放射治疗结合介入治疗对原发性肝癌骨转移瘤的疗效观察

目的探讨放射治疗结合介入治疗对原发性肝癌骨转移瘤的疗效及其应用价值。材料与方法对5例先后行放射治疗及介入治疗的原发性肝癌骨转移瘤患者进行回顾性分析。5例患者均为男性,年龄37～68岁。病理证实其肝脏原发肿瘤为肝细胞癌。外科手术切除或射频消融治疗术后1～15个月CT或MRI检查提示不同部位骨转移瘤,伴不同程度局部疼痛。其中1例为胸骨上段转移瘤;1例为右第十前肋局灶性膨胀性骨质破坏;2例右髂骨区出现不规则骨质破坏并有软组织肿块;另1例第4腰椎骨转移合并椎旁软组织肿块及神经根压迫症。5例患者均先后接受常规放射治疗及不同方式的介入治疗。联合治疗前后以目测模拟法（VAS法）对患者疼痛程度进行分级,并以影像学复查评价转移灶局部治疗效果。结果5例患者治疗前其疼痛VAS评分均在7分以上。联合治疗后完全缓解（VAS评分降至0分）2例,明显缓解（VAS评分降至1～3分）1例,中度缓解（VAS评分降至4～6分）1例,无缓解（VAS评分仍为7～10分）0例。5例患者联合治疗后AFP下降均〈50%。影像学复查提示骨转移病灶局部骨质破坏基本停止,软组织肿块明显缩小。病人治疗后生活质量明显提高,在不依赖镇痛药物的前提下基本可达到无痛睡眠,无痛休息和无痛活动。结论放射治疗结合介入治疗对原发性肝癌骨转移瘤有协同作用，可提高疗效，改善患者生存质量。

The therapeutic effect of radiotherapy combined with interventional therapy on osseous metastases of primary hepatic carcinoma patients

Objective To evaluate the therapeutic effect of radiotherapy combined with interventional therapy on osseous metastases of primary hepatic carcinoma patients.Methods Clinical data from five patients with primary hepatocellular carcinoma（HCC） were analyzed retrospectively.Bone metastases were found on all patients by CT or MRI 1～15 months after being treated with surgery or radiofrequency ablation to HCC.All patients had severe local pain at the metastatic lesion.One case had osseous metastasis in the upper part of sternum;another case had swelling focal osseous destruction at the right 10th rib.Irregular osteoclasia and soft tissue masses were found on the right ilium in two cases.The last one case had metastasis in the 4th lumbar vertebrae,companying with paravertebral soft tissue mass and nerve root compression syndrome.All of five patients sequentially underwent routine radiotherapy and interventional treatment.The relief extent of pain and local therapeutic effect were evaluated and compared before and after receiving combining treatment with visual analog scales（VAS） and CT or MRI examinations.Results The VAS scores for pain of all five patients were 7 points or above before being performed combining treatment.After treatment,VAS score dropped to 0 points in 2 cases（complete relief）,1～3 points in 2 case（evident relief） and the other one case dropped to 4～6 points（moderate relief）,there was 0 case remained 7 ～10 points（no relief）.VAS score of all patients significantly decreased after being performed combining treatment.The life quality of the patients improves as the pain relived.The data of tumor marker AFP dropped more than 50% in all fivecases.Bone destruction and soft-tissue mass was found significantly reduced in following-up imaging examination.Conclusion Radiotherapy combined with interventional therapy can relieve pain for osseous metastases and permit the patients to improve life quality evidently.This combining treatment could be considered as an appropriate therapeu