原发性肝癌介入治疗结合三维适形放射治疗疗效观察

Transcatheter arterial chemoembolization combined with 3-dimensional conformal radiotherapy for unresectable primary hepatic carcinoma

目的 评价肝动脉化疗栓塞 (TACE)结合三维适形放射治疗 (3DCRT)对原发性肝癌(PHC)的疗效。方法 对 94例不能手术切除的原发性肝癌患者 ,采用先TACE后 3DCRT相结合 ,观察疗效及生存率 ,并以Cox回归模型分析预后因素。 94例中单发病灶 82例 ,多结节病灶 12例。TACE1次者 5 9例 ,1次以上者 35例。放射治疗剂量 4 2～ 5 2Gy者 4 2例 ,5 3～ 6 0Gy者 5 2例。结果 治疗后 3个月、1年的肿瘤局部有效率分别为 90 .4 % (85 / 94 )、83.0 % (78/ 94 ) ;其中前者完全缓解 12例 ,部分缓解 73例 ,稳定 6例 ,进展 3例。 1、2、3年生存率分别为 93.6 %、5 3.8%、2 6 .0 % ,中位生存期 2 5 .0个月。多因素分析结果显示Child分级、临床分期及肿瘤数目对放射治疗后患者生存率的影响具有统计学意义。结论 TACE结合 3DCRT是治疗PHC的有效无创治疗手段。

ObjectiveTo evaluate the effects of transcatheter arterial chemoembolization (TACE) combined with 3-dimensional conformal radiation therapy(3DCRT )for unresectable primary hepatic carcinoma (PHC). MethodsNinety-four patients with unresectable PHC were initially treated with TACE and then sequentially with 3DCRT. The therapeutic effect and survival rate of the patients were assessed as endpoints with Cox proportional hazard model used to define prognostic factors. Of these 94 patients,82 presented with a solitary lesion and 12 with multiple ones. Fifty-nine patients received only one course of TACE while 35 several courses. The total radiation dose of 42-52 Gy was delivered to 42 patients, and 53-60 Gy to 52. ResultsThe local response rates were 90.4% (85/94) in 3 months and 83.0% (78/94) in 1 year after treatment with 12 CR,73 PR,6 NR and 3 PD. The 1-,2-,and 3-year survival rates were 93.6%,53.8% and 26.0% respectively,with a median survival duration of 25.0 months. In the multivariate analysis,the number of tumor lesion,Child's classification and clinical stage presented prognostic significance for overall survival (P<0.05).ConclusionTranscatheter arterial chemoembolization combined with 3DCRT is an effective,favored and feasible approach with minimal trauma in the treatment of unresectable liver cancer.