调强放疗治疗TACE后复发或残留PHC的疗效评价

Efficacy of Intensity-Modulated Radiotherapy for Recurrent or Residual PHC after Transcatheter Arterial Chemoembolization

目的:评价经肝动脉化疗栓塞(TACE)联合调强放疗(IMRT)治疗复发性或残留性原发性肝癌(PHC)的临床疗效和毒性反应。方法:39例接受两次及以上TACE治疗复发或残留的PHC患者,19例进行调强放疗(IMRT),放疗剂量50~60 Gy/25~30F;20例TACE维持治疗。比较两组治疗前后肿瘤大小和甲胎蛋白(AFP)水平变化、毒副反应及生存期。结果:至随访时IMRT组和TACE组的有效率(CR + PR)和中位生存时间分别为63.2% vs 25.0%和20.2个月vs 13.7个月,差异有统计学意义(P = 0.016和P = 0.021),IMRT组AFP下降水平明显优于TACE组,不良反应I、II级肝功能损伤高于TACE组。结论:IMRT对TACE治疗后局部复发或残留的PHC患者具有良好的临床疗效,毒性反应可以耐受。

Objective: To evaluate the clinical efficacy and toxicity of transcatheter arterial chemoembolization (TACE) combined with intensity modulated radiotherapy (IMRT) in recurrent or residual primary hepatocellular carcinoma (PHC). Methods: Thirty-nine PHC patients with recurrence or residual PHC underwent no less than TACE 2 fractions. The nineteen were treated with intensive radiotherapy (IMRT) at a dose of 50 - 60 Gy/25 - 30F and twenty continued TACE therapy. The size of tumor, alpha fetoprotein (AFP) level, toxicities and survival times were assessed after treatment in two groups. Results: Objective response rate (CR + PR) and median survival time of IMRT and TACE group were 63.2% vs 25.0% and 20.2 months vs 13.7 months respectively. The difference was significant (P = 0.016 and P = 0.021). The decrease of AFP was better in the IMRT and adverse reactions of grade I and II liver injury were higher than the TACE. Conclusion: IMRT has a good clinical effect on PHC patients with partial recurrence or residual after TACE, and has acceptable toxicity.