原发性肝癌合并门静脉癌栓放射治疗的预后分析

Prognostic analysis of radiotherapy for primary liver cancer complicated with portal vein tumor thrombus

目的评价三维适形放射治疗（3D-CRT）对晚期原发性肝癌（PLC）合并门静脉癌栓（PVTT）患者的疗效，分析肝癌放疗的预后因素。方法对108例PLC合并PVTT的患者行3D．CRT，肿瘤剂量28～63Gy（中位50．6Gy），分割剂量2～8Gy（中位4．0Gy），每周3～5次，每日或隔日1次。结果3D—CRT总有效率（CR＋PR）为40．7％（44／108），1、2、3年生存率分别为37．1％、14．5％、7．8％，中位生存时间8．0个月。多因素分析显示，肝动脉化疗栓塞（TACE）、放疗近期疗效是独立的预后因素。结论3D．CRT对PLC合并PVTT是一种有效的治疗手段，TACE及放疗近期疗效是影响PLC合并PVTT患者放疗的独立预后因素。

Objective To evaluate the efficacy of three dimensional conformal radiotherapy （3D-CRT） for advanced primary liver cancer （PLC） complicated with portal vein tumor thrombus （PVTT） and analyze the prognostic factors associated with radiotherapy. Methods 108 patients treated with 3D-CRT for PLC complicating PVTY between January 2000 and December 2013 were analyzed. The radiotherapy schedule was 28 - 63 Gy （ median 50.6 Gy） in 2 - 8 Gy （ median 4.0 Gy）/fraction, 3 - 5 fractions/week, once a day or every other day. Results The total effective rate （CR ＋ PR） was 40.7% （44/108）, with a 1 -, 2 -, 3- year survival rate of 37. 1%, 14. 5% and 7. 8%, respectively. The median survival time was 8.0 months. In a multivariate analysis, artery chemoembolization （TACE） and short-term response to radiotherapy were found to be statistically significant. Conclusion 3D-CRT is an effective treatment for PLC complicating PvTr, TACE and short-term response to radiotherapy may be independent prognostic factors for PLC complicating PVTT.