radiotherapy (HR) for unresectable liver cancer. Methods Ninety one patients with unresectable liver cancer were randomized into two groups: 43 patients were treated by IHAE plus HR and 48 patients were treated by IHAE alone. All patients also received hepatic arterial infusion chemotherapy including 40% lipiodol ≤ 20?mL,PDD 20～40?mg,adriamycin 40～80?mg ,mitomycin 10～20?mg,5 Fu 1 ?000～1?500?mg , embolization with gelatin sponge and hepatic artery ligation .Hyperfractionation radiotherapy with 120?cGy per fraction, two fractions per day with 6 hours interval was given to all patients as well. The total doses were 4 ?000～ 5 ?000?cGy in 3 ～ 4 weeks. Results The 1 , 3 , 5 year survival rates were 72.9%, 35.6% , 28.5% in IHAE+HR, and 52.0%, 11.8% , 4.6% in IHAE alone,respectively. The differences between these two groups were statistically significant (P< 0.05 ). Conclusions The results suggest that the treatment effects of IHAE+HR is better than that of IHAE alone and IHAE+HR is an effective approach to improve the long term survival of patients with unresectable liver cancer.