伽玛射线立体定向放射治疗早期原发性肝癌临床研究

Gamma stereotactic radiotherapy for early primary liver cancer

目的探讨体部伽玛刀放射治疗原发性肝癌的临床疗效。方法选取2011年6月至2014年6月解放军463医院收治的45例早期原发性肝癌患者为研究对象。采用体部伽玛刀治疗,治疗计划根据病灶大小及位置采用单靶点或多靶点照射;治疗单次剂量、总剂量及时间分割根据肿瘤大小、部位、全身状况、周围组织放射敏感性等决定。放射治疗后3个月进行近期疗效判定,观察患者的生活质量改善情况、病灶缓解率及不良反应发生情况。结果治疗后3个月复查腹部增强CT,完全缓解12例(26.7%),部分缓解27例(60.0%),总有效率为86.7%。甲胎蛋白(AFP)均见不同程度的下降,AFP<20μg/L有31例。肝区疼痛32例中,症状完全消失23例,减轻6例。半年后复查,局部无进展存活率78.0%,1年局部无进展存活率31.0%,2年后局部无进展存活率15.0%。无严重放射性肝炎、消化道出血等不良反应发生。结论体部伽玛刀放射治疗原发性肝癌安全有效,不良反应少或轻微,值得在临床上推广使用。

Objective To explore the clinical effect of gamma stereotactic radiotherapy for early primary liver cancer.Methods A retrospective study was performed on 45 patients with early primary liver cancer who were admitted from June 2011 to June 2014.Patients were performed gamma knife therapy,treatment plan were according to the size,position of lesions to perform single target of multiple target radiotherapy;the single dose,sub total dose and time division were according to size,position of lesions,whole body status,surrounding tissue radiation sensitivity.After 3 months of radiotherapy,short-term effect were evaluated,to observe the life quality changing status,lesions remission rate and adverse reactions.Results After treatment for 3 months reviewing abdominal enhanced CT,there were 12 cases（26.66%） of completely relieved,27 cases（60.00%） of partial relieved,and the total effective rate was 86.66%.A fetoprotein（AFP） all showed varying degrees of decline,31 cases with the AFP less than 20 μg / L.Among 32 cases of liver area pain,23 cases of complete resolution of symptoms,and 6 cases reduced.Check after half an year,local progression-free survival rate was 78%,1 year local progression-free survival rate was 31%,and 2 years after partial progression-free survival rate was 15%.No serious adverse reactions such as radiation hepatitis or gastrointestinal bleeding.Conclusion The gamma knife radiotherapy for primary liver cancer is safe and effective,with less or mild adverse reaction,wich is worth clinical promotion.