摘要
目的肝细胞癌伴门静脉癌栓预后极差,本研究的目的是评价常规分割三维适形放射治疗结合经皮介入肝动脉化疗栓塞治疗肝细胞癌伴门静脉癌栓的疗效。方法对32例不能手术切除的肝细胞癌伴门静脉癌栓患者采用三维适形放射治疗结合经皮介入肝动脉化疗栓塞治疗,三维适形放射治疗采用DT2 Gy/次,5次/周;根据肿瘤体积大小,给予DT45 Gy^60 Gy/23~30次,对于肿瘤体积比较大,不能耐受高剂量放射治疗的病人,在肝细胞癌伴门静脉癌栓达到处方剂量后,缩野针对门静脉癌栓加量至DT60 Gy/30次。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。结果原发灶肿瘤缓解率68.8%,门静脉癌栓缓解率87.5%,1、2、3年累积生存率分别是56.3%、31.3%、21.9%,中位生存期15个月。多因素分析显示卡氏评分、Child分级是影响预后的主要因素(P<0.05)。血清转氨酶升高和放射性肝损伤是常见的并发症。结论常规分割三维适形放射治疗结合经皮介入肝动脉化疗栓塞治疗肝细胞癌伴门静脉癌栓有较好的疗效,肝功能Child分级、卡氏评分是影响预后的主要因素。
Objective Prognosis of hepatocellular carcinoma （HCC） with portal vein tumor thrombus （PVTr） is extremely poor. The study evaluates the curative effect that 3 - dimensional conformal radiation therapy in conventional dose with transcatheter arterial chemoembolization treat HCC with portal vein tumor thrombus. Methods 32 patients with unresectable HCC complicated with PVTr were performed 3 - dimensional confonmal radiation therapy in conventional dose and TACE. According to the volume of the minors, radiotherapy was performed at an exposure of 2 Gy/time, 5 times/week, DT45 Gy-60 Gy/23-30 times for the larger volume of tumors, PVTr was performed 60 Gy/30 times after finishing the plan of radiotherapy. The objective responses were analyzed and the survival rates were assessed from the date of the begining of treatment using the Kaplan - Meier method. The Cox proportional hazards model was used to analyze the prognostic factors. Results The remission rate of HCC was 68.8%, the remission rate of PVTT was 87.5%. The overal survival rates were 56.3%, 61.3% and 21.9% at 1, 2, 3 years, respectively, with a median survival time of 15 months. Cox proportional hazards model analysis showed that Karnofsky grade and Child- Tureotte-Pugh class were the most important prognostic factors for the survival probability of the patients. The rise of serum transaminase and radiation- induced liver disease were the most treatment - related complications. Conclusion 3 - dimensional confonmal radiation therapy in conventional dose with transcatheter arterial chemoembolization is an effective and feasible approach to treat PVTr in unresectable HCC patients. Kamofsky grade and Child - Turcotte- Pugh class were identified as two predictor for PVTT in unresectable HCC patients.
出处
《实用肿瘤学杂志》
CAS
2006年第3期165-168,共4页
Practical Oncology Journal
关键词
肝肿瘤
门静脉癌栓
三维适形放射治疗
治疗性栓塞
Hepatic neoplasm
Portal thrombus
3- Dimensional confommal radiotherapy
Therapeutic embolizafion
