TACE联合RFA及125I放射性粒子植入治疗巨块型肝癌的临床效果

Clinical effect of TACE combined with RFA and 125I radioactive seed implantation in treatment of massive liver cancer

目的:研究肝动脉化疗栓塞术(TACE)联合射频消融(RFA)及^125Ⅰ放射性粒子植入治疗直径≥10 cm的巨块型肝癌的临床效果。方法:选取经我院临床或病理确诊的直径≥10 cm肝癌患者54例,分为对照组28例,行TACE+RFA治疗;联合组26例,行TACE+RFA+^125Ⅰ放射性粒子植入治疗;比较两组的治疗有效率和临床控制率;所有患者随访1~37个月,采用Kaplan-Meier方法对两组的生存情况进行分析,Log-rank检验比较生存曲线的差异。结果:联合组的有效率高于对照组(61.5% vs. 32.1%),差异有统计学意义(χ^2=4.685,P=0.030)。联合组的中位无进展生存期(PFS)为9个月,高于对照组的5个月,差异有统计学意义(P=0.010)。联合组的中位生存时间11个月,对照组中位生存时间6个月,联合组较对照组有延长趋势,但差异无统计学意义(P=0.079)。结论:对于直径≥10 cm的巨块型肝癌,TACE、RFA和125I放射性粒子三者序贯治疗在肿瘤无进展生存期、肿瘤缓解率方面较对照组治疗具有优势,实现了化疗栓塞、消融与局部放疗协同作用,不良反应小。

Objective: To investigate the clinical value of transarterial chemoembolization(TACE) combined with radiofrequency ablation(RFA) and ^125Ⅰ radioactive seed implantation for the treatment of liver cancer(≥10 cm). Methods: Fifty-four patients with live cancer clinical or pathological verified of ≥10 cm in our hospital were selected, and all patients underwent TACE. Patients were randomly divided into radiofrequency ablation group(TACE+RFA, control group, n=28) and RFA plus ^125Ⅰ radioactivity seed implantation group(TACE+RFA+^125Ⅰ, combined group, n=26). All patients were followed up for 1 to 37 months. The treatment efficiency and clinical control rate were compared between the two groups. Survival analysis was performed by Kaplan-Meier. Log-rank test was used to compare the survival curves. Results: The effective rate of the combined group was higher than that of the control group(61.5% vs. 32.1%), with significant difference(χ^2=4.685,P=0.030). The median PFS in combined group and control group was 9 months and 5 months(P=0.010), and the OS in combined group was longer than that in control group(11 months vs. 6 months,P=0.079). Conclusions: The sequential therapy with TACE, RFA and radioactive particle has advantages in treating liver cancer with the diameter ≥10 cm. The PFS and tumor remission rate in combined group were more favorable than those in control group.