体部伽玛刀治疗原发性肝癌的临床疗效和不良反应

摘要

目的:收集行体部伽玛刀治疗原发性肝癌患者的临床资料,分析其治疗方案及近期疗效,为原发性肝癌患者的临床治疗提供参考依据.方法:选择633例无法行手术治疗的原发性肝癌患者行伽玛刀治疗,按照国际抗癌联盟(UICC)公布的TNM分期方法,有明确TNM分期的患者351例,其中T3期患者251例(71.5%,251/351),T4期患者57例(16.2%,57/351).每次分割剂量为200~600 cGy,照射次数为2~13次,每日或隔日照射,每周5次,40%~85%等剂量曲线覆盖计划靶区(PTV).治疗结束后2~3个月45例患者行影像学及肿瘤标志物等复查,观察肿瘤直径变化情况,评价其近期疗效.结果:伽玛刀治疗期间,229例(36.2%)患者发生了不良反应,100例(15.8%)患者出现白细胞降低,137例(21.6%)患者出现血小板降低.出院时601例患者病情好转,22例无明显变化,5例病情加重,5例死亡.接受累积剂量为3 000 cGy~和3 500 cGy~组患者症状好转比例均高于累积剂量<3 000 cGy组(P<0.05).45例出院患者随访,2~3个月的部分缓解(PR)患者占80%(36/45),稳定(SD)患者占20%(9/45),总有效率为80%(36/45).不同肿瘤直径、单次剂量和累积剂量组有效率比较差异无统计学意义(P>0.05). 结论:体部伽玛刀治疗原发性肝癌患者不良反应发生的比例较低,近期有效率较为理想;体部伽玛刀治疗原发性肝癌患者是一种安全有效的治疗方法.%Objective:To collect the clinical materials of primary liver cancer patients treated by gamma knife and analyze the treatment methods as well as short-term efficacy,and to provide a reference for the clinical treatment of primary liver cancer patients.Methods:A total of 633 patients with inoperable primary liver cancer were treated by body gamma knife.According to the TNM staging method of Union for International Cancer Control(UICC), there were 351 cases with clear TNM staging.Among them, there were 251 cases (71.5%) at T3 stage and 57 cases(16.2%) at T4 stage.The prescription dose of 200-600 cGy each time to the 40%-85% dose line covering the planned target volume(PTV), this program was performed 5 times per week, and the number of treatment ranged from 2 to 13.The biochemical and imaging changes were observed 2-3 months after treatment to evaluate the short-term efficacy.Results:During the treatment, 229(36.2%)patients had adverse reactions,100 (15.8%) patients appeared the reduced white blood cells, and 137 (21.6%) patients appeared the reduced platelets.On discharge from the hospital, 601 patients were improved, 22 patients had no obvious change, 5 cases were worse, and 5 cases died.The proportion of improved patients who received the cumulative dose between 3 000 cGy to 4 000 cGy was higher than those who received the cumulative dose less than 3 000 cGy(P<0.05).After treatment, the curative effects were evaluated in 45 patients during two and three months, including PR 77.8%(35/45) and SD 22.2%(10/45), and the total effective rate was 77.8%(35/45).No statistical differences in effective rates were found between different tumor diameter, single dose, and cumulative dose groups(P>0.05).Conclusion:The proportion of adverse reactions in the primary liver cancer patients treated with body gamma knife is relatively low and the short-term efficacy is ideal.Body gamma knife treatment is a safe and effective treatment method for the primary liver cancer patients.