射波刀治疗原发性肝癌的初步结果

摘要

Objective To study the efficacy and toxicity of eyberknife radiosurgery for primary hepatic carcinoma.Methods From September 2006 to March 2008,17 patients with clinicai stage Ⅰ-Ⅲ primary hepatic carcilloma were treated with cyberknife at Tianjin Cancer Hospital.12 patients received previous treatment of surgery,or interventional therapy or radiofrequency therapy before the cyberknife radiosurgery.Totally 23 lesions in the liver were treatment.The median planning target volume(PTV)was 75 ml(13-35l ml).Fidueials were placed in or adjacent to the tumor one week before the CT scan simulatiOn.The median total prescription dose was 45 Gy(range:39-52 Gy)at 3-8 fractions and the median preseription isodose lines was of 78.0%(range:75.0%-81.0%.Resuits,The follow-up time was 3-30 months(median:14 months).All patients finished the treatment and slighfly fatigue was the most common complain.There were 12 patients alive and 5 patients died.All the lesions in liver treated by the cyberknife radiosurgery achieved local control.Conclusion The cyberknife radiosurgery for primary hepatic carcinoma showed a high rate of local control and minimal toxicity.Long time follow-up is necessary to evaluate the survival data and late toxicity.%目的 评价立体定位射波手术平台治疗肝癌患者的疗效以及初期的不良反应.方法 对17例原发性肝癌患者行射波刀治疗,共治疗肝脏病灶23个,同期治疗肝外病灶2个.肝脏病灶治疗均采用呼吸同步追踪技术,CT定位前1周植入金标到肿瘤内或肿瘤旁2 cm内.总剂量为39-52Gy,分割3-8次,处方剂量线范围为75.0%～81.0%.治疗后随访3-30个月,中位随访时间为14个月.按照世界卫生组织(WHO)的实体瘤近期疗效评价标准评定疗效,按1995年美国放射肿瘤学协作组(RTOG)和欧洲癌症治疗研究组织(EORTC)标准进行放射反应评级.结果 17例患者中,完全缓解(CR)3例,部分缓解(PR)11例,无变化(NC)3例,有效率为82.4%,临床获益率为100%.患者对治疗耐受良好,不良反应轻微.在随访期内,4例发生肝内转移,2例发生肺转移,1例发生骨转移,2例多发转移.至随访截止日期,有12例患者存活,5例死亡,17例患者的中位生存时间为14.3个月,中位无进展生存时间为12.8个月.结论 采用射波刀进行立体定向放射治疗原发性肝癌疗效显著,安全性好,但远期疗效仍需进一步随访.