术后后装放疗、吉西他滨化疗治疗原发性肝癌

Treatment of primary liver cancer with postoperative after-loading radiiotherapy and gemcitabine

目的:探讨术后后装放疗加吉西他滨全身化疗对原发性肝癌的治疗效果。方法:自1999年10月至2001年12月,将44例行肝癌切除术的原发性肝癌患者随机分为综合治疗组和对照组,每组22例。综合治疗组术中放置施源管3-6根,确定驻留点3-8个,术后3-10天行后装放疗,单次剂量10Gy,照射2-4次,总剂量20-40 Gy。放疗结束3周后,开始吉西他滨化疗,静滴1.4g每周1次,4周为1周期,每周期3次,共6个周期。对照组手术后不放、化疗。手术前后定期查血常规、肝功能、AFP、胸片、B超或CT。结果:综合治疗组后装放疗后AFP转阴率100%(17/17),对照组62.5%(10/16)(P<0.05);6月复发率0,低于对照组27.3%(6/22)(P<0.01);综合治疗组一年复发率18.2%(4/22)、转移率0和一年生存率100%(22/22),与对照组的45.5%(10/22)、13.6%(3/22)和77.3%(17/22)均有显著差异(P<0.05)。结论:术后后装放疗加吉西他滨全身化疗是提高原发性肝癌近期治疗效果,降低复发率和转移率的有效手段。

Purpose: To evaluate the effect of postoperative after-loading radiotherapy with the use of gemcitabine in 22 patients with primary liver cancer. Methods: From Oct 1999 to Dec 2001, 22 patients with primary liver cancer underwent postoperative after-loading radiotherapy 3-10 days after hepatectomy and chemotherapy using gemcitabine (1 400 mg every week for three weeks, repeated after one week interval, total cycles were 6), compared with 22 cases of sole hepatectomy. 3-6 catheters were placed for irradiation after hepatectomy. The single-dose of after-loading radiotherapy was 10 Gy, 2-4 sessions per person. Results: The rate of AFP negative-reversion was 100% (17/17) in the treated group, higher than in control group 62. 5% (10/16) (P<0. 05). In the treated group, the 1-year relapse rate, metastases rate and survival rate were 18. 2% (4/22), 0 and 100% (22/22), in the control group they were 45. 5% (10/22), 13. 6% (3/22) and 77. 3% (17/22). There were significant differences between the 2 groups in relapse rate, metastases rate and survival rate within a year(P<0. 05). Conclusions: Postoperative after-loading radiotherapy with gemcitabine is an effective way for the treatment of primary liver cancer.