介入治疗联合三维适形放疗治疗肝细胞癌伴门静脉癌栓疗效观察

目的评价三维适形放射治疗结合经皮肝动脉化疗栓塞治疗肝细胞癌伴门静脉癌栓的疗效。方法对36例不能手术切除的肝细胞癌伴门静脉癌栓患者,采用三维适形放射治疗结合经皮肝动脉化疗栓塞进行治疗,放射治疗采用常规分割,总量介于36～60 Gy之间,观察近期疗效,用Kaplan-Meier法进行生存分析。结果肿瘤缓解率为47.2%,1,2,3年累积生存率分别是55.5%、38.9%和22.2%,中位生存期11.2个月。放射性肝炎是最常见的并发症。结论介入治疗联合三维适形放疗治疗肝细胞癌伴门静脉癌栓有较好的疗效。对何种治疗剂量较为合适以及治疗方法先后顺序的选择,还需进一步探讨。

Observation on the efficacy of interventional therapy combined with 3-dimensional conformal radiation therapy in treatment of hepatocellular carcinoma with portal vein tumor thrombus

Objective To evaluate therapeutic efficacy of 3-dimensional conformal radiation therapy combined with transcatheter arterial chemoembolization （TACE） for portal vein tumor thrombus in patients with hepatocellular carcinoma. Methods Thirty-six patients with unresectable hepatocellular carcinoma complicated with portal vein tumor thrombus were treated with 3-dimensional conformal radiotherapy and TACE. Radiotherapy was performed in conventional fractionation, with total dose of 36-60 Gy. The objective re- sponse was analyzed and the survival rate was assessed from the date of beginning of treatment using the Kaplan-Meier method. Results The objective response rate was 47.2%. The overall survival rates were 55.5% ,38. 9% ,and 22. 2% at 1, 2, 3 years, respectively, with a median survival time of 11.2 months. Radiation-induced hepatitis was the most common treatment-related complication. Conclusion Interventional therapy combined with 3-dimensional conformal radiation therapy is an effective and feasible approach for treatment of portal vein tumor thrombus in unresectable hepatocellular carcinoma patients. However, how to select right therapeutic dose and the order of therapeutic methods need to be studied further.