| 伽马刀治疗31例原发性肝癌门脉和/或下腔静脉癌栓临床观察 |
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| 引用本文： | 杨远游,程海明,穆晓峰,宁健.伽马刀治疗31例原发性肝癌门脉和/或下腔静脉癌栓临床观察[J].现代肿瘤医学,2014,0(5):1130-1133. |
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| 作者姓名： | 杨远游 程海明 穆晓峰 宁健 |
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| 作者单位： | 武警总医院肿瘤放疗中心，北京 100039 |
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| 摘 要： | 目的:分析伽马刀治疗原发性肝癌门脉和/或下腔静脉癌栓的疗效及预后影响因素。方法:2006年至2012年我院收治31例原发性肝癌门脉癌栓和/或下腔静脉癌栓患者行伽马刀立体定向放射治疗。以40%-60%等剂量曲线为处方剂量线，中位处方剂量44Gy（范围:32-52Gy），1次/日、5次/周、3.5-5Gy/次，8-13次完成，临床靶区根据需要为癌栓包括或不包括肝原发病灶。治疗后每1-3个月复查血常规、血生化、肿瘤标志物、影像学检查（CT或MRI）。随访时间4-50个月，中位随访时间12个月，随访结束时间2013年6月。结果:总生存期4-50个月，中位生存期（MST）12个月，癌栓有效率（CR+PR）83.9%，其中CR 15例（48.4%），PR 11例（35.5%），SD 4例（12.9%），PD 1例（3.2%）。1年生存率58.1%，2年生存率9.7%。Kanplan-meier单因素分析显示癌栓部位（P=0.039）、处方剂量（P=0.009）的生存差异有统计学意义（IVC组好于PVTT组，处方剂量>44Gy组好于≤44Gy组），COX模型多因素分析显示处方剂量是影响预后的有意义因素（P=0.015）。结论:伽马刀治疗原发性肝癌门脉/下腔静脉癌栓安全有效、毒副反应轻、并发症少，可延长生存期，是原发性肝癌门脉/下腔静脉癌栓治疗可选方式，处方剂量是影响预后的有意义因素。
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| 关 键 词： | 原发性肝癌 门静脉/下腔静脉癌栓 伽马刀 疗效 预后因素 |
Gamma - knife treatment on 31 patients with primary liver cancer with portal and/or in-ferior vena cava tumor thrombus |
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| Yang Yuanyou,Cheng Haiming,Mu Xiaofeng,Ning Jian.Gamma - knife treatment on 31 patients with primary liver cancer with portal and/or in-ferior vena cava tumor thrombus[J].Journal of Modern Oncology,2014,0(5):1130-1133. |
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| Authors: | Yang Yuanyou Cheng Haiming Mu Xiaofeng Ning Jian |
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| Affiliation: | Cancer Radiotherapy Center，Armed Police General Hospital，Beijing 100039，China. |
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| Abstract: | Objective：To analyze the effectiveness and Prognostic factor of Gamma - knife treatment on Primary liver cancer Portal vein and/ or inferior vena cava tumor thrombus. Methods：2006 to 2012 in our hosPital 31 cases of Primary liver cancer Portal vein thrombosis and/ or inferior vena cava tumor thrombus Patients were treated by suPer Gamma - knife to Perform stereotactic radiotheraPy. PrescriPtion dose to 40% - 60% isodose line,A 44Gy total medi-an dose（rang：32 - 52Gy）were Prescribed to the 40% - 60% isodose line and in 8 - 13 fraction of 3. 5 - 5Gy each for clinical target volume. The clinical target volume included tumor thrombus with or without the Primary lesion of liv-er. At the end of treatment,blood count,blood chemistry,tumor markers and imaging（CT or MRI）were tested every 1- 3 months later. Follow - uP time was 4 - 50 months with the median follow - uP time of 12 months,follow - uP re-view to the end of June 2013. Results：Over survival Period was 4 - 50 months with a median survival of 12 months,1- year survival rate was 58. 1% ,2 - year survival rate 9. 7% . Tumor thrombus resPonse rates（CR ＋ PR）83. 9% ,CR 15 cases（48. 4% ）,PR 11 cases（35. 5% ）,SD 4 cases（12. 9% ）,PD 1 case（3. 2% ）. KanPlan - meier Univariate a-nalysis showed that the difference of survival in tumor thrombus site（P = 0. 039）and PrescriPtion dose（P = 0. 009） were significative（grouP of IVC was better than grouP of PVTT,grouP of ﹥ 44Gy was better than grouP of ≤44Gy）. COX multivariate analysis showed that PrescriPtion dose was significative Prognostic factor（P = 0. 015）. Conclusion：Gamma - knife treatment on Primary liver cancer with Portal and/ or inferior vena cava tumor thrombus is safe and ef-fective with mild toxicity and fewer comPlications,and it can Prolong survival,Gamma - knife is one of the oPtional ways of Primary liver cancer with Portal/ inferior vena cava tumor thrombus treatment. PrescriPtion dose is significative Prognostic factor. |
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| Keywords: | Primary liver cancer Portal vein/inferior vena cava tumor thrombus Gamma-knife effectiveness Prog-nostic factor |
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