摘要
目的:探讨大分割三维适形放射治疗(3-dimensional conformal radiation therapy,3DCRT)对复发性肝癌的疗效及其预后的影响因素。方法:对46例不能手术切除的复发性肝癌进行大分割3DCRT,根据肿瘤体积大小,每次分割剂量4～8Gy,每周3次,隔日1次,照射次数为6～15次(中位10次),总治疗时间为2～5周(中位治疗时间4周),相当于生物效应剂量(biological effective dose,BED)56～94Gy,中位剂量79Gy。观察近期疗效,用Kaplan-Meier方法进行生存分析,用COX比例风险模型分析多因素对生存率的影响。结果:肿瘤完全缓解(complete remission,CR)率为10.9%,部分缓解(partial remis-sion,PR)率为56.5%,病情无变化(nochange,NC)率为21.7%,进展(progressive disease,PD)率为10.9%,总有效率(CR+PR)为67.4%。1、2和3年的累积生存率分别为60.3%、43.4%和27.4%,中位生存时间为18个月(2～85个月)。单因素分析显示大体肿瘤体积(gross tumor volume,GTV)、病灶个数、肝硬化和复发方式对预后的影响均有统计学意义(P<0.05),而多因素分析显示病灶个数、复发方式和GTV大小对生存率的影响有统计学意义(P<0.05)。放射性肝炎和胃肠管出血是最常见的并发症。结论:大分割3DCRT对复发性肝癌患者有较好的疗效,其放疗不良反应可接受。病灶个数、复发方式和肿瘤的大小是患者的独立预后因素。
Objective：To investigate the therapeutic effect of hypofractionated three-dimensional conformal radiotherapy （3DCRT） on recurrent hepatocellular carcinoma （HCC） and elucidate the prognostic factors. Methods：Forty-six patients with unresec-table recurrent HCC were treated with hypofractionated 3DCRT. According to the volume of the tumors,the fractionated dosage was set at 4-8 Gy/time,3 times/week,1 time every other day,6-15 times （median 10 times）. The total therapy time was 2-5 weeks （median 4 weeks）,and the biological effective dose （BED） was 56-94 Gy （median BED 79 Gy）. The short-term effects were observed and the survival rates were analyzed using the Kaplan-Meier method. The Cox proportional hazard model was used to analyze the effect of multiple factors on survival rate. Results：The complete remission （CR） rate was10.9%,and partial remission rate （PR） was 56.5%. The no change （NC） ratio was 21.7%,and the progressive disease （PD） ratio was 10.9%. The response rate （CR＋ PR） was 67.4%. The 1-,2-,3-year overall survival rates were 60.3%,43.4%,and 27.4%,respectively. The median survival time was 18 months （from 2 months to 85 months）. Univariate conditional logistic regression model indicated that gross tumor volume （GTV） ,the number of lesions,hepato-cirrhosis and recurrence pattern were associated with prognosis. Multivariate analysis showed that the number of lesions,recurrence pattern and the size of GTV were independent prognostic factors （P〈0.05）. Radiation-induced liver disease （RILD） and gastrointestinal bleeding were the most common treatment-related complications. Conclusion：Hypofractionated 3DCRT is effective in the treatment of unresectable recurrent HCC and the adverse reactions are tolerable. The number of lesions,category of recurrence and the size of GTV are identified as the independent factors for predicting the prognosis of recurrent HCC.
出处
《肿瘤》
CAS
CSCD
北大核心
2009年第10期980-984,共5页
Tumor
基金
广西省自然科学基金资助项目(编号:0728198)
关键词
癌
肝细胞
复发
放射疗法
适形
预后
Carcinoma hepatocellular Recurrence Radiotherapy conformal Prognosis
