摘要
背景与目的肝细胞癌常伴有门静脉癌栓且预后极差,有学者用三维适形放射治疗常规剂量分割模式进行治疗取得了较好的疗效。本研究的目的是评价低分割三维适形放射治疗(3-dimensionalconformalradiationtherapy,3DCRT)结合经皮肝动脉化疗栓塞(transcatheterarterialchemoembolization,TACE)治疗肝细胞癌(hepatocellularcarcinoma,HCC)伴门静脉癌栓(portalveintumorthrombus,PVTT)的疗效。方法对35例不能手术切除的HCC伴PVTT患者,采用低分割3DCRT结合TACE进行治疗,根据肿瘤体积大小,放射采用每次4～8Gy,3次/周;48～60Gy,8～12分次,3.0～3.5周完成。观察近期疗效,用Kaplan-Meier法进行生存分析,采用Cox比例风险模型作多因素分析。结果肿瘤缓解率为71.4%,1、2、3年累积生存率分别是59.3%、31.6%、26.6%,中位生存期11个月。多因素分析显示Child分级是影响预后的主要因素(P<0.05)。放射性肝炎和胃肠道出血是最常见的并发症。结论大分割3DCRT结合TACE治疗HCC伴PVTT有较好的疗效。肝功能Child分级与患者的预后有密切关系。
BACKGROUND & OBJECTIVE: Hepatocellular carcinoma (HCC) often results in portal vein tumor thrombus (PVTT), and the prognosis of the patients is extremely poor. It has been reported that some oversea scholars achieved fine therapeutic effects in treatment of this disease by 3 dimensional conformal radiation therapy (3DCRT) in fractionated conventional dose. The aim of this study was to evaluate the efficacy of 3 dimensional conformal hypofractionated single high dose radiotherapy combined with transcatheter arterial chemoembolization (TACE) for portal vein tumor thrombus in patients with hepatocellular carcinoma. METHODS: From May 1998 to December 2000, 35 patients with unresectable HCC complicated with PVTT were treated with 3 dimensional conformal hypofractionated single high dose radiotherapy and TACE. According to the volume of the tumors, radiotherapy was performed at an exposure of 4-8 Gy/time, 3 times/week, 48-60 Gy, 8 12 times, 3.0 3.5 weeks. The objective responses were analyzed and the survival rates were assessed from the date of the beginning of treatment using the Kaplan Meier method. The Cox proportional hazards model was used to analyze the prognostic factors. RESULTS: The objective response was 71.4%. The overall survival rates were 59.3%, 31.6%, and 26.6% at 1, 2, 3 years, respectively, with a median survival time of 11 months. Cox proportional hazards model analysis showed that Child Pugh class was the most important prognostic factors for the survival probability of the patients. Radiation induced liver disease (RILD) and gastrointestinal bleeding were the most common treatment related complications. CONCLUSIONS: 3 Dimensional conformal hypofractionated single high dose radiotherapy combined with TACE is an effective and feasible approach to treat PVTT in unresectabe HCC patients. Child Pugh class was identified as a predictor for PVTT in unresectabe HCC patients.
出处
《癌症》
SCIE
CAS
CSCD
北大核心
2004年第7期825-828,共4页
Chinese Journal of Cancer
基金
广东省自然科学基金重点项目(013056)~~
关键词
肝肿瘤
门静脉癌栓
放射疗法
治疗性栓塞
Hepatic Neoplasm
Portal thrombus
Radiotherapy
Therapeutic embolization
