奥沙利铂和吉西他滨栓塞化疗联合三维适形放疗治疗晚期原发性肝癌疗效观察

Clinical observation of embolism chemotherapy with gemcitabine and oxaliplatin combined with three dimensional conformal radiation therapy in the treatment of advanced primary liver cancer

目的研究三维适形放疗(3DCRT)与奥沙利铂实施栓塞化疗联合吉西他滨(Gemox方案)治疗原发性肝癌晚期患者的疗效及毒副作用,为临床上治疗原发性肝癌提供参考建议。方法选取我院收治的原发性肝癌晚期患者64例,随机分为观察组34例和对照组30例,对照组采用吉西他滨联合顺铂(GP方案)加三维适形放疗(3DCRT)进行治疗,观察组采用奥沙利铂联合吉西他滨(Gemox方案)加三维适形放疗(3DCRT)进行治疗。观察并比较两组患者的治疗效果及毒副作用。结果两组患者的近期疗效比较,观察组受益率为85.29%、对照组为83.33%,两组疗效经非参数检验差异均无统计学意义(Z=-0.021,P>0.05);两组不良反应比较,在粒细胞减少率、血小板减少率、胃肠道反应发生率方面对照组明显高于观察组,其差异具有统计学意义(P<0.05);周围神经损害发生率观察组明显高于对照组,差异具有统计学意义(P<0.05);在血红蛋白减少率、肝功损害发生率、放射性食管炎发生率方面观察组和对照组比较,差异均无统计学意义(P>0.05);观察组生存率为73.5%(25/34),中位生存期为14个月;对照组生存率为66.6%(20/30),中位生存期为12.4个月;经K-M检验两组生存曲线,差异无统计学意义(χ2=0.017,P>0.05)。结论三维适形放疗(3DCRT)与奥沙利铂实施栓塞化疗联合吉西他滨(Gemox方案)治疗原发性肝癌晚期患者不能够改变患者的生存期及疗效,但是可以减少不良反应的发生。

Objective To study the efficacy and side effects of three dimensional conformal radiotherapy（3DCRT） combined with embolism chemotherapy with oxaliplatin and gemcitabine on the treatment of patients with advanced primary liver cancer, and provide some suggestions for the clinical treatment of primary liver cancer.Methods Sixty-four patients with advanced hepatocellular carcinoma were selected and randomly divided into observation group（34 cases） and control group（30 cases）. The control group was given gemcitabine plus cisplatin（GP regimen） combined with three-dimensional conformal radiotherapy（3DCRT） treatment, and the observation group was treated with oxaliplatin and gemcitabine（Gemox） combined with three-dimensional conformal radiotherapy（3DCRT）treatment. The curative effect and side effect were compared between the two groups. Results The recent curative effects in the two groups were compared. The benefit rate was 85.29% in the observation group, compared with 83.33%in the control group, with no statistically significant difference（Z=0.021, P〉0.05）. Compared with the control group in adverse reactions, the rates of granulocyte decrement, platelet decrement and the incidence of gastrointestinal reaction were lower while the incidence of peripheral nerve damage rate was higher in the observation group, with statistically significant differences（P〉0.05）. However, there was no difference between the two groups in the hemoglobin reduction rate and the incidences of liver damage and radiation esophagitis（P〉0.05）. The survival rate was 73.5%（25/34） in the observation group versus 66.6%（20/30） in the control group, while the median survival time was 14 months in the observation group versus 12.4 months in the control group. There was no statistically significant difference in survival curve by K-M test between the two groups（χ^2=0.017, P〉0.05）. Conclusion Three dimensional conformal radiotherapy（3DCRT） combined with embolism chemotherapy with oxaliplatin and gemcitabine（Gemox regimen） in treatment of patients with primary liver cancer in advanced stages can not change their survival time and outcome, instead, it is expected to reduce the occurrence of adverse reactions.