原发性肝癌介入栓塞结合三维适形放疗的临床观察

Clinical effect of chemoembolization combined with three dimensional conformal radiation therapy for the treatment of hepatocellular carcinoma

目的:探讨介入栓塞治疗结合三维适形放疗(3D-CRT)治疗不能手术切除的原发性肝癌的疗效,探讨其预后影响因素。方法:46例不能手术切除的原发性肝患者先行动脉介入栓塞治疗1～4次,治疗后再行3D-CRT。结果:46例患者中完全缓解(CR)5例,部分缓解(PR)28例,总有效率(CR+PR)71.7%(33/46)。46例患者均获随访,中位生存期为17个月,1和2年生存率分别为47.9%(23/48)和33.3%(16/48)。单因素分析结果显示,肿瘤数目、肿瘤直径和肝外转移对生存期有显著影响,χ2值分别为4.042、4.255和9.671,P值分别为0.047、0.039和0.002。16例患者出现乏力、恶心和呕吐等毒副作用,均可耐受,6例出现Ⅰ～Ⅱ级肝损伤,经保肝治疗后恢复。结论:动脉介入栓塞治疗结合3D-CRT治疗不能手术切除的原发性肝癌有较好的疗效,且不良反应可以耐受;肿瘤数目、肿瘤直径、肝外转移是影响预后的主要因素。

OBJECTIVE： To discuss the clinical effect and prognostic factors of transcatheter arterial chemoemboliza- tion combined with three dimensional conformal radiation therapy in patients with unresectable hepatocellular carcinoma. METHODS： Totally 46 patients with unresectable hepatoeellular carcinoma were involved. Three dimensional conformal ra- diation therapy （3D-CRT）was given after transcatheter arterial chemoembolization （TACE）1 to 4 times. RESULTS： The efficiency was 71. 7~ （including 5 complete remission, 28 partial remission）. All 46 patients were followed, the median survival time was 17 months, 1-year and 2- year survival rate were 47.9%（23/48）and 33.3 % （16/48）,respectively. Sin- gle factor analysis showed that the number, diameter of hepatocellular carcinoma and extrahepatic metastases were the main prognostic factors,P value were 0. 047,0. 039 and 0. 002. There were 16 patients with side effects such as hypody- namia,nausea,vomiting which could be tolerated. Six patients appeared Liver injury I -- ]] who were cured after Liver treatment. CONCLUSIONS： Transcatheter arterial chemoembolization combined with three dimensional conformal radia- tion therapy are effective for patients with unresectable hepatocellular carcinoma. Side effects are tolerable. The number, diameter of hepatocellular carcinoma and extrahepatic metastases may be prognostic factors for patients with unresectable hepatocellular carcinoma.