血管内近程放疗与序贯三维适形放疗治疗门静脉主干癌栓的疗效对比

Endovascular brachytherapy vs. sequential three-dimensional conformal radiotherapy for the treatment of main portal vein tumor thrombus: a comparative study

目的比较血管内近程放疗(EVBT)与序贯三维适形放疗(3-DCRT)治疗门静脉主干癌栓(MPVTT)的安全性和疗效。方法对2012年5月至2014年6月接受支架植入和TACE治疗的176例肝细胞肝癌合并MPVTT患者的病历资料进行回顾性分析,其中123例(A组)同期在门脉主干内植入125I粒子条,余53例行序贯3-DCRT(B组)。比较两组患者的生存期、疾病无进展生存期、支架通畅期及治疗相关不良事件的发生率。结果无严重治疗相关不良事件发生。平均随访(11.7±8.3)个月,A组及B组的平均生存期分别为(11.7±1.2)和(9.5±1.8)个月(P=0.002),平均疾病无进展生存期分别为(5.3±0.7)和(4.4±0.4)个月(P=0.010),平均支架通畅期分别为(10.3±1.1)及(8.7±0.7)个月(P=0.003)。结论相对序贯3-DCRT,EVBT联合支架植入和TACE能显著延长HCC伴MPVTT患者的生存期。

Objective To compare the safety and efficacy of endovascular brachytherapy （EVBT） with those of sequential three-dimensional conformal radiotherapy （3- D CRT） in treating main portal vein tumor thrombus （MPVTT）. Methods The clinical data of a total of 176 hepatocellular carcinoma （HCC） patients complicated by MPVTT, who were treated with portal vein stenting and TACE during the period from May 2012 to June 2014, were retrospectively analyzed. Of the 176 patients, additional EVBT by using 125I seeds strand was carried out in 123 patients （group A） at the same time, and in the remaining 53 patients （group B） sequential 3-D CRT was conducted. The overall survival, progression free survival, stent patency period and the incidence of treatment-related complications were compared between the two groups. Results No serious treatment-related complications occurred after therapy. During a mean of （11.7±8.3） months follow- up period, the mean survival was （11.7±1.2） months in group A and （9.5±1.8） months in group B （P= 0.002）. The mean progression free survival in group A and in group B was （5.3±0.7） months and （4.4±0.4） months respectively （P=0.010）. The mean stent patency period in group A and in group B was （10.3±1.1） months and （8.7±0.7） months respectively （P=0.003）. Conclusion Compared to sequential 3-D CRT, EVBT combined with portal vein stenting and TACE can significantly improve the overall survival of patients with HCC complicated by MPVTF.（J Intervent Radiol, 2017, 26： 787-792）