28例大肝癌立体定向放疗疗效观察

Observation of clinical efficacy of stereotactic body radiotherapy in 28 cases of large hepatocellular carcinoma

目的观察立体定向放疗大肝癌的生存及不良反应。方法对2011-2014年在三0二医院收治的28例单发大肝癌行立体定向放疗患者进行观察。PTV处方剂量39~61 Gy分3~9次,其中20例同步介入治疗。Kaplan-Meier法计算总生存、无进展生存、局控率,Cox模型对总生存率影响因素进行分析,Logistic回归分析对放射性肝损伤的影响因素。结果1、2、3、5年总生存率分别为75%、57%、54%、22%,无进展生存率分别为59%、47%、36%、18%,局控率分别为92%、86%、86%、86%。4例患者出现放射性肝损伤,无因放射性肝损伤死亡病例。Child-Pugh分级是总生存率和放射性肝损伤的影响因素。结论初步认为立体定向放疗是大肝癌患者的可替代的安全的治疗手段。

Objective To observe the survival and side effects of stereotactic body radiotherapy (SBRT) in large hepatocellular carcinoma (HCC) patients. Methods Twenty-eight large HCC patients undergoing SBRT in 302 Military Hospital from November 1, 2011 to January 31, 2014 were observed. The prescribed dose was 39-61 Gy/3-9f. Among them, 20 patients simultaneously received transcatheter arterial embolization. The overall survival (OS), progression-free survival (PFS) and local control (LC) rates were calculated by using Kaplan-Meier method. The influencing factors of OS were analyzed by Cox regression model. The influencing factors of radiation-induced liver disease (RILD) were identified by using Logistic regression analysis. Results The 1-, 2-, 3-and 5-year OS rates were 75%, 57%, 54% and 22%, respectively. The 1-, 2-, 3-and 5-year PFS rates were 59%, 47%, 36% and 18%, respectively. The 1-, 2-, 3-and 5-year LC rates were 92%, 86%, 86% and 86%, respectively. Four patients suffered from RILD and none died from RILD. Child-Pugh classification was the influencing factor of OS and RILD. Conclusion It is preliminarily believed that SBRT is an alternative and safe treatment for patients with large HCC.