Objective To evaluate the efficacy of three-dimensional conformal radiotherapy (3D-CRT) in the treatment of patients with massive primary liver cancer.Methods Forty-one patients with massive primary liver cancer were treated with 3D-CRT at 200cGy factions to a total doses of 3500cGy to 5000cGy (mean 3960cGy).All patients were followed-up for 6 to 40 (21±5)months.Short-term efficacy was evaluated according to WHO tumor evaluation standard.All patients were checked-up at each visit for the blood routine,liver function,AFP,BUS,CT and MRI.Results 41 patients accomplished the treatment.The local response rates were 70.7％ (29/41)after treatment in 16 with PR,in 13 with SD.The 1,2 year survival rates were 29.27％,19.51％.In the multivariate analysis,the therapeutic effects,metastasis,clinical staging and the diameter of the tumors presented prognostic significance for overall survival(P＜0.05).The total dose and Child grade did not present prognostic significance for overall survival (P≥0.05).Conclusions 3D-CRT is appropriate for massive primary hepatic carcinomas and can prolong the survival times.%目的 分析三维适形放射(3D-CRT)治疗巨大型原发性肝癌的疗效,以了解3D-CRT在大肝癌治疗中的价值及不良反应.方法 对41例巨大型原发性肝癌采用3D-CRT治疗,每次照射剂量为200cGy,总剂量为3500 ～ 5000 cGy(中位剂量为3960cGy),随访时间为6～40(21 ±5)个月.按WHO肿瘤治疗疗效考评标准评价近期疗效,计算1年和2年患者生存率.随访期间定期复查血常规、肝功能、甲胎蛋白、B超、CT和MRI等.结果 在41例患者中,在最后一次随访时,部分缓解(PR)16例(39.0％),稳定(SD)13例(31.7％),进展(PD)或死亡12例(29.3％)；在治疗结束3个月后复查,AFP下降幅度＞50％者为43.8％(14/32)；本组患者6个月生存率为68.3％,1年和2年生存率分别为29.3％和19.5％；经COX回归多因素分析显示,近期疗效(x2=3.655,P=0.000)、是否远处转移(x2=0.748,P=0.030)、临床分期(x2=3.327,P=0.004)、肿瘤直径大小(x2=1.509,P=0.037)与生存相关,而照射总剂量(x2=0.550,P=0.050)和Child分级(x2=1.143,P=0.057)与生存无明显相关性；放疗后41.5％出现胃肠道症状,58.5％出现白细胞计数下降,4.9％在6个月后发生非典型放射性肝病.结论 3D-CRT对巨大型原发性肝癌有一定的姑息治疗作用,能够适当延长患者生存期.
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