125I粒子植入或3DCRT联合TACE治疗晚期原发性肝癌患者临床疗效对比研究

Clinical comparison of 125I seed implantation or 3DCRT and TACE combination in treatment of patients with advanced hepatocellular carcinoma

目的研究125 I粒子植入或者三维适形放射治疗(3DCRT)联合肝动脉化疗栓塞(TACE)治疗肝细胞癌(HCC)患者的临床疗效。方法采用随机数字表法将92例HCC患者分为观察组和对照组,每组46例。在观察组,采用125 I粒子植入联合TACE治疗,对照组患者接受3DCRT联合TACE治疗。检测血清甲胎蛋白(AFP)、甲胎蛋白异质体(AFP-L3)和高尔基体蛋白73(GP73)。结果治疗后第4周时,观察组和对照组疾病控制率分别为62.5%和57.5%(P>0.05)],观察组和对照组1 a生存率分别为52.5%和45.0%(P>0.05)];治疗前和治疗后1月,两组血清AFP、AFP-L3和GP73水平比较,差异均无统计学意义(P>0.05);在治疗期间,两组白细胞降低、贫血、血小板降低和胃肠道反应发生率比较,差异均无统计学意义(P>0.05),观察组放射性肝损伤严重程度较对照组显著减轻,差异有统计学意义(P<0.05)。结论采用TACE治疗晚期肝癌患者短期有效,与125 I粒子植入或3DCRT联合治疗可提高疗效,但联合125 I粒子植入可能副反应更轻。

Objective The purpose of this study was to observe the clinicalefficacy of 125 I seed implantation or 3-dimensional conformal radiation therapy(3DCRT)and transcatheter artery chemoembolization(TACE)combination in treatment of patients with advanced hepatocellular carcinoma(HCC).Methods 92 patients with advanced HCC were recruited and were randomly divided into observation and control group,with 46 cases in each group.The patients in observation group were treated with 125 I seed implantation and TACE combination,and those in the control group were treated with 3D CRT combined with TACE.The short-term efficacy was evaluated and adverse reactions were recorded.Serum alpha-fetoprotein(AFP),alpha-fetoprotein heterogenous L3(AFP-L3)and Golgi protein(GP73)were detected.Results The disease control rates at 4th week after treatment in the observation and the control group were 62.5%and 57.5%(P>0.05),and the 1-year survival rates in the two groups were 52.5%and 45.0%(P>0.05);at presentation and one month after treatment,there wereno significant differences as comparison of serum AFP,AFP-L3 and GP73 levels in the two groups(P>0.05);the incidences of leucopenia,anemia,thrombocytopenia,and gut reaction during the treatment in the two groups were notsignificantly different(P>0.05),while the incidence of radiation-induced liver injury in the observation group was much lower than that in the control(P<0.05).Conclusion The short-term efficacy of 125 I seed implantation combined with TACE in the treatment of patients with advanced HCC is similar to that of 3D CRT combined with TACE,while the former is safer a mild side effects occur.