原发性肝癌合并门静脉和下腔静脉癌栓的调强放疗疗效分析

Intensity modulated radiation therapy for primary liver cancer with portal vein/inferior vena cava tumor thrombosis

目的：观察调强放疗治疗原发性肝癌（primary liver cancer，PLC）合并门静脉（portal vein tumor thrombosis，PVTT）和（或）下腔静脉癌栓（inferior vena cava tumor thrombosis，IVTT）的效果及预后影响因素。方法：回顾分析2013年1月至2015年5月在武警北京总队第三医院放疗中心接受调强放疗（intensity modulated radiation therapy，IMRT）的41例PLC合并PVTT和（或）IVTT患者，放疗等效生物剂量（BED）48～94 Gy。观察其近期、远期疗效，Log-rank法进行单因素分析，Cox模型进行多因素预后分析。结果：全组患者治疗不良反应轻微，≥2级消化道反应、血液学毒性及放射性肝损伤发生率分别为29.3%、26.8%、14.6%。放疗后CR、PR、SD、PD者分别为29.3%、31.7%、39.0%和0，客观有效率61.0%。全组患者1年生存率34.1%，中位生存期11个月。单因素分析中Child-Pugh分级、治疗后AFP水平、治疗前胆碱酯酶水平是影响预后的因素（P=0.012、0.004、0.001）。结论：IMRT是治疗PLC合并PVTT的一种安全有效的方法。

Objective：To evaluate the clinical outcomes of patients after intensity modulated radiation therapy （IMRT） for hepatocellu-lar carcinoma （HCC） with portal vein tumor thrombosis （PVTT） or inferior vena cava tumor thrombosis （IVTT）. Methods：A registry data-base of 41 patients treated with IMRT for HCC with PVTT or IVTT in Radiotherapy Center of No.3 Hospital of Beijing Chinese People Armed Police Forces between January 2013 and May 2015 were analyzed retrospectively. The biological effective dose of radiation was ranged 48-94Gy. Short-term effects and prospective efficacy were observed. Log-rank test, Cox regression were used for survival analysis and prognostic factor identification. Results： Grade 2 or higher level gastrointestinal reaction was observed in 12 patients （29.3%）. Hematological toxicity was observed in 11 patients （26.8%）, and radiation-induced liver disease was observed in 6 patients （14.6%）. We found that 29.3%of patients achieved a complete response and 31.7%of patients achieved a partial response. The stable and progressive disease rates were 39.0%and 0.0%, respectively. Median patient survival was 11 months, and the 1-year survival rate was 34.1%. The significant independent variables associated with the overall survival included Child-Pugh grade, AFP test, and CHE lev-el. Conclusion：IMRT is a safe and effective treatment for PVTT or IVTT in patients with HCC.