伽玛刀联合介入治疗原发性肝癌与单纯介入治疗原发性肝癌临床疗效分析

摘要

Objective To evaluate the effect and tolerance of patients with hepatocellular carcinoma(HCC)treated by γ-ray three-dimensional conformal radiotherapy (3-DCRT) combined with transcatheter arterial chemoembolization(TACE) ,comparing effect of TACE alone with that of TACE combined with 3-DCRT for patients with hepatocellular primary carcinoma.Methods 250 patients with HCC were randomly divided into TACE alone group( n = 125) and TACE combined with 3-DCRT group( n = 125).125 cases were treated with TACE firstly.TACE was performed using lipiodol,cisplatin, followed by gelatin sponge cubes, 3-DCRT was performed after 1 -3 times of TACE.50％- 85％ isodose curve included PTV,dosage of 350 - 450 cGy/ fractions,5 times a week,a total of 10 -12 fractions was used for the patients.125 cases were treated purely with TACE for 1 - 3 times.Results The total effective rate after three months and overall survival rates after 1,3,5 years in TACE combined with 3-DCRT group (76.8％ and 72.9％ ,45.0％ ,21.83％ ,respectively) were significantly higher than that in TACE alone group (52.8％and 55.0 ％,20.1％, 11.4 ％, respectively) ( P ＜0.05).Conclusion 3-DCRT+ TACE is better than TACE alone for HCC.%目的 探讨肝动脉介入栓塞化疗联合伽马刀治疗与单纯介入法治疗原发性肝癌的疗效比较.方法 将250例不能手术的肝癌患者随机分为介入加放疗组(综合组)与单纯介入组(对照组).综合组125例先行碘油、顺铂、明胶海绵等经肝动脉化疗栓塞1～3次后,再进行γ射线适形放疗.用50%～85%等剂量线包绕计划靶区,单次剂量为350～450 cGy/次,每周5次,共计10～12次.对照组125例患者仅进行3次肝动脉化疗栓塞(方法 同上).结果 治疗后综合组3个月总有效率(近期疗效)为76.8%(96/125),1、3、5年的累计生存率分别为72.9%,45.0%,21.8%;对照组3个月总有效率(近期疗效)为52.8%(66/125),1、3、5年的累计生存率分别为55.0%,20.1%,11.4%.两组生存率比较差异有统计学意义(P<0.05).结论 与单纯肝动脉介入化疗法相比,肝动脉介入化疗并栓塞联合伽玛刀是治疗原发性肝癌更有效的方法 .