原发性小肝癌三维适形放疗的疗效评价

Evaluation of three-dimensional conformal radiation therapy for small primary hepatocellular carcinoma

目的观察三维适形放射治疗原发性小肝癌的临床疗效.方法对32例原发性小肝癌患者在CT定位下以5mm层厚靶区连续扫描,静脉双期碘造影剂增强扫描,精确定位治疗靶区并调整剂量分布,使100%等剂量曲线包绕100%PTV剂量体积.照射剂量-时间-分次为48～63 Gy-12～18 d-6～9次,以Varian600C/D直线加速器实现放疗计划.结果 1个月后13例部分缓解(40.6%);3个月后16例部分缓解(50%);半年后17例部分缓解(53.1%);1年后4例部分缓解(12.5%)、28例完全缓解(87.5%).随访3年,1年后生存率为100%、3年后1例死亡,死亡原因为脑出血.经统计分析,治疗前后肝功能无显著变化(P=0.15),治疗后甲胎蛋白较治疗前显著降低(P=0.025).结论三维适形放射治疗是原发性小肝癌有效的无创治疗手段.

Objective To evaluate the therapeutic effect of three-dimensional conformal radiation therapy (3D-CRT) on small hepatocellular carcinoma. Methods Between May 1998 and Dec 2002, 32 patients with small primary hepatocellular carcino-ma underwent 3D-CRT (mean total dose of 55 Gy, ranging from 48 to 63 Gy, given in 6 to 9 fractions completed within 12 to 18 d). The clinical target volumes (CTVs) were covered with 100% isodose curve, using 6 MV X-ray. CT studies before and during a follow-up period of 3 years after 3D-CRT were conducted to evaluate the therapeutic effects, with alpha-feto-protein (AFP) levels also tested. Results Completed remission of the tumor occurred in 87.5% (28/32) of the cases, and partial remis-sion (PR) was obtained in 12.5% (4/32) of the cases after one year. The 1-year survival rate at stage Ⅲwas 100%, and 2- and 3-year survival rates were both 97%, with death occurring only in one case because of cerebral hemorrhage. AFP levels of these patients with hepatocellular carcinoma were all significantly decreased (P=0.025). Conclusion3D-CRT is an effective method in the treatment of patients with small primary hepatocellular carcinoma.