TACE联合三维适形放疗治疗巨块型原发性肝癌35例临床报告

目的探讨肝动脉灌注栓塞化疗（TACE）联合三维适形放疗（3D-CRT）治疗巨块型原发性肝癌的近期疗效及生存期。方法对35例巨块型原发性肝癌先采用TACE治疗1～2次，4～6周后再行三维适形放疗，肿瘤直径〈6cm者，处方量3—5Gy／次，总剂量45～55Gy；肿瘤直径〉6cm，处方量2Gy／次，总剂量56～60Gy。放疗期间口服熊去氧胆酸、复方丹参及保肝治疗，治疗前及治疗后3个月查AFP及肝脏CT。结果AFP明显下降，与治疗前相比差异有显著性（P〈0．01），肿瘤完全缓解（CR）占22．9％（8／35），部分缓解（PR）占51．4％（18／35），稳定（SD）20．0％（7／35），进展（PD）占5．7％（2／35），总有效率74．2％（26／35）。1年生存率54．2％（19／35），2年生存率25．7％（9／35），3年生存率14．3％（5／35）。结论TACE联合3D-CRT治疗巨块型原发性肝癌，局部控制率高，生存期明显延长。

Clinical report on 35 cases of massive primary hepatic carcinoma treated with three-dimensional conformal radiotherapy and TACE

Objective To evaluate short-term curative effect and survival period of patients with massive primary hepatic carcinoma treated with three-dimensional conformal radiotherapy（3D-CRT） and transcatheter arterial chemoembolization（TACE）. Methods Thirty-five primary hepatic carcinoma patients were treated with TACE for 1-2 times first. Then after an interval of 4-6 weeks, the conformal radiotherapy was given. If the diameter of the tumor was less than 6 cm, the dose was 3-.5 Gy each time, and the total dose was 45-55 Gy. If the diameter of the tumor was larger than 6cm,the dose was 2 Gy each time,and the total dose was 56-60 Gy. The patients received oral Felviten ursodeoxycholic acid, Salvia miltiorrhiza composite and liver protection treatment during radiotherapy. The results of AFP and liver-CT examination after 3 months of treatment were compared with those before treatment. Results AFP decreased obviously compared with before treatment（ P 〈 0. 05 ）. The response were complete remission（CR） 22. 9% （ 8/35 ）, partial remission（PR） 51.4% （ 18/35 ）, stable disease （ SD ） 20% （ 7/35 ） , and progression disease （ PD ） 5.7% （2/35）, overall response rate （ CR ＋ PR） 74. 2% （ 26/35 ）, and the 1-, 2- and 3-year survival rates were 54. 2% （19/35） ,25.7% （9/35）, 14. 3% （5/35）. Conclusions 3D-CRT combined with TACE for treatment of primary hepatic carcinoma can achieve high local control rate and good short-term curative effect.