125I粒子植入联合肝动脉化疗栓塞治疗中晚期原发性肝癌的近期疗效

摘要

Objective To evaluate the efficacy and safety of 125I seed implantation combined with transcatheter arterial chemoembolization (TACE) in the treatment of primary hepatocellular carcinoma (PHC).Methods 156 patients who had unresectable PHC seen from January 2012 to December 2015 in our unit were randomly assigned into the study group (76 patients) and the control group (80 patients).The study group of patients were treated with intra-hepatic implantation of 125I seed + TACE,and the control group of patients were treated with three dimensional conformal radiotherapy (3DCRT) + TACE.After ra diotherapy the two groups of patients underwent 2 to 3 times TACE treatment.The biomarker levels were compared between the two groups before and after treatment,and the short-term efficacy,clinical safety and 1 year survival rates were assessed.Results The success rates of the treatment for the two groups were both 100％.Patients in the study group were implanted with 1 016 125I seeds,with an average of (13.7 ± 2.5) seeds per patient.The two groups had no significant difference on short-term efficacy (P ＞ 0.05).The DCR,ORR and 1 year survival rates in the study group were 63.2％,92.1％,55.5％,and they were 61.3％,90.0％,58.1％ in the control group,respectively.There were no significant differences between these 2 groups (P ＞ 0.05).At 1 month after treatment,the two groups had no significant differences onAFP,IGF-Ⅱ and IGFBP-2 [(5.08±0.85) μg/L vs.(5.12 ±0.79) μg/L,(4.77 ±0.58) μg/L vs.(4.86 ±0.53) μg/L,(4.98 ±0.67) μg/L vs.(5.04 ±0.71) μg/L] (P＞0.05).There were no signif-icant differences on chemotherapy drug toxicities between the two groups (P ＞ 0.05).The incidence of radi-ation hepatitis in the study group was 1.3％,while the incidences of radiation dermatitis,hepatitis,gastriculcer in the control group were 5.0％,8.8％,2.5％,respectively.The radiation dermatitis incidence inthe study group was significantly lower than that of the control group (P ＜ 0.05).In the study group,2 pa-tients (2.6％) had their 125I seed slightly moved.Conclusion The short-term efficacy of 125I seed implan-tation plus TACE in the treatment of PHC is no less than the 3DCRT + TACE regimen,but with less radia-tion side effects.%目的 评估125I粒子植入联合经导管肝动脉化疗栓塞(TACE)治疗原发性肝癌(PHC)的疗效与安全性.方法 将2012年1月至2015年12月收治的156例无法切除PHC患者随机分为研究组(76例)和对照组(80例).研究组予肝内125I粒子植入+TACE方案,对照组予三维适形放疗(3DCRT) +TACE方案,两组放疗后均予2～3次TACE治疗.比较两组患者治疗前后生物标志物水平,评估近期疗效、临床安全性及1年生存率.结果 两组治疗均顺利完成.研究组共植入125I粒子1 016枚,平均(13.7±2.5)枚/例.两组近期疗效差异无统计学意义(P＞0.05).研究组肿瘤控制率(DCR)、客观有效率(ORR)、1年生存率分别为63.2％、92.1％、55.5％,对照组分别为61.3％、90.0％、58.1％,差异均无统计学意义(P均＞0.05).治疗结束1个月,两组AFP、IGF-Ⅱ、IGFBP-2均无显著差异,分别为(5.1±0.9)μg,/L比(5.1 ±0.8)μg/L、(4.8±0.6)μg/L比(4.9±0.5)μg/L、(5.0±0.7) μg/L比(5.0±0.7) μg/L,均P＞0.05.两组化疗药物毒性反应差异无统计学意义(P＞0.05).对照组放射性肝炎、皮炎、胃溃疡发生率分别为5.0％、8.8％、2.5％.研究组放射性肝炎发生率为1.3％.研究组放射性皮炎发生率显著低于对照组(P＜0.05).研究组有2例(2.6％)患者出现125I粒子轻度游走.结论 125I粒子植入+TACE方案治疗不可手术切除PHC近期疗效至少不劣于3DCRT+TACE方案,放射性损伤更少.