原发性肝癌超分割放射治疗辅以肝动脉化疗的临床研究

Hyperfractionation radiotherapy combined with hepatic artery catheterization chemotherapy for unresectable primary liver cancer

目的 分析比较Ⅱ期不能手术的原发性肝癌施行超分割放射治疗辅以肝动脉插管化疗、肝动脉结扎 (A组 6 5例 )与常规分割放射治疗辅以肝动脉插管化疗、肝动脉结扎 (B组 6 5例 )的疗效。方法 全组 130例均经剖腹探查判定不能手术。分期为Ⅱ期 ,且经病理学诊断。分组系根据探查时间顺序采用单、双号的原则。 2个组均先化疗后放射 ,且 6d/周化疗 ,3d/周超分割或 5d/周常规分割放射治疗交替夹心。肝动脉化疗采用顺铂 10mg滴注。放射治疗采用 6～ 8MVX射线或60 Coγ射线 ,超分割采用 2 5 0cGy/次 ,2次 /d。结果 A组的甲胎蛋白定量下降一半者占 89.7% (35 / 39) ,B组占6 7.6 % (2 5 / 37)。A组 1、3、5生存率为 90 .8%、6 3.1%、2 3.1% ,B组分别为 73.9%、4 1.5 %、9.2 % ,A组高于B组 (P <0 .0 5 )。A组的PR率、Ⅱ步手术切除占总例数的比例分别为 90 .8%、35 .4 % ,B组分别为 70 .8%、12 .3% ,A组高于B组 (P <0 .0 1)。两组主要不良反应相近 (P >0 .0 5 )。结论 超分割放射治疗辅以肝动脉插管化疗、肝动脉结扎 ,系治疗不能手术肝癌有效、合理的治疗方案。该方案能有效地减轻症状、缩小瘤体、提高手术切除率、延长生存期 ,且操作较为简单易行。

Objective To compare the effect of hyperfractionation radiotherapy combined with hepatic artery catheterization chemotherapy and hepatic artery ligation (group A, 65 patients) with conventional fractionation radiation combined with hepatic artery catheterization chemotherapy and hepatic artery ligation (group B, 65 patients) for unresectable primary liver cancer.Methods A total of 130 stage Ⅱprimary liver patients confirmed by pathology and evaluated as unresectable by exploratory laparotomy were divided evenly into group A and group B by the sequence of exploration. The two groups were comparable in age, sex, tumor type and positive fetal protein (AFP). Group A patients were treated by hepatic artery chemotherapy (PDD, 10 mg/day) 6 days a week with hepatic artery ligation followed by hyperfractionation radiotherapy (250 cGy/f, bid) 3 days a week with the scheme alternated weekly. Group B patients were treated by conventional fractionation radiotherapy with the same scheme of chemotherapy as group A. The total dose of PDD and radiotherapy for both groups were 240 mg and 45Gy. Results The AFP level was reduced to half in 89.7% of patients in group A and 67.6% in group B. The 1 , 3 and 5 year survival rates were 90.8%, 63.1%, 23.1% for group A and 73.9%, 41.5% 9.2% for group B, the difference was statistically significant (P<0.05). The PR rate and step Ⅱ surgical resection rate were 90.8%, 35.4% for group A and 70.8%, 12.3% for group B with the difference also significant (P< 0.01 ). The toxic reactions were similar in the two groups (P>0.05). Conclusions Hyperfractionation radiotherapy combined with hepatic artery catheterization chemotherapy and hepatic artery ligation is an effective and reasonable therapeutic scheme for unresectable liver cancer. It can effectively relieve symptoms, reduce the tumor, increase second surgical resection rate and prolong the survival. At the same time, the operation is simple and relatively easy.