肝动脉栓塞化疗联合放疗治疗不能手术的原发性肝癌的临床观察

目的　观察肝动脉栓塞化疗（ＴＡＣＥ）联合直线加速器或全身伽玛刀治疗不能手术的原发性肝癌（ＰＨＣ）的疗效及毒副反应。方法　２００５年７月至２００８年６月，１０８例不能手术的ＰＨＣ患者中５０例行ＴＡＣＥ联合直线加速器放疗（加速器组），５８例行ＴＡＣＥ联合全身伽玛刀放疗（伽玛刀组）。ＴＡＣＥ灌注化疗药物包括丝裂霉素（ＭＭＣ）１０～２０ｍｇ、氟尿嘧啶（５-ＦＵ）１０００～１５００ｍｇ、表阿霉素（Ｅ-ＡＤＭ）３０～５０ｍｇ，栓塞剂为４０％超液态碘化油５～２０ｍｌ。直线加速器治疗用６ＭＶ Ｘ，９５％等剂量线包绕ＰＴＶ，４０～６０Ｇｙ／１５～２５ｆ，３～５ｆ／周；伽玛刀治疗用月亮神立体定向伽玛射线旋转聚焦全身放射治疗系统（ＬＵＮＡ-ＴＭ-２６０），４０％ ～６０％等剂量线包绕ＰＴＶ，单次剂量３～６Ｇｙ，３～５ｆ／周，照射总量３０～５０Ｇｙ。联合应用ＴＡＣＥ为１～３个疗程。结果　加速器组及伽玛刀组的中位生存期分别为１４个月和１６个月，中位肿瘤进展时间（ＴＴＰ）分别为７.６个月和８.１个月；２年局部控制率分别为４５.４％和４３.６％（χ^２ ＝０.０２０，Ｐ＝０.８８７），３年局部控制率分别为３６.５％和３７.９％（χ^２ ＝０.０４０，Ｐ＝０.８４１）；２年生存率分别为４１１％和３９６％（χ^２ ＝０.０２１，Ｐ＝０.８８５），３年生存率分别为３４.３％和３０.２％（χ^２ ＝０.３６８，Ｐ＝０.５４４）。加速器组中出现１例放射诱发的肝病，伽玛刀组未见相关病例。结论　直线加速器和伽玛刀联合ＴＡＣＥ治疗ＰＨＣ均安全可靠，疗效相当。

Effects of radiotherapy combined with transcatheter arterial chemoembolization on patients with advanced unresectable primary hepatocellular carcinoma

Objective To evaluate the effects of transcatheter arterial chemoembolization(TACE) combined with radiation therapy on patients with advanced unresectable primary hepatocellular carcinoma(PHC).Methods From July 2005 to June 2008,108 patients with advanced unresectable PHC were divided into 2 groups.Fifty patients were treated with linear accelerator combined with TACE(accelerator group),and 58 patients were treated with body gamma knife combined with TACE(gamma knife group).For accelerator group,6MV-X ray w...