外照射配合肝动脉栓塞治疗不能手术切除的原发性肝癌的临床研究

背景与目的:肝动脉栓塞化疗(transcatheter arterial chemoembotization, TACE)是目前治疗不能手术切除的原发性肝癌的常规治疗方法,但单纯TACE疗效较差,3年生存率约20%左右,本研究旨在探讨TACE结合外照射治疗不能手术的原发性肝癌的疗效。方法:1994年6月～2002年4月间,54例不能手术的原发性肝癌患者接受TACE加外照射(综合组)治疗,同时选取60例同期治疗的单纯TACE患者作为对照组,两组资料具有可比性。TACE采用Seldingers法经股动脉穿刺插管,将插管插入肝固有动脉后,注入造影剂,明确已插入肿瘤区供血血管后再注入化疗药物(MMC ADM CBP)和碘油配制的悬液,同时根据肝肿瘤的供血情况用明胶海绵栓塞供血动脉血管,4～8周后重复。综合组患者先进行TACE治疗1～4次,放射治疗在TACE后21～28天进行,用真空袋固定体位,54例中有36例采用普通增强CT扫描结合碘油沉积和体表标志进行模拟机定位,11例采用CT鄄sim设计治疗计划,靶区的确定根据CT扫描所提示的肿瘤大小和碘油的沉积情况外扩1.5cm,同时在模拟机下观察患者的呼吸运动度,视情况在照射野的Y轴方向增加1～2cm,7例患者应用3维治疗计划系统计算剂量分布,尽可能保护正常肝组织、双侧肾脏和脊髓。照射剂量36～60Gy,平均照射剂量53.3Gy,每次1.8～2Gy,5次/周。结果:TACE

External radiation and combined transcatheter arterial chemoembolization for unresectable primary liver cancer

BACKGROUND & OBJECTIVE: Transcatheter arterial chemoembolization (TACE) is the routine treatment for unresectable primary liver cancer, but 3-year survival rate of patients received TACE alone is only about 20%. This research was to evaluate efficacy of external radiotherapy (RT) combined with TACE on unresectable primary live cancer. METHODS: From Jun. 1994 to Apr. 2002, 114 patients with unresectable primary liver cancer were non-randomized to receive TACE plus RT (54 patients), or TACE alone (60 patients) as control. For TACE, after skiagram confirmed catheterization, suspension of 300 mg of carboplatin, 50-60 mg of epirubicin, 14-20 mg of mitomycin, and 10-30 ml of iodized oil was perfused into hepatic arteries, 1-2 mm of Gelfoam particles was given to embolize hepatic arteries according to blood supply conditions of tumors, this process was repeated every 4-8 weeks. Either group was treated with 1-4 sessions of TACE. In TACE+RT group, patients received radiation on tumor and generous margin 21-28 days after TACE. The radiation dose was 46-60 Gy in daily 2 Gy fractions. RESULTS: In TACE+RT group, response rate (AFP titer decrease of >50%) was 61.1%, and 1-, 2-, 3-year survival rates of TACE+RT group were significantly higher than those of TACE group (66.5% vs. 53.9%, 48.4% vs. 37.2%, and 37.4% vs. 17.8%, P<0.05). Three-year survival rate correlated with tumor size, liver function grade, and portal vein embolus. CONCLUSION: TACE combined with RT may prolong survival time of patients with unresectable primary live cancer.