三维适形放疗联合１２５Ｉ粒子植入治疗晚期巨块型肝癌的临床观察

目的　探讨三维适形放疗（３Ｄ-ＣＲＴ）联合１２５Ｉ粒子植入治疗晚期难治性巨块型肝癌的疗效及安全性。方法　２００９年１月至２００９年１２月我科收治２２例晚期巨块型肝癌患者，先行肝动脉化疗栓塞术（ＴＡＣＥ），对术中血供不丰富、碘油沉积不显著的１０例患者于ＴＡＣＥ术后１周行３Ｄ-ＣＲＴ，予ＤＴ５０Ｇｙ后再行１２５Ｉ放射性粒子植入术。粒子植入术前根据患者的肿瘤大小确定植入粒子数，均在Ｂ超引导下经皮穿刺按计划在肿瘤内永久性植入１２５Ｉ粒子持续行内照射。粒子植入术后１个月复查ＣＴ及ＡＦＰ等。按照ＲＥＣＩＳＴ１.０和ＮＣＩＣＴＣＡＥ３.０标准分别评价疗效和毒副反应。结果　１０例患者均顺利完成３Ｄ-ＣＲＴ联合１２５Ｉ粒子植入治疗，获ＰＲ６例，ＳＤ３例，ＰＤ１例。主要毒副反应为白细胞减少，１级白细胞减少２例，２、３级白细胞减少各１例，无上消化道出血发生。粒子植入术后１周，６例患者有轻微肝区胀痛，其中１例有肝包膜下轻度血肿，２例出现１级谷丙转氨酶升高，予保肝等对症处理后均缓解；未出现粒子植入后游走现象以及胃肠、造血系统等毒性反应。结论　初步观察３Ｄ-ＣＲＴ联合１２５Ｉ粒子植入治疗１０例晚期难治性巨块型肝癌的近期疗效满意，安全且可操作性强，可能适合于ＴＡＣＥ效果欠佳的患者，远期疗效有待进一步随访观察。

Three-dimensional conformal radiation therapy plus 125I partical implantation for advanced huge-type hepatocarcinoma patients

Objective To investigate the efficacy and safety of three-dimensional conformal radiation therapy（3D-CRT）plus 125I partical implantation for advanced huge-type hepatocarcinoma patients with transcatheter arterial chemoembolization（TACE）failure.Methods The 22 huge-type patients eligibled from January 2009 to December 2009.Of these patients,10 patients who underwent TACE failure that blood confesses were not enrich and iodine oil deposition was not notable,received 125I partical implantation after 3D-CRT at dose of DT 50 Gy.The particle population of ascertains implantation was according to the size of tumors,permanency implantation 125I particles continued irradiating after skin puncture under the guidance of B-ultrasonography.After one month for particle implantation CT and AFP was reexamined and efficacy and safety was evaluated.Results Six cases achieved partial remission,3 cases achieved stable disease,1 case achieved progressive disease in 10 patients.Six patients had slight ache in liver area after 1 week of particle implantation,1 patient among them had light subcapsular hemorrhage of liver,2 patients glutamate alanine aminotransferase rised,there were good for the disease after treatment.There wasn＇t other toxicity reaction such as stomach intestine,hemopoietic system.Conclusion 3D-CRT plus 125I partical implantation for advanced huge-type hepatocarcinoma patients with TACE failure is effective,safe and easy-operated,but the long-term effect remains further follow-up observation.