三维适形放疗联合肝动脉化疗栓塞治疗肝癌伴门脉癌栓的疗效及预后分析

Efficiency and prognostic factors of three-dimensional conformal radiotherapy combined with transcatheter arterial chemoembolization for hepatocellular carcinoma with portal vein tumor thrombus

目的：探讨三维适形放疗联合肝动脉化疗栓塞治疗原发性肝癌合并门静脉癌栓的疗效并分析相关预后因素.方法：回顾性分析2008年5月-2010年10月我院收治的34例原发性肝癌伴门静脉癌栓患者的临床资料,所有患者先行肝动脉化疗栓塞治疗1～2次,然后采用三维适形放疗技术针对门静脉癌栓（部分包括肝内肿瘤）行外照射治疗,6MV-X线,DT45～60 Gy,2～4 Gy/次,3～5次/周,12～30次完成,放疗结束后6～8周观察癌栓及肝内肿瘤的近期疗效,随访1、2年生存率,对可能影响预后的因素进行单因素及多因素分析.结果：门静脉癌栓完全缓解3例（8.8%）,部分缓解16例（47.1%）,稳定9例（26.5%）,进展6例（17.6%）,癌栓治疗有效率为55.9%,肝脏原发肿瘤完全缓解2例（5.9%）,部分缓解15例（44.1%）,稳定10例（29.4%）,进展7例（20.6%）,肝内肿瘤治疗有效率为50%.1、2年生存率分别为44.1%、23.5%,多因素分析显示肿瘤大小,肝功能Child-Pugh分级对患者生存率的影响有显著意义（P〈0.05）.结论：三维适形放疗联合肝动脉化疗栓塞治疗原发性肝癌合并门静脉癌栓的疗效较好,不良反应低,患者耐受性好,值得在临床推广.肿瘤大小,肝功能Child-Pugh分级是影响患者生存率的主要因素.

Objective： To evaluate the efficiency and prognostic factors of three-dimensional conformal radiotherapy combined with transcatheter arterial chemoembolization for hepatocellular carcinoma with portal vein tumor thrombus（pvrgr）. Methods： The clinical data of 34 HCC patients with PVTF who were received by nantong tumor hospital from May 2008 to October 2010 were analyzed retrospectively. All the patients were treated with transcatheter arterial chemoembolization once or twice,combined with three-dimensional conformal radiotherapy. The radiotherapy was designed to focus on the tumor thrombus with or without primary intrahepatic tumors,to deliver a total dose of 45-60 Gy/12-30 F,3-5 F/W. Observing the recent curative efficacy after 6-8 weeks,follow-up the one year and two years survival rate. Predictors of survival were identified using univariate and multivariate analysis. Results： The remission rate of PvTr was 55.9% with CR 3 cases（8.8%）, PR 16 cases （47.1%）,SD 9 cases （26.5%） and PD 6 cases （17.6%）. The overall response rate of HCC was 50% with CR 2 cases（5.9%）,PR 15 cases（44.1%）,SD 10 cases（29.4%） and PD 7 cases（20.6%）. The one year and two years survival rate were 44.1% and 23.5% respectively. Multivariate analysis revealed that the size of tumor,Child-Pugh class were independent prognostic factors for the survival probability of patients（P〈0.05）. Conclusions： Three-dimensional conformal radiotherapy combined with transcatheter arterial chemoembolization is an effective method in the treatment of hepatocellular carcinoma with portal vein tumor thrombus with tolerable adverse effects. It is worthy of clinical application. The size of tumor, Child- Pugh class were independent prognostic factors for the survival probability of patients.