目的 评价立体定向放疗治疗肝细胞癌伴下腔静脉癌栓的疗效.方法 在66例肝细胞癌伴下腔静脉癌栓患者中,36例接受立体定向放射治疗,30例未接受放射治疗.结果 36例接受伽玛刀治疗的癌栓患者,12例(33.3%)癌栓完伞缓解,10例(27.8%)部分缓解,13例(36.1%)稳定,1例(2.8%)进展.癌栓治疗有效率为61.1%,1年生存率为27.8%,中位生存期为9.8个月;未放疗的30例患者1年生存率为11.5%,中位生存期为3.5个月.多因素分析显示,放疗组病人生存情况与肝内病灶单多发有关.Child-Pugh分级是影响预后的主要因素.结论 立体定向放射治疗可明显延长肝细胞癌伴有下腔静脉癌栓患者的生存期.%Objective To evaluate the effects of stereotactic conformal therapy (SCT)in the treatment of patients with hepatocellular carcinoma with tumor thrombus in inferior vena cava. Methods 66 hepatocellular carcinoma patients with tumor thrombus in inferior vena cava were reviewed and analyzed by Kaplan-Meier and Cox regression analysis. 36 patients with tumor thrombus in inferior vena cava with hepatocellular carcinoma were treated with stereotactic conformal therapy (body gamma knife),and 30 patients did not receive stereotactic conformal therapy, The planned target volume was encompassed by 50％ to 70％ isodose line,and tumor dose was 3Gy to 4Gy per fraction,with total dose ranging from 30Gy to 48Gy. Results In 36 patients with stereotactic conformal therapy,12(33.3％ )were in complete remission, 10(27.8％ )in partial remission ,13 ( 36.1％ )were in no change,and 1 (2.8％)showed disease progression. The remission rate of tumor thrombus in inferior vena cava was 61.1％ and one-year survival rate was 27.8％ with the median survival of 9.8 months. In the non-SCT-treated 30 patients,one-year survival rate was 11.5％ and the median survival was 3.5 months. Cox proportional hazards model analysis showed that the number of tumors and Child-Pugh class were the independent prognostic factor for the survival probability of the patients. Conclusion The stereotactic conformal radiotherapy is an effective method for treatment of tumor thrombus in inferior vena cava in patients with hepatocellular carcinoma.
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