适形放疗联合介入化疗治疗原发性肝癌的临床研究

目的评价肝动脉化疗栓塞（TACE）联合立体适形放射治疗（3DCRT）对原发性肝癌的效果和不良反应。方法自2002-2005年,66例原发性肝癌患者进行随机分组研究,治疗组34例进行TACE联合3DCRT治疗,先行2次TACE治疗,然后行3DCRT,总剂量为45-55Gy,2-5Gy/Fx/周,对照组32例单纯行TACE治疗,共4次。结果治疗组34例患者总有效率为（RR）76.5%（26/34）,对照组为（RR）46.9%（15/32）;治疗组和对照组1、2、3年生存率分别为61.8%、41.2%和29.4%比46.9%、18.8%、6.3%。两组总有效率（RR）、1年生存率差异无统计学意义（P〉0.05）,2年生存率、3年生存率差异有统计学意义（P〈0.05）。两组不良反应相似。结论TACE结合3DCRT治疗原发性肝癌能明显提高临床治疗效果,而不良反应未见增加。

Three-dimensional conforntal radiotherapy combined with transcatheter arterial chemoembolization for hepatocellular carcinome

Objective To evaluate the response and tolerance in the hepatocellular carcinoma patients by three-dimensional conforntal radiotherapy eombined with transcatheter arterial ehemoembolization. Methods From 2002 to 2005,66 eases with hepatoeellular carcinoma were enrolled into this study ,34 patients and 32 patients were randomly divided into transcatheter arterial chemoembolization combined with three-dimensional conforntal radiotharapy group（TACE/3DCRT） and transcatherter arterial chemoembolization alone group （TACE）respectively. TACE/3DCRT group patients underwent TACE 2 courses. Then they received 3DCRT after an interval of about one month. The total radiation dose was 45 - 55 Gy, in daily 2 - 5Gy fractions, with 5 fractins in week. TACE group received 4 cycles of treatment with transeatheter arterial chemoembolization. The efficacy and toxicity were evaluated according to WHO standard. Results The overall response rate was 76.5% （CR0, PR26 ）in TACE/3DCRT group of 34 eases and 46.9% （CR0, PR15 ）in TACE group of 32 cases. The difference in response rate was statistieally signifieant between the two groups（ x^2 = 6. 136 ,P〈0.05 ）. The survival rate of 1 year was 61.8% in TACE/3DCRT group, and 46.9% in TA- CE group（ x^2 = 1. 474 ,P〉0.05 ）, no significance existed. The survival rate of 2 years was 41.2% in TACE/3DCRT group and 18. 8% in TACE group（ x^2=3. 926,P〈0. 05） ,the survival rate of 3 years was 29. 4% in TACE/3DCRT group and 6. 3% in TACE group（ x^2 = 5. 945, P〈0.05 ）, significance existed. But the difference treatment-releted toxicitied between these two groups were not significant. Conclusion TACE combined with 3DCRT is an effective and feasible aproach with minimal trauma in treatment of hepatocellular carcinoma.