立体定向放射治疗肝癌的临床应用

目的：探讨立体定向放射治疗（X线刀）肝癌的适应症,禁忌症和近期疗效。方法：采用深圳奥沃（OUR）公司生产的体部X线刀治疗计划系统和立体定位框架,结合英国菲利蒲公司SL－75直线加速器对30例肝癌患者进行了立体定向放射治疗。30例肝癌中,原发性肝癌18例,40个病灶,转移性肝癌12例,23个病灶。60％－80％的剂量曲线包绕病灶边缘,肿瘤中心剂量为8－10Gy/次（肿瘤直径小于3cm的10Gy/次,大于3cm的8Gy/次）,隔日1次,共4－6次。结果：30例患者共63个病灶,X线刀治疗后1,3,6,12个月复查有效率（病灶消失和病灶缩小）分别为25．4％（16／63）,44．5％（28／63）,30．1％（24．63）和28．6%(18／63）,病灶无变化比率分别为：39.7％（25／63）,23.8％（15／63）,17.5%(11/63)和7.9%(5/63)。3个月时二缩小最明显,6个月以后出现病灶再增大,6,12个月复查病灶增大比率分别为12．7％（8／63）和28．6％（18．63）。1例患者治疗后病灶明显缩小又行第二次和第三次X线刀治疗。现已带瘤存活1年以上。全部病例中位生存期12．4个月,1年生存率43％（13．30）,结论：立体定向放射治疗中晚期肝癌临床有较好的效果,副作用小,可作为肝癌姑息治疗的有效选择之一。

The clinical application of the stereotactic radiotherapy for liver cancer

Objective To study the indication, contraindication and clinical results of stereotactic radiotherapy(X knife)for liver cancer.Methods 30 cases of liver cancer(hepato cellular and metastases)were treated by X knife included the modern 3 D treatment planning system and the stereotactic body frame made in Shenzhen OUR company combined with SL 75 accelerator made in PILIPPS England. The 18 primary one in the 30 cases were received 8 10Gy per day, with peripheral clips were covered in 60% and 80%, the total dose in the center of tumor were 40Gy 50Gy. The 12 metastasis one in 30 cases received 8 12Gy per day, 5 days by X knife alone.Results The 1 ,3 ,6 , and 12 month local control rate of the 63 focus in 30 cases after X knife treatment is 25.4%(16/63)?44 5%(28/63)?30 1(24/63) and 28.6%(1/63);respectively. The no change rate of focus were 55.6%(35/63)?41.3%(26/63)?28 6%(18/63) and 23.8%(15/63)respectively. The focus recurrence appeared in 6 months after treatment. The recurrence rate in 6 , and 12 month were 12.7%(8/63) and 28.6%(18/63) respectively. The second and the third treatment with X knife alone were used for 2 focuses of one case because partial remission after the first treatment and the one has survival with tumors over one year. The 1 year survival rate of 30 cases with the primary and the metastasis liver cancer was 43%(13/30). The middle time of survival period was 12 4 months.Conclusion The stereotactic radiotherapy can be used in practice for liver cancer. There have better effect and lesser side effect with the method. It can be used being good selection of treatment for advanced liver cancer.