Sequential transcatheter arterial chemoembolization,three-dimensional conformal radiotherapy,and high-intensity focused ultrasound treatment for unresectable hepatocellular carcinoma patients

The purpose of this study was to evaluate the outcome of patients with unresectable hepatocellular carcinoma（HCC） treated by sequential therapy of transcatheter arterial chemoembolization（TACE）,three-dimensional conformal radiotherapy（3-DCRT） and high-intensity focused ultrasound（HIFU）.From October,2005 to September,2010,120 patients with unresectable HCC received the sequential treatments of several courses of TACE followed in 2-4 weeks by 3-DCRT and then a single session of HIFU with a curative intent.The median tumor irradiation dose was 40 Gy.Tumor response,toxicity and overall survival rate were analyzed.Clinicopathologic factors affecting the primary technique effectiveness and overall survival rates were investigated by univariate analysis or multivariate analysis.All 120 HCC patients were followed up by the last follow-up time.Among these patients,hepatic toxicities due to treatment were notable in 9 cases.Gastrointestinal bleeding after the overall treatment occurred in 2 cases,leukopenia of grade III was detected in 1 case,radiation-induced liver disease（RILD） was observed in 2 patients,and first-and second-degree skin burn around the HIFU treatment zone were observed in 2 patients and 1 patient,respectively.Among 120 patients,23,83 and 14 cases achieved partial response,stable disease and progressive disease,respectively.The overall survival rates at 1 year,3 years and 5 years were 70%,35% and 15%,respectively,with a median survival time of 26 months.Both Child-Pugh liver function grading and radiation dose were determined to be independent predictors for overall survival revealed by the multivariate analysis.It is concluded that the sequential therapy of TACE,3-DCRT and HIFU is a promising therapeutic regimen for unresectable HCC.

TACE联合3-DCRT及热疗治疗中晚期原发性肝癌的疗效观察

目的 探讨肝动脉灌注栓塞化疗（TACE）联合三维适形放疗（3-DCRT）及热疗治疗中晚期原发性肝癌的疗效及不良反应.方法 对54例肝癌患者先行TACE治疗1～2次,一次TACE后行4次热疗;4周后行3-DCRT治疗,同时行热疗.放疗分割剂量2.6～3.0Gy/次,总剂量46～60Gy,热疗1周2次,间隔72h.观察近期疗效及不良反应.结果 54例肝癌患者治疗后,完全缓解（CR）13例（24.1%）;部分缓解（PR）35例（64.8%）;稳定（NC）4例（7.4%）;进展（PD）2例（3.7%）;总有效率（CR＋PR）为88.9%（48/54）.治疗后AFP均有不同程度的下降.1、2、3年生存率分别为77.8%、59.3%、40.7%.结论 TACE联合3-DCRT及热疗治疗中晚期原发性肝癌具有较好的疗效,不良反应无明显增加.

N0期胸段食管癌患者肿瘤长度、直径、体积对其放射治疗后生存状况的影响

目的:探讨N0期胸段食管癌患者肿瘤长度、直径、体积对其放射治疗后近远期生存状况的影响.方法:选取2007-01/2008-12河南省新乡市中心医院放疗科收治的88例N0期胸段食管癌患者为研究对象,分析患者原发肿瘤靶区(gross tumor volume,GTV)长度、直径、体积对其放疗后近远期生存状况的影响.结果:GTV长度≥5 cm组甲级率与5年生存率分别为14.29%、19.05%低于<5 cm组36.96%、43.48%,肿瘤最大直径>3 cm组甲级率为16.00%,5年生存率为20.00%,均低于直径≤3 cm组39.47%、47.37%,肿瘤体积≥35cm3组甲级率为14.58%,5年生存率为20.83%,均低于直径<35 cm3组40.00%、45.00%.经Cox风险模型分析可知,肿瘤长度、直径是影响患者近期及远期疗效的危险因素.结论:GTV长度、直径、体积可影响N0期胸段食管癌患者放疗后近期疗效及远期生存率,其中肿瘤长度及直径是影响患者近期疗效及远期生存状况的独立危险因素.

鼻咽癌常规放疗与三维适形放疗摆位误差的对比分析

目的通过鼻咽癌常规放疗与适形放疗摆位误差的比较，找出摆位时存在的问题，并找出解决方法。方法以进行放射治疗的40例鼻咽癌患者为对象，20例患者接受常规外照射，另外20例行适形放疗，对其摆位误差进行分析。结果40例患者共拍摄120张射野验证片。常规放疗组摆位误差x轴（3．95±2．10）mm、Y轴（3．50±2．03）mm和Z轴（3．02±2．10）mm大于适形放疗组的x轴（1．78±1．03）mm、Y轴（1．53±0．92）mm和z轴（1．60±1．11）mm。结论通过严格的质量控制和采用适形放疗可以减少摆位误差，有效地提高摆位的雷傅忡．

食管癌三维适形后程加速超分割放射治疗的疗效分析

目的 评价三维适形后程加速超分割放射治疗食管癌的疗效及放疗反应、并发症。方法 2002年2月至2004年5月，71例食管鳞癌随机分成两组，三维适形后程加速超分割组36例，食管病变上下外约4cm，前后、左右外约0．5～1cm作为PTV1，每次2GY，每周5次，DT40GY后，病变上下外约2cm，前后、左右外约0．5～1cm作为PTV2，每日2次，每次1．5GY，间隔4～6小时，总疗程6周，总剂量67GY／38次。非三维适形后程加速超分割组35例，时间、剂量、分割方式同适形组。所有病例均采用8MV—X外照射。结果 1、2、3年的生存率和原发肿瘤的局控率，与非适形后程加速超分割比较，适形组明显提高，分别为88．9％、75％、63．9％比68．6％、51．4％、40％和86．1％、72．2％、58．3％比65．7％、48．5％、34．3％。适形组的急性放射反应明显低于非适形后程加速超分割组，两组有显著差别。结论 本研究的初步结果表明食管癌适形后程加速超分割放射治疗的疗效优于非适形后程加速超分割组。