原发性大肝癌调强放疗的疗效及预后分析

Efficacy and prognostic factors of intensity-modulated radiotherapy for large primary hepatocellular carcinoma

目的探讨调强放射治疗对不适宜手术以及射频消融、介入等其他局部治疗无效的原发性大肝癌的临床疗效及预后影响因素。方法回顾性分析2008年4月-2011年8月武警总医院肿瘤内科收治的29例接受调强放疗的原发性大肝癌患者的临床资料。单次剂量2～6 Gy,5 F/w,总剂量50～70 Gy。观察近期疗效及预后。生存率计算采用Kaplan-Meier法,差异性检验采用Log-rank法,并采用Cox回归模型进行多因素分析。结果完全缓解率3.57%,部分缓解率32.14%,疾病稳定率53.57%,进展率10.72%,总体中位无进展生存时间（PFS）6.43个月,中位生存期（OS）11.43个月,1、2年生存率分别为46.79%和25.23%。单因素分析显示肿瘤缓解率为PFS的独立预后因子,Cox多因素分析显示PFS的独立预后因子为肿瘤缓解率和处方剂量,OS的独立预后因素为肿瘤缓解率、肿瘤直径、肿瘤体积。常见放疗急性不良反应为胃肠道不适、放射性肝损伤及骨髓抑制。结论调强放疗对于不能手术治疗及其他局部治疗无效的原发性大肝癌是一个安全、有效的选择。

Objective To investigate the efficacy of intensity- modulated radiotherapy（ IMRT） in treating large primary hepatocellular carcinoma（ LHCC） which is unsuitable for surgery or has poor response to radiofrequency ablation,interventional therapy,and other local treatments,and to identify the prognostic factors for survival. Methods We retrospectively analyzed the clinical data of 29 LHCC patients who received IMRT from April 2008 to August 2011. There were five fractions per week and the dose for each fraction was 2 to 6 Gy; the total dose was 50 to 70 Gy. The short- term efficacy and prognosis were observed and analyzed. The Kaplan- Meier method was used to calculate survival rates and the log- rank test was used for survival difference analysis. Multivariate analysis was performed using the Cox regression model. Results The complete remission,partial remission,stable disease,and disease progression rates were 3. 57%,32. 14%,53. 57%,and 10. 72%,respectively. The overall median progression- free survival（ PFS） time was 6. 43 months,and the median overall survival（ OS） time was 11. 43 months. The 1- and 2- year survival rates were 46. 79% and 25. 23%,respectively. Univariate analysis showed tumor response rate was an independent prognostic factor for PFS. The Cox proportional hazard model suggested the tumor response rate and prescribed dose were the independent prognostic factors for PFS. In addition,the independent prognostic factors for OS included tumor response rate,tumor diameter,and tumor volume. The common acute radiotherapy toxicities included gastrointestinal discomfort,radiation- induced liver damage,and myelosuppression. Conclusion IMRT is a safe and effective option for the LHCC patients who are unsuitable for surgery or in the cases that other local therapies fail.