伽马刀治疗22例巨块型原发性肝癌临床观察

摘要

Objective:To analyze the effectiveness and prognostic factor of Gamma-knife treatment huge hepato-cellular carcinoma. Methods:From August 2005 to April 2012,22 patients with huge hepatocellular carcinoma were treated by Gamma-knife. A 42Gy median dose ( range:30-50Gy) were prescribed to 40%-60% isodose line and performed in 9-13 fraction of 3-5Gy each. The target included primary tumor with or without vien thrombosis. Blood and imaging( CT or MRI) were tested every 1-3 months after treatment. Follow-up time was 3-36 months and ended in Sep. 2013. Results:Survival period was 3-36 months with a median survival time of 6. 5 months. Survival rate of 1-3 years were respectively 31. 8%,22. 7%,4. 5%. Response rate was 68. 2%(CR 3 cases,PR 12 cases,SD 6 cases ,PD 1 case). 5 cases appeared late RTOG standard grade III radioactive liver injury. Kanplan-meier univariate analy-sis showed that the difference of survival in AFP(P=0. 002) and equivalent biological dose (P=0. 002)were statisti-cally significant (AFP<1171ng/ml is better than≥1171ng/ml,≥60Gy is better than<60Gy). The COX multivariate regression analysis showed that equivalent biological dose was significant prognostic factor(P=0. 009). Conclusion:Gamma-knife treatment is one of optional treatment ways for huge hepatocellular carcinoma. Patients with huge hepato-cellular carcinoma still need to be given adequate dose to improve local tumor control rate and prognosis.%目的：：分析伽马刀治疗巨块型原发性肝癌的疗效及预后因素。方法：2005年8月至2012年4月22例巨块型肝癌行伽马刀治疗,以40%-60%等剂量曲线为处方剂量线,中位剂量42Gy(范围30-50Gy),3-5Gy/次,9-13次完成。靶区为肝内病灶包括或不包括门脉癌栓。治疗后每1-3个月行血液和影像学检查(CT或MRI)。随访时间3-36个月,2013年9月结束。结果：总生存期3-36个月,中位生存期6.5个月,1-3年生存率分别为31.8%、22.7%、4.5%,有效率68.2%( CR 3例,PR 12例,SD 6例, PD 1例)。5例出现RTOG标准III级晚期放射性肝损伤。 Kanplan-meier单因素分析显示AFP(P=0.002)、等效生物剂量(P=0.002)的生存差异有统计学意义(AFP<1171ng/ml好于≥1171ng/ml,≥60Gy好于<60Gy)；COX多因素分析显示等效生物剂量是有意义的预后影响因素(P=0.009)。结论：伽马刀治疗为巨块型肝癌可选方式之一,巨块型肝癌仍应给予足够剂量以改善肿瘤局控率和预后。