原发性肝癌肝动脉热灌注化疗栓塞联合3DCRT的初步临床研究

Study on the Clinical Effects of Hepatic Arterial Perfusion Chemoembolization Combined with 3DCRT

目的探讨肝动脉热灌注化疗栓塞联合三维适形放射治疗（3DCRT）原发性肝癌的近远期疗效及其对血清肿瘤标志物的影响。方法选取2007年3月-2012年8月间于笔者医院诊治的原发性肝癌患者80例为研究对象，按照治疗方式的不同利用随机数字表法将患者分为肝动脉热灌注化疗栓塞联合3DCRT组（联合组）和单独肝动脉热灌注化疗栓塞组（单独组），每组各40例。对比观察两组患者的近远期临床疗效及血清肿瘤标志物的改变水平。结果单独组患者的治疗总体有效率为40．00％（16／40），明显低于联合组的72．50％（29／40，x^2=8．548，P=0．003）；而且，联合组的疾病控制率为97．50％（39／40）也显著高于单独组的82．50％（33／40，x^2=5．000，P=0．025）；但是，单独组和联合患者不良反应发生率比较差异无统计学意义（x^2=0．621，P=0．431）；另外，联合组患者中位生存时间为15．1个月，明显长于单独组患者的12．3个月（x^2=4．716，P=0．030）；尽管治疗结束两组患者的血清肿瘤标志物CEA、NSE、CYFRA21—1、CA125和CA129—9水平均明显降低，但联合组的改善幅度明显高于单独组，差异均具有统计学意义（P〈0．05）。结论肝动脉热灌注化疗栓塞联合3DCRT治疗能够提高原发性肝癌患者临床治疗效果并改善血清肿瘤标志物水平。

Objective To investigate short term and long term curative effect of hepatic arterial perfusion chemoembolization com- bined with threedimensional conformal radiotherapy （3DCRT） for primary hepatocellular carcinoma and their influence on the level of serum tumor markers. Methods The 80 cases of primary liver cancer patients from 2007 March to 2012 August in our hospital were selected as the research object, and they were divided into hepatic arterial perfusion chemoembolization combined with 3DCRT group （ combined - treatment group） and hepatic arterial perfusion chemoembolization group （ single - treatment group） , with 40 cases in each group. Short and long term clinical efficacy and serum tumor marker levels changes were compared between two groups. Results The overall efficiency of single -treatment group was 40% （16/40） , showing significantly lower than that of combined - treatment group of 72.50% （29/40 ,x^2 = 8. 548, P = 0. 003 ）. Also, The disease control rate of combined - treatment group was 97.50% （39/40） which significantly higher than that of single - treatment group of 82.50% （33/40,x^2= 5. 000, P = 0. 025） was the adverse reaction rate between combined -treatment group and single- treatment group showed no significant difference （x^2 = 0. 621, P = 0. 431 ）. The median survival time of combined - treatment group was 15.1 months, showing significantly longer than single - treatment group of 12.3 months （x^2= 4. 716, P = 0. 030）. Although the serum tumor markers CEA, NSE, CYFRA21 -1, CA125 and CA19 -9 of the two groups decreased obviously at the end of treatments, but the combined - treatment group showed significantly higher than that of single - treatment group （P 〈 0.05 ）. Conclusion Hepatic arterial perfusion chemoembolization combined with 3DCRT can improve the clinical therapeutic effect in patients with primary hepatocellular carcinoma and can improve the level of serum tumor markers.