三维适形放射治疗联合经皮肝动脉化疗栓塞不同序贯顺序治疗原发性肝癌伴门静脉癌栓的临床对照

Clinical control of different sequential order of three-dimensional conformal radiotherapy combined with transcatheter arterial chemoembolization for portal vein tumor thrombus in patients with hepatocellular carcinoma

目的 探讨三维适形放射治疗（3DCRT）和经皮肝动脉化疗栓塞（TACE）不同序贯顺序治疗原发性肝细胞癌（HCC）伴门静脉癌栓（PVTT）的临床疗效和不良反应. 方法 将2008年11月至2012年3月收治的65例HCC伴PVTT患者随机分为2组,A组32例,先给予3DCRT治疗,之后予TACE治疗;B组33例,先给予TACE治疗,之后予3DCRT治疗.计数资料比较采用四格表x2检验和构成比Y2检验;等级资料比较采用秩和检验;生存分析采用Kaplan-Meier法计算.结果 A、B两组的治疗有效率分别为68.8％、69.7％,两组比较x 2=0.232,P=0.793,差异无统计学意义.A、B两组的中位生存期、局部控制率、生存率、门静脉癌栓有效率、AFP改善率比较,P值均＞0.05,差异均无统计学意义.B组肝功能恶化程度高于A组.两组患者随访2 ～ 25个月,未见严重并发症.结论 对伴门静脉癌栓的原发性肝癌采用3DCRT联合TACE治疗的疗效较好,不良反应少,先给予3DCRT治疗再行TACE治疗较先行TACE治疗再行3DCRT治疗对肝功能影响较小.

Objective To study the influence of the sequence of three-dimensional conformal radiotherapy （3DCRT） and transcatheter arterial chemoembolization （TACE） on the efficacy and toxicity of treatment in patients with hepatocellular carcinoma （HCC） with portal vein tumor thrombus （PVTT）.Methods A total of 65 patients who were diagnosed with primary HCC with PVTT were enrolled in the study from November 2008 to March 2012 and were randomly divided into the following two groups：group A,32 patients treated with 3DCRT followed by TACE; group B,33 patients treated with TACE followed by 3DCRT.Results The total efficacy rates of groups A and B were 68.8% and 69.7% （x2 =0.232,P 〈 0.793）.The survival rates,effective percentage of PVTT and AFP remission rates were not significantly different between group A and group B.The exacerbation rate of liver function was significantly higher for group B than for group A （P 〈 0.05）.No serious complication was found in the follow-up period for either group.Conclusion The combination of 3DCRT and TACE is a relatively effective local treatment for patients with primary HCC and PVTT.Compared with TACE followed by 3DCRT,3DCRT followed by TACE may have a negative influence on liver function.