摘要
目的：晚期不能手术胆管癌患者，目前仍未有统一的治疗标准。本文将回顾性分析晚期不能手术的胆管癌的治疗效果并探讨其治疗策略。方法：1986年～2003年本院收治的晚期不能手术的胆管癌患者24例，其中21例（87．5％）治疗前行胆道减压术。接受传统的常规外照射（常规组）14例，三维适形放疗（适形组）10例，其中配合全身化疗5例均为出现淋巴结或远处转移者。结果：（1）全组有效率75．0％，其中适形组和常规组的局部完全缓解率分别为50．0％（5／10）、7．1％（1／14）（P=0．05）；总胆红素转为正常者79．2％（19／24）。（2）全组平均生存时间为11．0个月，6、12、18、24个月生存率分别为62．5％、37．5％、12．5％、4．2％。其中，适形组和常规组的平均生存时间分别为17．2和6．7个月（P〈0．001）。（3）放疗毒副反应可以接受，两组的发生率相仿。（4）60Gy以上和小于60Gy的平均生存时间分别为18．0和6．9个月（P〈0．001）。（5）配合化疗患者近期疗效满意。结论：（1）放疗是晚期胆管癌的主要治疗手段，适形放疗进一步提高局控率和生存率，可常规应用。（2）联合放、化疗可能有益于提高疗效。（3）生存时间与放疗剂量呈正相关，为提高局控率及生存率，可考虑联合应用外照射与腔内放疗。
Objective：There is no standard for the management of unresectable advanced cholangiocarcinoma till now. This paper will retrospectively analyze the results of unresectable advanced cholangiocarcinoma and try to discuss its strategies of treatment. Methods：24 cases unresectable advanced cholangiocarcinoma treated in our hospital from 1986 to 2003 were observed. 21 （87.5%） had been performed biliary drainage before the treatments. 14 cases received conventional external beam radiotherapy（ Group CEBR ） and 10 three-dimensional conformal radiation therapy（ Group 3-DCRT）. 5 patients having suffered from lymph or blood metastases got a combined radio-chemotherapy. Results： （ 1 ） The overall response rate was 75.0%. The complete remission rate for Group CEBR and 3-DCRT was 50. 0% （5/10） , 7. 1% （1/14） , respectively, P ：0. 05. The recovery ratio of total bilirubin was 79.2% （19/24）. （2） The mean survival time（MST） of all patients was 11.0 months, and their 6-, 12-, 18-and 24-month survival rates were 62. 5%, 37. 5% , 12. 5% , and 4. 2% , respectively. For Group CEBR and 3-DCRT, the MST was 17. 2 months, 6. 7 months, respectively, p 〈 0. 001. （3）The rate of toxicity was acceptable, with no significance of difference for Group CEBR and 3-DCRT. （4） The MST of those who received a dose over 60Gy and lower than 60Gy was 18.0 months, 6. 9 months, respectively, p 〈 0. 001. （5） Those having combined chemotherapy achieved a satisfactory short-term result. Conclusion： （ 1 ） Radiotherapy should be considered as an important strategy for patients with unresectable advanced cholangiocarcinoma. 3-DCRT is better than CEBR in improving local control and survival and could be routinely used. （ 2 ） Combined radio-chemotherapy may perhaps ameliorate the results of treatment. （ 3 ） There is a positive relation between the survival time and the dose received. Combined with intraluminal brachytherapy may be reasonable in an attempt to have a better local control and survival rate.
出处
《临床肿瘤学杂志》
CAS
2006年第8期600-603,共4页
Chinese Clinical Oncology
关键词
胆管癌
放射治疗
三维适形放射治疗
化学治疗
Cholangiocarcinoma
Radiotherapy
Three-dimensional conformal radiation therapy （ 3-DCRT ）
Chemotherapy
