不可手术的原发性肝癌放疗效果影响因素及预后分析

Analysis of efficiency and influence factor of intensity- modulated radiotherapy for inoperable primary hepatocellular carcinoma

目的:探讨三维适形/适形调强放疗对不可手术的原发性肝癌的治疗效果、不良反应以及影响疗效和预后的相关因素。方法:回顾性分析2013年7月至2016年5月我院45例行放疗的不可手术的原发性肝癌患者(其中12例合并静脉癌栓,33例曾行肝动脉化疗栓塞术)的临床资料。患者放疗结束后1~3个月观察近期疗效,随访1、2、3年,对影响疗效和预后的相关因素进行分析。结果:放疗后肝癌原发灶完全缓解(CR)4例(8.9%),部分缓解(PR)16例(35.5%),疾病稳定(SD)17例(37.8%),疾病进展(PD)8例(17.8%);静脉癌栓者CR 1例(8.33%),PR 3例(25.0%),SD 6例(50.0%)和PD 2例(16.67%)。肝癌原发灶及静脉癌栓放疗客观缓解率分别为44.4%和33.3%。放疗期间出现Ⅲ度以上的不良反应有恶心呕吐、骨髓抑制、食欲下降和疲乏等。影响放疗效果的因素有肿瘤直径、ΔCT值、肿瘤处方剂量以及是否曾接受介入治疗。45例患者1、2、3年生存率分别为59.8%、40.9%和2.22%。多因素分析结果显示,肿瘤体积、肿瘤分期、静脉癌栓是影响预后的重要因素。结论:三维适形/适形调强放疗对不可手术原发性肝癌疗效较好,不良反应患者可耐受。肿瘤的直径、血供、肿瘤处方剂量是影响肝癌放疗效果的关键因素,肿瘤体积、分期及是否合并静脉癌栓是影响预后的独立因素。

Objective:To investigate the efficacy,adverse reactions and influence factors of three-dimensional conformal/intensity modulated radiotherapy(3D-CRT/IMRT)for inoperable primary hepatocellular carcinoma(HCC).Methods:The clinic data of 45 patients with inoperable primary HCC who received 3D-CRT/IMRT in our hospital from July 2013 to May 2016 were retrospectively studied,including 12 patients with portal vein tumor thrombus,and 33 patients underwent transarterial chemoembolization(TACE)before radiotherapy.The short-term efficacy of the treatment was observed 1-3 months after radiotherapy.These patients were followed up for 1,2,and 3 years and the factors of influencing efficacy and prognosis were analyzed.Results:After radiotherapy,there were 4 cases(8.9%)complete remission(CR),16 cases(35.5%)partial remission(PR),17 cases(37.8%)stable disease(SD),and 8 cases progressive disease(PD)(17.8%)in primary liver leision.In the patients with venous thrombus,1 case was CR(8.33%),3 cases were PR(25.0%),6 cases were SD(50.0%)and 2 cases were PD(16.67%).Objective remission rates of primary liver leision and venous thrombus after radiotherapy were 44.4%and 33.3%,respectively.During the radiotherapy,the adverse reactions more than Ⅲ degree were nausea and vomiting,myelosuppression,loss of appetite and fatigue.Factors influencing the efficacy of radiotherapy included tumor diameter,ΔCT value,prescription dose and ever received interventional therapy.The 1-year,2-year and 3-year survival rates of the patients underwent 3D-CRT/IMRT were 59.8%,40.9% and 2.22%,respectively.Multivariate analysis showed that tumor volume,tumor stage and tumor venous thrombus were the important factors affecting prognosis.Conclusion:3D-CRT/IMRT is an effective method in the treatment of inoperable primary HCC with low adverse reactions and good tolerance.Tumor diameter,blood supply and radiotherapy dose are the key factors affecting the efficacy of radiotherapy on liver cancer,and tumor volume,stage and tumor thrombus are independent factors affecting the prognosis of patients.