射波刀联合经肝动脉化疗栓塞治疗原发性肝癌患者疗效研究

Cyberknife stereotactic radiotherapy and transcatheter arterial chemoembolization as an option of treatment for patients with primary liver cancer

目的观察采用射波刀联合经肝动脉化疗栓塞(TACE)治疗原发性肝癌(PLC)患者的疗效。方法2016年1月~2019年5月在我院肝病科和上海长海医院诊治的PLC患者58例,被随机分为TACE治疗组29例和TACE联合射波刀立体定向放射治疗29例。结果术后随访,联合组总有效率为82.8%,显著高于TACE组的58.6%(P<0.05);治疗后,联合组血清血管内皮生长因子(VEGF)水平为(200.4±20.6)pg/ml,显著低于TACE组[(326.5±31.5)pg/ml,P<0.05],基质金属蛋白酶(MMP)水平为(30.16±28.9)ng/L,显著低于TACE组[(74.2±7.5)ng/L,P<0.05],甲胎蛋白(AFP)水平为(632.5±60.3)μg/L,显著低于TACE组[794.6±71.8)μg/L,P<0.05];治疗后,联合组血清丙氨酸氨基转移酶(ALT)水平为(48.4±2.7)U/L,显著高于TACE组[(35.4±4.0)U/L,P<0.05];联合组不良反应发生率为44.8%,与TACE组的48.3%比,无显著性差异(P>0.05)。结论采用TACE联合射波刀立体定向放射治疗PLC患者具有较好的临床疗效,其远期效果还有待于进一步观察。

Objective The aim of this study was to observe the short-term efficacy of cyberknife stereotactic radiotherapy(CSR)and transcatheter arterial chemoembolization(TACE)as the first line treatment for patients with primary liver cancer(PLC).Methods 58 patients with PLC were recruited in this study between January 2016 and May 2019,and were randomly divided into two groups.29 patients received TACE and other 29 patients underwent TACE and CSR.Serum vascular endothelial growth factor(VEGF),matrix metalloproteinase(MMP)and AFP were detected.Results The total effective rate in TACE and CSR combination group was 82.8%,significantly higher than 58.6%in TACE-treated group(P<0.05);after treatment,serum VEGF level in the combination-treated group was(200.4±20.6)pg/ml,significantly lower than[(326.5±31.5)pg/ml,P<0.05],serum MMP level was(30.16±28.9)ng/L,significantly lower than[(74.2±7.5)ng/L,P<0.05],and serum AFP level was(632.5±60.3)μg/L,significantly lower than[(794.6±71.8)μg/L,P<0.05]in the TACE-treated group;serum alanine aminotransferase level was(48.4±2.7)U/L,significantly higher than[(35.4±4.0)U/L,P<0.05]in TACE-treated group;the incidence of side effects was 44.8%,not significantly different compared to 48.3%in TACE-treated group(P>0.05).Conclusion The TACE and cyberknife stereotactic radiotherapy in treatment of patients with PLC non suitable for surgery has a good short-term clinical efficacy,which needs further investigation.