肝转移瘤立体定向适形放疗临床分析

目的探讨立体定向适形放疗对肝转移瘤的疗效。方法对63例共121个转移病灶实施立体定向适形放疗，肿瘤中心剂量30～68GY，每次5～8GY，分6～8次，每周2、3次，疗程2～4周，计划靶区体积1．8～130．0cm3，设伊8个非共面照射野，利用同步铅挡块，80％等剂量线包括靶区边界。结果肿瘤消退有效率（CR＋PR）86．8％（105／121），其中CR33．1％（40／121），PR53．7％（65／121），NC10．7％（13／121），PD2．5％（3／121）。肿瘤剂量30-45GY组：CR14．3％（3／21），50-58GY组：CR29．4％（20／68）（P〈O．05）；60-68GY组，CR53．2％（17／32）（P〈0．05）。原发灶病理学类型为鳞癌CR73．3％（11／15）；病理学类型为软组织来源CR12．5％（1／8）（P〈0．05）。低分化组CR47．2％（17／36）、中高分化组CR27．1％（23／85）（P〈0．05）。肿瘤直径〈2．0cm组CR75．9％（22／29）；肿瘤直径2．0-5．0cm组CR24．2％（15／62）（P〈0．05）；肿瘤直径〉5．0cmCR10．0％（3／30）（P〈0．05）。结论立体定向适行放疗为肝转移瘤治疗的有效手段，疗效与肿瘤剂量、原发灶病理学类型及肿瘤体积大小关系密切。

Clinical analysis of stereotactic conformanl radiotherapy for metastases liver carcinoma

[Objective] To detect the treatment effect of stereotactic conformal radiotherapy for metastases liver carcinoma. [Methods] 63 patients with 121 metastases 30~68 GY, 5~8 GY per times, 6~8 times per course, 2~3 times per week, 2~4week per course, planning target volume(PTV)1.8~130.0 cm3. Among 6~8 irradiation static confrmai fields are delivered. The clinical tumor volume was totally encompassed within the exposure by 80% of the prescribed epual does. [Result] The total effective rate of the treatment, was 86.8%(105/121), CR 33.1%, PR 53.7%(65/121), NC 10.7%(13/121), PD 2.5%(3/121). The group that tumor center does was 30~45 GY: CP 14.3%(3/12), The group that tumor center does was 50~58 GY: CR 29.4%(20/68)(P <0.05). The group that tumor center does is 60-68GY: CR 53.2% (17/32)(P <0.05). The group that primary tumor pathological types was squamous cell carcinoma: CR 73.3%(11/15), The group that primary tumor pathological types soft-tissue cell carcinoma: CR 12.5%(1/8) (P <0.05). The group that low-differentianed cell: CR 47.2%(17/36), The group that middle or hight-differentiated cell:CR 27.1%(23/85) (P <0.05). The group that tumor less than 2.0 cm in diameter: CR 75.9%(22/29), the group that tumor from 2.0 to 5.0 cm in diameter: CR 24.2% (15/62) (P <0.05). The group that rumor more than 5.0 cm in diameter: CR 10.0%(3/30) (P <0.05). [Conclusions] The stereotactic conformal radiotherapy is a effective methods for metastases liver carcinoma. The effect is relate to the tumor center does the primary pathological types and the tumor volume.