肝动脉栓塞化疗联合放疗治疗原发性肝癌的疗效分析

摘要

Objective:To analyse therapeutic effect and side - effect on the combined transcatheter arterial chemo-embolization(TACE)and radiotherapy for advanced primary liver cancer. Methods:All 52 cases of advanced liver cancer were divided into two groups. Therapy group 25 cases were treated by TACE combined radiotherapy,control group 27 cases by TACE. The median surviral time(MST),12,24 - months survival rate and average survival time (AST)between two groups were compared. Results:In therapy group and controlgroup,average TACE were 2. 4(1 - 6)and 3. 07(1 - 8)times,RR was 88% and 25. 9% ,MST was 22 and 5 months,AST was(14. 62 ± 1. 86)and(7. 47 ± 1. 29)months(P = 0. 0024),12,24 - months survival rate were(54. 31 ± 10. 95)% and(19. 94 ± 7. 91)% , (45. 26 ± 12. 31)% and(10. 64 ± 6. 51)%(P < 0. 05). Among 52 cases of TACE,complication were 8 cases of vomiting,abdominal pain of 16 cases,fever 18 of cases. Adverse reactions included 3 cases of Ⅳ degree neutropenia inhibition. There was no side - effect of radiotherapy. Conclusion:The efficacy of TACE combined radiotherapy is su-perior to that of TACE. The side - effect is moderate. It is an effective therapy for advanced liver cancer.%目的：分析肝动脉栓塞化疗（TACE）联合放射治疗对不能手术的原发性肝癌的疗效与不良反应。方法：2010年1月至2012年12月 TACE 联合放疗治疗25例原发性肝癌患者（治疗组），单纯 TACE 治疗原发性肝癌27例（对照组）。TACE 选择肝脏肿瘤供血血管，注入氟尿苷500-1000mg 和/或顺铂40-60mg，吡柔比星20-40mg +碘化油5-20ml 混悬剂，大肝癌合用明胶海绵1/3条，剪成碎末栓塞血管。研究组 TACE 1-2次后2-3周，行三维适形放疗，总剂量 DT 30-60Gy/15-30f，1.8-2Gy/（f·d），5次/周。结果：治疗组25例共计 TACE 术60次，平均2.4（1-6）次，完成总剂量 DT 30-60Gy/15-30f，2例患者的远处转移灶同时放疗；对照组27例共计 TACE 术83次，平均3.07（1-8）次。52名患者均可评价疗效。治疗组与对照组的有效率为88.0%和25.9%，中位生存时间为22和5个月，平均生存时间为（14.62±1.86）和（7.47±1.29）个月，组间差异非常显著（P =0.0024）。6、12、18、24个月生存率有显著性差异（P <0.05）。52例患者栓塞化疗并发症有呕吐8例，腹痛16例，发热18例，3例出现Ⅳ度白细胞抑制，无肝肾功能损害，放疗期间未观察到毒副反应。结论：TACE 联合放射治疗较单纯 TACE 对晚期原发性肝癌疗效好，毒副反应未增加。