三维适形放射治疗门静脉癌栓

目的探讨三维适形放射治疗原发性肝细胞癌合并之门脉癌栓疗效,并观察其不良反应。方法采用8MV-X线直线加速器对32例原发性肝细胞癌合并之门脉癌栓进行三维适形外放射治疗。单次剂量2 Gy,每周5次,总照射剂量46～64 Gy。根据测量CT增强扫描所示癌栓最大长径和彩超显示门脉血流情况评估疗效,记录生存期,评估不良反应。结果完全缓解2例,部分缓解12例,总有效率为43.8%。癌栓类型是影响缓解率的主要因素。中位生存时间13.2月,1、2、3、4年生存率分别为56.3%、31.3%、21.9%、9.4%。没有出现3级或4级急性放射性损伤,未出现晚期放射性损伤。结论常规分割三维适形外放射疗法治疗门静脉癌栓,有效率高、不良反应轻,值得进行进一步临床研究。

Three dimensional conformal radiothepapy for patients with portal vein tumor thrombosis

Objective To investigate the efficacy and toxicity of three-dimensional conformal radiothepapy（3D-CRT） for patients with portal vein tumor thrombosis（PVTT） based on HCC.Methods Thirty-two patients with PVTT based on unresectable hepatocelluar carcinoma treated with 3D-CRT were evaluated.RT was delivered with a curative intent,and the radiation dose was 46～64 Gy with 2 Gy as a daily dose.The tumor response was evaluated by the change in maximum tumor size on CT scans and color Doppler US examination.The surviral time was recorded and the morbidity evaluated by the Common Terminology Criteria for Adverse Everts v3.0.Results An objective tumor response rate was 56.3% with complete response（CR） in 2 patients and partial response（PR） in 12 patients.The type of PVTT was the most important reactic factor for PVTT response to radiotherapy.The survival rates of 1-,2-,3-,4-year were 56.3%,31.3%,21.9% and 9.4%,respectively（Median survival time was 13.2 months）.There was no grade 3 or 4 acute toxicity,and no patients developed tardive damage correlated with radiation.Conclusions Conventional fraction 3D-CRT for PVTT based on unresectable hepatocelluar carcinoma results in 56.3% of tumor response with acceptable toxicity.Further investigation is needed.