单纯性适形放疗中晚期原发性肝癌的疗效评价

Value of conformal radio therapy for middle stage or advanced primary hepatocellular carcinoma

目的初步评价单纯性立体定向适形放射治疗技术应用于中晚期肝癌的临床疗效.方法立体定向适形放射治疗系统治疗198例原发性中晚期肝癌患者,6 MV x射线使90%等剂量曲线包绕100%的剂量体积,照射剂量48～63 Gy/6～9 f,共12～18 d.结果治疗后不同阶段复查CT.198例病人中,1个月后部分缓解41%(81/198),3个月后为48%(95/198),半年后94%(186/198),无变化为5%(10/198),进展为1%(2/198);门脉癌栓消退率65.6%(31/48).Ⅲ期肝癌病人1年生存率68%(40/59),2年生存率41%(24/59),3年生存率35%(21/59).3年生存的21例肝癌患者中,ⅢA期19例,ⅢB期2例.Ⅳ期肝癌治疗平均生存13个月,最长达25个月.43例治疗前肝功能正常的患者治疗后肝功能均无明显变化.155例肝功能不全的患者治疗后6个月肝功能较治疗前无显著差异性(P＞0.05).结论立体定向适形放射治疗是治疗中晚期肝癌有效的无创治疗手段.

Objective To evaluate the value of conformal radio therapy in the treatment of primary hepatocellular carcinoma (HCC) in advanced stages. Methods Altogether 198 patients with advanced HCC underwent three-dimensional conformal radio therapy (3D-CRT) in a dose range 48 to 63 Gy in 6 to 9 fractions completed in a course of 12 to 18 d. The total clinical tumor volume (CTV) received more than 90% of the prescribed irradiation dose delivered through 6MV X ray. CT examinations were performed before 3D-CRT and in the three-year follow-up period to verify the therapeutic effects. Results Partial tumor remission was achieved in 81 cases (41%) 1 month after the treatment and 95 cases (48%) 3 months later. Ten cases (5%) failed to respond to the treatment, while the majority (186, 94%) showed tumor remission 6 months after the treatment, with only 2 cases (1%) had progression of the tumors. In the 48 patients with cancer embolus in the portal vein, 31 (65.6%) showed evidence of diminished embolus. The alpha-fetoprotein levels in the HCC patients were reduced significantly after the treatment (P=0.015). Among the stage-Ⅲpatients 1-year survival rate was 68%, 2-year survival rate was 41%, and 3-year survival rate was 35%. Conclusion3D-CRT is an effective method for treating advanced HCC.