肝动脉栓塞化疗联合立体定向放射治疗原发性肝癌的疗效分析

摘要

Objective:To analyse the therapeutic effects and side -effect of the transcatheter arterial chemoembo-lization(TACE)combined with stereotactic body radiation therapy (SBTR)for patients with unresectable hepatocel-lular carcinoma.Methods:All 96 cases of advanced hepatocellular carcinoma were divided into 2 groups,44 cases in therapy group treated with TACE and SBTR,52 cases in control group treated with TACE alone.For TACE,(30 ~50) mg epirubicin,(1 000 ~1 500)mg 5 -fluorouracil and /or (40 ~60)mg cisplatin were perfused into the hepatic arter-ies,(3 ~18)ml iodized oil was given to emobolized the hepatic arteries.For SBRT,LUNA -260 whole body -gamma knife radiosurgery was used,≥50% isodose curve included PTV,and the total treatment dose was 30 ~50Gy/5 ~12f,5 times per week.Average dose of liver <23Gy,V30 <30%.Results:For therapy group and control group,average TACE were 2.0(1 ~6)and 3.6(1 ~7)times.Medium survival time(MST)were 18.1 and 10.6 months respective-ly.The 2 year's local control rates were 42.5% and 32.8% respectively,and 3 year's local control rates were 35.8%, 22.5%(P =0.044,P =0.040).For therapy group,2 and 3 years survival rates were 40.5% and 32.2% respective-ly,and for control group,they were 29.2% and 20.3% respectively.All of them showed a statistically significant differences for 2 and 3 year's survival rates(P =0.048,P =0.032).There were 2 cases with radiation induced liver disease(RILD)in therapy group.Conclusion:The efficacy of TACE combined with SBRT is superior to that of TACE alone for advanced hepatocellular carcinoma.The side -effect is moderate and clinical acceptable.%目的：分析肝动脉栓塞化疗（TACE）联合立体定向放射治疗（SBRT）不能手术的原发性肝癌的疗效及毒副反应。方法：96例不能手术的原发性肝癌患者，TACE 联合 SBRT 治疗44例（研究组），单纯 TACE 治疗52例（对照组）。TACE 灌注化疗药物为：氟尿嘧啶（5－FU）（1000～1500）mg 和／或顺铂[DDP（40～60） mg]，表阿霉素（E －ADM）（30～50）mg，栓塞剂为超乳化碘油（3～18）ml。SBRT 采用月亮神立体定向伽玛射线旋转聚焦全身放射治疗系统，≥50％等剂量线包绕 PTV，单次剂量3～6Gy，5次／周，照射总量30～50Gy。结果：研究组和对照组的 TACE 平均次数分别为2．0（1～6）和3．6（1～7）。中位生存期分别为18．1个月和10．6个月。两组2年局部控制率分别为42．5％、32．8％，3年局部控制率分别为35．8％、22．5％，两组比较有显著的统计学意义（P ＝0．044，P ＝0．040）。2年生存率分别为40．5％、29．2％，3年生存率分别为32．2％、20．3％，2年、3年总生存率比较两组均有统计学差异（P ＝0．048，P ＝0．032）。研究组发现 2例放射诱发的肝病。结论：TACE 联合 SBRT 比单纯 TACE 对不能手术的原发性肝癌治疗疗效好，毒副反应未增加。