伽玛刀治疗门静脉癌栓的疗效和安全性分析

Efficacy and safety of gamma-knife in the treatment of portal vein tumor thrombus

目的分析伽玛刀治疗原发性肝癌合并门静脉癌栓的疗效,为综合治疗提供依据。方法选择2010年1月至2014年12月中国武警总医院治疗的105例原发性肝癌合并门静脉癌栓患者,其中男性97例,女性8例;年龄12~71岁,平均年龄49岁。其中61例患者采用基础治疗加伽玛刀治疗(伽玛刀治疗组),44例仅行基础治疗(对照组)。局部放射治疗癌栓,单次给予3~6 Gy,8~15 F,总剂量给予30~60 Gy,50%等剂量曲线覆盖计划靶区(PTV)。治疗后测量门静脉癌栓的体积变化,不针对肝癌原发灶进行疗效评价,并随访生存情况。应用Kaplan-Meier法获得生存曲线,分析计算累积生存率。结果治疗1个月后评价近期疗效,伽玛刀治疗组19例(31.2%)癌栓完全缓解,16例(26.2%)癌栓部分缓解,23例(37.7%)癌栓稳定,3例(4.9%)癌栓进展,总有效率57.4%。对照组3例(6.8%)癌栓完全缓解,10例(22.7%)癌栓部分缓解,23例(52.3%)癌栓稳定,8例(18.2%)癌栓进展,总有效率29.5%。两组治疗总有效率比较,差异有统计学意义(χ^(2)=12.879,P<0.05)。随访时间12~48个月,伽玛刀治疗组生存时间3~24个月,中位生存期11个月,1年生存率为45%;对照组生存时间2~18个月,中位生存期7个月,1年生存率17%。两组中位生存时间比较,差异有统计学意义(P<0.05)。两组患者恶心呕吐、厌食、白细胞减少、贫血、血小板减少及肝功能损伤发生率比较,差异无统计学意义(P>0.05)。结论对于原发性肝癌合并门静脉癌栓,伽玛刀是一种安全并且有效的治疗方式。

Objective To evaluate the efficacy and safety of gamma-knife therapy in treatment of primary liver cancer(PLC)with portal vein tumor thrombosis(PVTT),and provide insights in comprehensive treatment.Methods From January 2010 to December 2014,105 PLC patients with PVTT were enrolled,which included 97 males and 8 females,aged 12-71 years old with mean age of 49 years old.All of them were divided into gamma-knife therapy group(n=61,basic treatment combined with gamma-knife therapy)and control group(n=44,only basic treatment).Based on the 50%isodose coverage of planning target volume(PTV),patients performed radiation dose with 3-6 Gy per fraction,8-15 fractions,and total marginal dose of 30-60 Gy focused on PVTT.The volume change of PVTT after treatment was measured,and short-term efficacy,overall survival,and adverse effect of treatment were evaluated.The Kaplan-Meier method was used to obtain survival curve,and cumulative survival rate was analyzed and calculated.Results The short-term efficacy was evaluated 1 month post treatment.In gammaknife therapy group,19 cases(31.2%)showed complete remission of PVTT,16 cases(26.2%)with partial remission,23 cases(37.7%)stable and 3 cases(4.9%)progressed,the total effective rate was 57.4%.In control group,3 cases(6.8%)showed complete remission of PVTT,10 cases(22.7%)with partial remission,23 cases(52.3%)stable and 8 cases(18.2%)progressed,the total effective rate was 29.5%.The difference of treatment total effective rate between 2 groups was statistically significant(χ^(2)=12.879,P<0.05).Follow-up for 12-48 months,gamma-knife therapy group survival time was 3-24 months with median survival time of 11 months,and 1-year survival rate was 45%.While in control group,survival time was 2-18 months with median survival time of 7 months,and 1-year survival rate was 17%.The difference in median survival time between 2 groups was statistically significant(P<0.05).There were no significant differences in incidence of nausea and vomiting,anorexia,leukopenia,anemia,thrombocytopenia and hepatic dysfunction between 2 groups(P>0.05).Conclusion It is demonstrated that gamma-knife is a safe and effective treatment for PLC with PVTT.