索拉非尼联合立体定向精确放疗治疗肝癌肺转移疗效观察

摘要

Objective:To observe the curative effect and adverse reaction of Sorafenib combined stereotactic body radiation therapy (SBRT)in the treatment of primary hepatocellular carcinoma (HCC)with pulmonary metastasis,and to evaluate the safety of combine treatment.Methods:Sixty primary HCC patients with pulmonary metastasis were recruited from June 2011 to June 2013.The patients were equally divided into combine treatment group,which received Sorafenib combined SBRT treatment and control group with only SBRT treatment.The curative effect,adverse reaction after three months of treatment,and long-term curative effect (1 year,2 years survival rate and median survival time)were compared between two groups.Results:After a three months of follow-up,the total efficiency rate of combined treatment group was 80.2%,which was significantly higher than control group of 73.3%(P= 0.045).The median time to progression in combined treatment group was 8.5 months,and control group was 4.6 months (P= 0.02).The one year survival rate in combined treatment was 53.3%(16/30),two year survival rate was 30%(9/30);and in control group,one year survival rate was 46.7%(14/30),two year survival rate was 20%(6/30).The median survival time of combined treatment group was 13.2 months,and that of control group was 11.8 months(P= 0.019).The toxicity in the two groups was tolerated,and no serious adverse reactions occurred.Conclusions:The Sorafenib combined with SBRT can improve the time to progression and median survival time of HCC patients with pulmonary metastasis without increasing the incidences of adverse events.%目的：观察靶向药物索拉非尼（sorafenib）联合立体定向精确放射治疗（stereotactic body radiation therapy，SBRT）治疗原发性肝癌（HCC）肺转移的临床疗效和不良反应，评价联合治疗的安全性。方法：将2011年6月至2013年6月收治的60例HCC伴肺转移患者分2组，联合治疗组30例，行索拉非尼联合SBRT；对照组30例，仅行SBRT。比较两组患者治疗结束3个月的短期疗效及不良反应以及长期疗效（1年、2年生存率及中位生存期）。结果：治疗后3个月随访，联合治疗组总有效率80．2％，显著高于对照组（73．3％）（P＝0．045）；联合治疗组中位疾病进展时间为8．5个月；对照组为4．6个月，具有统计学差异（P＝0．02）；联合治疗组1年、2年生存率分别为53．3％（16／30）、30％（9／30）；对照组1年、2年生存率分别为46．7％（14／30）、20％（6／30）；联合治疗组中位生存时间为13．2个月，对照组为11．8个月，两组差异有统计学意义（P＝0．019）；两组患者毒性反应均可耐受，无严重不良反应。结论：索拉非尼联合SBRT与单纯SBRT组相比，可显著提高HCC肺转移的疾病进展时间和中位生存期，且无明显严重不良反应的发生。