TACE联合调强放疗对不可切除原发性肝癌的疗效研究

Therapeutic efficiency of transcatheter arterial chemoembolization combined with intensity modulated radiation therapy against un-resectable primary hepatocellular carcinoma

目的对不可切除的原发性肝癌经动脉化学栓塞(TACE)联合调强放疗(IMRT)治疗后病人的生存率、局部无进展生存期(LPFS)和不良反应进行分析,并探讨联合治疗的安全性和有效性。方法回顾性分析2013年1月—2015年12月于上海东方肝胆外科医院放疗科接受治疗的98例不可切除的原发性肝癌病人,其中男66例,女32例,年龄34～79岁,平均(57.7±4.5)岁。随机分为单纯TACE治疗组49例,TACE联合IMRT组49例,每6个月复查,随访时间2年。单纯TACE治疗组与联合治疗组首要的观察指标包括肿瘤局部控制率、总生存期(OS)和LPFS。次要的观察指标为不良反应发生率,包括乏力、肝肾功能损伤、骨髓抑制反应及胃肠道反应。2组间数据的比较采用χ~2检验。采用Kaplan-Meier法绘制生存曲线,2组间生存指标比较采用log-rankχ~2检验。结果截至2017年12月底,中位随访时间12个月(1～24个月),共有53例病人死亡(TACE组死亡31例,TACE联合IMRT组死亡22例),45例病人生存。TACE联合IMRT组的治疗总有效率、总生存率和中位生存时间、LPFS均高于单纯TACE治疗组(均P<0.05)。联合治疗组不同级别中性粒细胞减少和血小板减少的发生率均高于单纯TACE治疗组(均P<0.05),2组间肝肾功能损伤和胃肠道的不良反应发生率差异均无统计学意义(均P>0.05)。结论虽然联合治疗组比单纯TACE治疗组的不良反应发生率高,但能够提高不可切除的原发性肝癌病人的生存率,延长中位生存时间和LPFS,TACE联合IMRT可以作为一种可靠而有效的治疗方法。

Objective Survival rate,local progression-free survival(LPFS)and adverse reactions of patients treated with transcatheter arterial chemoembolization(TACE)combined intensity modulated radiotherapy(IMRT)were analyzed for unresectable primary liver cancer.The safety and efficacy of combined therapy were also discussed.Methods A retrospective analysis was conducted on 98 patients with primary liver cancer from January 2013 to December 2015 in radiotherapy center,Shanghai eastern hepatobiliary surgery hospital,Forty-nine cases were randomly selected and treated with TACE,the other 49 cases were treated with TACE combining IMRT.Among them,66 were males and 32 were females,age ranging from 34 to 79 years,with an average age of 57.7±4.5 years.The patients were re-examined after every 6 months,with the total follow-up period for 2 years.The primary observation indicators of TACE group and combination group included local tumor control rate,total survival time(OS)and LPFS.Secondary observation indicators were incidence of adverse reactions,including fatigue,liver and kidney dysfunction,bone marrow suppression and gastrointestinal reaction.The inter-group comparison was performed byχ~2 test.The Kaplan-Meier survival curve was used,and the log-rankχ~2 was used to compare survival indices between two groups.Results Till the end of December 2017,the median follow-up period was 12(1-24)months,53 patients died(31 in the TACE group,22 in the TACE+IMRT group),and 45 patients were alive.Total effective rate,overall survival rate,median survival time and LPFS of TACE combined with IMRT group were higher than those of TACE group(all P<0.05).The incidence of neutropenia and thrombocytopenia at different levels in combined treatment group was higher than that in the TACE group(all P<0.05).There was no significant difference in incidence of liver and kidney injury and gastrointestinal adverse reactions between two groups(all P>0.05).Conclusion Although incidence of adverse reactions in combined treatment group were higher than that in TACE group at different levels,it can improve survival rate of unresectable primary hepatocellular carcinoma patients,prolong median survival time and local progressionfree survival time.which can be considered as an reliable and effective treatment method.