| 弥漫性肝癌予以单次大剂量放疗与单纯最佳支持治疗的姑息止痛疗效 |
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| 引用本文： | 陈炬辉,刘文晖,许元基,滕开原,洪亮,周永涛,陈隐,杨华清,吴君心,潘建基,程文芳.弥漫性肝癌予以单次大剂量放疗与单纯最佳支持治疗的姑息止痛疗效[J].中国肿瘤临床,2020,47(24):1265-1269. |
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| 作者姓名： | 陈炬辉 刘文晖 许元基 滕开原 洪亮 周永涛 陈隐 杨华清 吴君心 潘建基 程文芳 |
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| 作者单位： | ①.福建省肿瘤医院，福建医科大学附属肿瘤医院放疗科（福州市 350014） |
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| 摘 要： | 目的 比较采用"最佳支持治疗联合单次大剂量肝区照射(7.5~8.0 Gy)"与"单纯最佳支持治疗"姑息治疗伴有疼痛症状的弥漫性肝癌的临床疗效。 方法 分析2016年1月至2017年12月福建省肿瘤医院收治的符合纳入研究标准的弥漫性肝癌伴随肝区疼痛症状的患者, 将其随机分为两组:实验组采用最佳支持治疗联合单次大剂量肝区照射(7.5~8.0 Gy); 对照组仅采用单纯最佳支持治疗。观察并统计两组治疗后30天内和60天内症状改善情况疼痛简明记录量表(brief pain inventory, BPI)评分减少>2分或日吗啡消耗量减少>25%]、生存质量改善情况(基于WHO-QOL-100标准)、患者生存差异及实验组放疗后的不良反应。 结果 共纳入26例患者, 随机分成实验组13例(原发性肝癌12例, 转移性肝癌1例), 对照组13例(原发性肝癌11例, 转移性肝癌2例)。治疗后30天内进行疗效评估, 实验组有10例疼痛明显缓解, 对照组无疼痛明显缓解病例, 差异具有统计学意义(P < 0.01);实验组9例生存质量改善, 对照组仅1例生存质量改善, 差异具有统计学意义(P < 0.01);治疗后60天内进行疗效评估, 实验组10例疼痛明显缓解, 对照组仍无疼痛明显缓解病例, 差异具有统计学意义(P < 0.01);实验组9例生存质量改善, 对照组仅1例生存质量改善, 差异具有统计学意义(P < 0.01);治疗后30天和60天实验组和对照组生存率分别为77% vs.64%和54% vs.38%, 差异无统计学意义(P>0.05);实验组放射治疗中的耐受性良好, 未发现3~4级不良反应。 结论 对于弥漫性肝癌(原发或转移性), 出现肝区疼痛症状患者, 在最佳支持治疗的基础上, 采用单次大剂量肝区照射(7.5~8.0 Gy), 患者耐受良好, 可明显缓解疼痛, 并提高生存质量, 但对延长生存期尚无获益。
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| 关 键 词： | 弥漫性肝癌 支持治疗 单次大剂量放疗 止痛 生存质量 |
| 收稿时间： | 2020-07-27 |
Analgesic effect of single high-dose radiotherapy plus optimal supportive treatment in patients with diffuse liver cancer |
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| Affiliation: | ①.Department of Radiation Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou 350014, China②.Department of Radiation Oncology, Mengchao Hepatobiliary Hospital of Fujian Medical University, Fuzhou 350025, China |
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| Abstract: | Objective To compare the analgesic effects of optimal supportive treatment plus radiotherapy with a single high dose of 7.5-8 Gy vs.optimal supportive treatment on pain in patients with diffuse liver cancer. Methods Twenty-six patients with diffuse primary or metastatic liver cancer and liver pain treated at Fujian Cancer Hospital between January 2016 and January 2017 were retrospectively studied.They were assigned into two groups:one group was treated with optimal supportive treatment plus intensity-modulated radiotherapy with a single high dose of 7.5-8 Gy to the total or subtotal liver (experimental group); the other group was only treated with optimal supportive treatment (control group).During 30 days and 60 days of complete treatment, the improvement in symptoms (brief pain inventory score of >2 or a daily morphine dose reduction of >25%), quality of life (WHO-QOL-100 scale), and the number of survivors were compared between the two groups. Results Thirteen patients (12 with primary cancer and 1 with metastatic cancer) were enrolled in the experimental group, and the other 13 patients (11 with primary cancer and 2 with metastatic cancer) were enrolled in the control group.During the 30-day and 60-day treatment periods, the symptoms of 10 patients in the experimental group significantly improved; however, none of the patients in the control group showed an improvement in symptoms (all P < 0.01). The quality of life improved in 9 patients in the experimental group and 1 patient in the control group (all P < 0.01).However, no significant difference was found in the survival rate between the two groups (P>0.05). Conclusions Optimal supportive treatment plus radiotherapy with a single high dose of 7.5-8 Gy to the liver is relatively effective in patients with diffuse liver cancer.It could significantly improve the patients'symptoms and quality of life.However, there was no significant difference in survival between the two groups. |
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