肝动脉化疗栓塞、射频消融联合^125I粒子植入序贯治疗不可切除原发性肝癌疗效观察

Therapeutic Observation： Sequential Therapy of TACE Combined with RFA and ^125I Particle Im- plantation for Unresectable Hepatocellular Carcinoma

【目的】探讨肝动脉化疗栓塞（TACE）、射频消融（RFA）联合^125I粒子植入序贯治疗不可切除的原发性肝细胞肝癌（HCC）的临床疗效。【方法】收集2014年3月至2016年2月收治20例不可切除HCC患者（共32个癌灶，病灶大小3～12cm）。所有癌灶先进行TACE，1周后在CT引导下进行RFA，再过1周后在CT引导下进行^125I粒子植入治疗，^125I粒子植入采用术前TPS计划、术中CT引导下同轴法进行，粒子植入处方剂量（PD）为80～100Gy，术后即时或1周内CT检查传入TPS验证粒子植入质量。随访观察患者临床症状、甲胎蛋白（AFP）、肝功能、影像学（肿瘤体积）等改变情况以及临床疗效、肿瘤复发情况和相关并发症。【结果】20例患者治疗后临床症状均有明显缓解；AFP均有明显下降，与治疗前比较差异有统计学意义（P〈0．05）；ALT、TBIL、ALB均降低，但与术前比较差异无统计学意义（P〉0．05）；影像检查见：肿瘤片状坏死、有不同程度的碘油沉积、肿瘤体积较治疗前明显缩小（P〈0．05），增强后无明显强化；^125I粒子植入术后即时TPS验证结果：技术成功率为100％，即粒子植入质量很好，D9。〉MPD，1例CI=1，植入粒子剂量的不均匀度〈20％PD。随访时间3～24个月（平均12．7个月），全组肿瘤完全坏死率为93．75％（30／32），中位生存时间为11．2个月，半年和1年生存率分别为95％和75％。未出现严重并发症。【结论】TACE、RFA联合^125I子植入序贯治疗不可手术切除HCC，近期疗效明显，有望成为不可手术切除原发性HCC更有效的新的治疗模式。

[Objective]To discuss the clinical efficacy of the combined treatment of transcatheter aiterial chemoembolization （TACE）, CT-guided radiofrequency ablation （RFA） and radioactive ^125I particle implantation for unresectable hepatocellular carcinoma （HCC）.[Methods]Twenty patients with HCC were collected from March 2014 to February 2016 （a total of 32 cancer foci, 3-12 cm）. All cancers were inicially treated with TACE, 1 week later with RFA guided by CT, and with ^125I particle implantation under CT guidance another week later. ^125I particle implantation was performed by preoperative TPS and intraoperative CT guided coaxial method, The prescription dose （PD） of particle implantation was 80-100 Gy, CT detection was transferred into TPS immediately after operation to verify the quality of particle implantation. The changes of clinical symptoms, alpha fetoprotein （AFP）, liver function, imaging （tumor volume） and the clinical efficacy, tumor recurrence and related complications were observed through follow-up.[Results]20 patients were significantly relieved after treatment, AFP was significantly decreased compared with the conditions before treatment, the difference was statistically significant （ P 〈0.05）;ALT, TBIL and ALB were all decreased, but there was no significant difference （ P 〉0.05）; The imaging examination showed that the tumor necrosis, iodized oil deposition at different degree and the tumor volume were significantly reduced compared with those before treatment （ P 〈0.05）, and there was no obvious enhancement after enhancement; the immediate TPS verification after ^125I particle implantation showed that the technical success rate was 100%, that was, the quality of particle implantation was very good, D90 〉 MPD, CI= 1 in 1 case, the dose inhomogeneity of implanted particles was 20%PD. The follow-up time was 3- 24 months （mean, 12.7 months）, the complete necrosis rate of the whole group was 93.75% （30/32）, the median survival time was 11.2 months, and the half year and the 1 year survival rates were 95% and 75%, respectively. No serious complications occurred,[Conclusion]The recent curative effect of TACE, RFA combined with 125 1 particle implantation in the treatment of unresectable HCC is obvious, and it is expected to be a more effective therapy model for HCC.