原发性肝细胞癌伴门静脉癌栓患者接受立体定向放射治疗的疗效观察

目的评价原发性肝细胞癌伴门静脉癌栓患者接受立体定向放射治疗(射波刀)的疗效。方法收集我院2011年1月—2015年5月原发性肝细胞癌伴门静脉癌栓患者59例,均接受射波刀治疗。门静脉癌栓的大体肿瘤体积为24.6~1265.0 cm3,中位数399.0 cm3,单次分割剂量5~13 Gy/次(中位数10 Gy),照射次数4~8次(中位数6次),肿瘤剂量35~56 Gy(中位数49 Gy),每d或隔1~2 d照射1次。采用寿命表法进行生存分析,Cox回归模型分析生存相关的影响因素。结果 59例肝癌伴门静脉癌栓患者接受射波刀治疗,中位无疾病进展生存期为5.19个月,中位总生存期为11.84个月,疾病控制率为62.71%(37/59),治疗后1年、2年、3年的累积生存率分别为49.15%(29/59)、20.34%(12/59)、11.86%(7/59)。Cox回归分析显示:术前AFP水平、性别、年龄、病灶大小、肿瘤数目、肝功能Child-Pugh分级、腹水、癌栓类型及总剂量大小对患者生存期无明显影响。结论射波刀是肝癌伴门静脉癌栓患者较理想的治疗方法,可显著延长患者生存期。

Efficacy of stereotactic radiotherapy for patients with primary hepatocellular carcinoma and portal vein tumor thrombosis

ObjectiveTo explore the efficacy of stereotactic radiotherapy (cyberknife therapy)for patients with primary hepatocellular carcinoma and portal vein tumor thrombosis.MethodsFifty-nine cases of patients, who were hospitalized from January 2011 to May 2015, with primary hepatocellular carcinoma and portal vein tumor thrombosis were enrolled into this study, and all patients were treated with cyberknife therapy. The gross tumor volume (GTV) of patients ranged from 24.6 cm3 to 1265.0 cm3, the median was 399.02 cm3, the fractionated dose ranged from 5 Gy to 13 Gy( the median was 10Gy), the tumor treatment dose f ranged from 35 Gy to 56 Gy(the median was 49 Gy ), divided into 4-8 fractions (the median was 6). All patients received cyberknife therapy every day or every other day. The survival data were analyzed by life table method, and the influencing factors were analyzed by Cox regression model. ResultsFifty-nine patients all received cyberknife therapy, the median progression free survival for these patients was 5.19 months, the median overall survival was 11.84 months. In the local control rate of these patients, disease control rate is 62.71% (37/59). The overall survival rates at year 1, 2 and 3 after treatment were 49.15% (29/59), 20.34% (12/59) and 11.86% (7/59). Cox multiple factor analysis showed that AFP before radiotherapy, sex, age, tumor size, tumor number, liver function, ascites, thrombosis type and dosage were not related to the patients’ survival.ConclusionsAs for patients with primary hepatocellular carcinoma and portal vein tumor thrombosis, cyberknife therapy is an ideal treatment which can markedly prolong the overall survival.