体部γ2刀治疗原发性肝癌的疗效分析

 目的　观察γ刀治疗原发性小肝癌的远近期疗效和放疗不良反应。方法　37 例原发性小肝癌 患者采用体部γ刀放疗。50 %～60 %等剂量线包绕PTV ,60 %～70 %等剂量线包绕GTV ,GTV 生物等 效剂量达80 Gy 以上。27 例患者配合TACE 1～2 次。结果　完全消失9 例,部分缓解22 例,稳定4 例, 进展2 例。肿瘤局控率83. 78 % (31/ 37) , 1 ～5 年生存率分别为78. 38 % (29/ 37) , 62. 16 % ( 23/ 37 ) , 43. 24 %(16/ 37 ) , 32. 43 % ( 11/ 37) , 33. 3 % ( 5/ 15) 。平均生存期为31 月。单发病灶4 年生存率达 55. 56 %(11/ 20) ,疗效与根治手术生存情况相接近,不良反应可以耐受。结论　对于拒绝手术或不能手 术的原发性小肝癌患者,体部γ刀不失为一种较为有效的根治治疗手段,但合适的总剂量和分次剂量尚 需进一步探讨。

Eff iciency of Body2γ2Knife for Patients with Primary Hepatocellular Carcinoma

Objective 　To investigate the short and long2term therapeutic effectiveness and complication of body2γ2knife in patient s with small hepatocellular carcinoma ( SHCC) . Methods 　Thirty2seven patient s with SHCC were t reated by body2γ2knife therapy. The isodose curve (50 %～60 %) was covered about planning target volume ( PTV) ,The isodose curve (60 %～70 %) was covered about gross tumor volumes ( GTV) . The biological effective dose is 80 Gy at least to the GTV. Twenty2seven patient s was t reated in combination with TACE 1 or 2 times. Results 　Tumor disappeared in 9 patient s , tumor size decreased in 22 patient s , remained unchanged in 4 patient s , and enlarged in 2 patient s. The local cont rol rates were 83. 78 %(31/ 37) . The overall survival rate of 1 、2 、3 、4 、52year was 78. 38 %(29/ 37) ,62. 16 %(23/ 37) , 43. 24 %(16/ 37) ,32. 43 %(11/ 37) ,33. 3 %(5/ 15) 。The median follow2up duration was 27 months. The overall survival rate of 4 year with solitary lesion was 55. 56 % (11/ 20) . The therapeutic effectiveness is comparable to radical operation with acceptable complication. Conclusion 　Body2γ2knife radiotherapy is a feasible approach of radical cure for patient s refuse operation or are not suitable for operation. However , the suitable total dose and f ractional dose need further discussion.