原发性肝癌放射治疗的疗效及放射性肝损伤的相关影响因素分析

Curative effect of radiotherapy on primary liver cancer and the correlative influencing factors of radiation liver injury

目的观察原发性肝癌放射治疗疗效和放射性肝损伤(RILD)的影响因素及不同放射剂量对生存率的影响。方法选择2011―2018年中国人民解放军联勤保障部队第九〇一医院无法手术治疗的肝癌病人175例,放射治疗总剂量为30~60 Gy之间,单次剂量范围为1.8~4.0 Gy,每周3~5次。评价放疗疗效和放射性肝损伤,比较影响疗效的各因素之间的关系,分析不同剂量对生存率的影响。结果治疗结束3个月,客观缓解率(CR+PR)为58.86%,单次剂量>3~4 Gy,而总剂量>50~60 Gy显示更好的近期疗效(P<0.05),但剂量对生存率的影响差异无统计学意义(P>0.05),性别、child-pugh分级、经肝动脉化疗栓塞术(TACE)、分期对近期疗效的影响差异有统计学意义(P<0.05),年龄、病毒感染、癌栓对近期疗效的影响差异无统计学意义(P>0.05)。分割剂量、年龄、child-pugh分级、分期对放射性肝损伤的影响差异有统计学意义(P<0.05),总剂量对放射性肝损伤的影响差异无统计学意义(P>0.05)。结论性别、child-pugh分级、TACE术、分期、分次剂量及总剂量与肝癌近期疗效有关,剂量的差异与生存率无关,大分割RILD发生率高,年轻、child-pughA级、分期早的病人放射性肝损伤发生率相对低。

Objective To observe the effect of radiotherapy on primary liver cancer and the influence factors of radiation induced liver damage,as well as the effect of different radiotherapy doses on survival rate.Methods One hundred and seventy-five cases of liv⁃er cancer who could not be treated surgically in the 91st Hospital of the Joint Service Force of the Chinese People's Liberation Army from 2011 to 2018 were selected.The total dose of radiotherapy was between 30 Gy and 60 Gy,and the single dose was between 1.8 Gy and 4 Gy,3 to 5 times a week.The efficacy of radiotherapy and radiation liver injury were evaluated,the relationship between the factors that affect the efficacy was compared,and the impact of different doses on survival was analyzed.Results After 3 months of treatment,the objective response rate(CR+PR)was 58.86%,single dose>3-4Gy,and total dose>50-60 Gy,which showed better short-term effi⁃cacy(P<0.05),but there was no statistically significant difference in the dose effect on the survival rate(P>0.05);there were statistically significant differences in the effects of gender,child-pugh grade grade,transhepatic arterial chemoembolization(TACE),and staging on the short-term efficacy(P<0.05);there was no statistically significant difference in the effects of age,virus infection,the effect of tu⁃mor emboli on the short-term curative effect(P>0.05).The effect of dose segmentation,age,child-pugh grade and stage on radioactive liver injury was statistically significant(P<0.05),there was not statistically significant difference in the effect of total dose on radiation induced liver damage(P>0.05).Conclusions Gender,child-pugh grade,TACE,staging,fractional dose,and total dose are related to the short-term efficacy of liver cancer,and the dose difference is not related to survival rate.The incidence of large segment RILD is high,while the incidence of radiation induced liver damage is relatively low in young,child-pugh grade A,and early stage patients.