伽马刀治疗31例原发性肝癌门脉和/或下腔静脉癌栓临床观察

摘要

Objective:To analyze the effectiveness and Prognostic factor of Gamma - knife treatment on Primary liver cancer Portal vein and/ or inferior vena cava tumor thrombus. Methods:2006 to 2012 in our hosPital 31 cases of Primary liver cancer Portal vein thrombosis and/ or inferior vena cava tumor thrombus Patients were treated by suPer Gamma - knife to Perform stereotactic radiotheraPy. PrescriPtion dose to 40% - 60% isodose line,A 44Gy total medi-an dose(rang:32 - 52Gy)were Prescribed to the 40% - 60% isodose line and in 8 - 13 fraction of 3. 5 - 5Gy each for clinical target volume. The clinical target volume included tumor thrombus with or without the Primary lesion of liv-er. At the end of treatment,blood count,blood chemistry,tumor markers and imaging(CT or MRI)were tested every 1- 3 months later. Follow - uP time was 4 - 50 months with the median follow - uP time of 12 months,follow - uP re-view to the end of June 2013. Results:Over survival Period was 4 - 50 months with a median survival of 12 months,1- year survival rate was 58. 1% ,2 - year survival rate 9. 7% . Tumor thrombus resPonse rates(CR + PR)83. 9% ,CR 15 cases(48. 4% ),PR 11 cases(35. 5% ),SD 4 cases(12. 9% ),PD 1 case(3. 2% ). KanPlan - meier Univariate a-nalysis showed that the difference of survival in tumor thrombus site(P = 0. 039)and PrescriPtion dose(P = 0. 009) were significative(grouP of IVC was better than grouP of PVTT,grouP of ﹥ 44Gy was better than grouP of ≤44Gy). COX multivariate analysis showed that PrescriPtion dose was significative Prognostic factor(P = 0. 015). Conclusion:Gamma - knife treatment on Primary liver cancer with Portal and/ or inferior vena cava tumor thrombus is safe and ef-fective with mild toxicity and fewer comPlications,and it can Prolong survival,Gamma - knife is one of the oPtional ways of Primary liver cancer with Portal/ inferior vena cava tumor thrombus treatment. PrescriPtion dose is significative Prognostic factor.%目的：分析伽马刀治疗原发性肝癌门脉和/或下腔静脉癌栓的疗效及预后影响因素。方法：2006年至2012年我院收治31例原发性肝癌门脉癌栓和/或下腔静脉癌栓患者行伽马刀立体定向放射治疗。以40%-60%等剂量曲线为处方剂量线，中位处方剂量44Gy（范围：32-52Gy），1次/日、5次/周、3.5-5Gy/次，8-13次完成，临床靶区根据需要为癌栓包括或不包括肝原发病灶。治疗后每1-3个月复查血常规、血生化、肿瘤标志物、影像学检查（CT 或 MRI）。随访时间4-50个月，中位随访时间12个月，随访结束时间2013年6月。结果：总生存期4-50个月，中位生存期（ MST ）12个月，癌栓有效率（ CR + PR ）83.9%，其中CR 15例（48.4%），PR 11例（35.5%），SD 4例（12.9%），PD 1例（3.2%）。1年生存率58.1%，2年生存率9.7%。KanPlan - meier 单因素分析显示癌栓部位（P ＝0.039）、处方剂量（P ＝0.009）的生存差异有统计学意义（IVC 组好于 PVTT 组，处方剂量﹥44Gy 组好于≤44Gy 组），COX 模型多因素分析显示处方剂量是影响预后的有意义因素（P ＝0.015）。结论：伽马刀治疗原发性肝癌门脉/下腔静脉癌栓安全有效、毒副反应轻、并发症少，可延长生存期，是原发性肝癌门脉/下腔静脉癌栓治疗可选方式，处方剂量是影响预后的有意义因素。