放疗、肝动脉灌注化疗及两者联合治疗局部晚期肝癌的临床疗效分析

目的:探讨放疗、肝动脉灌注化疗（transcatheter arterial chemoembolization，TACE）及放疗联合TACE在治疗局部晚期肝癌中的价值。方法:回顾性分析45例IIIb-IVa期肝癌。单纯放疗10例，单纯TACE 8例，联合治疗13例，姑息治疗14例，比较近期疗效、不良反应、无疾病进展生存时间、总体生存时间。结果:放疗组完全缓解（CR）0例，部分缓解（PR）6例，有效率60%。TACE组CR 0例，PR 3例，有效率38%。联合组CR 0例，PR 8例，有效率62%，有统计学差异（P=0.041)。TACE与放疗、联合治疗组均有统计学差异（P=0.028，P=0.021）。放疗组、TACE组、联合组中位总生存时间（OS）和PFS分别为7个月、7个月、22个月（P＜0.001）和4个月、3个月、13个月（P＜0.001），均有统计学差异，姑息组中位OS为3个月。三组均未出现严重不良反应，消化道反应及诱发乙肝比较无统计学差异。不良反应方面，发热（P＜0.001）、腹痛(P＜0.001)、肝功能不良(P=0.007)三组比较有统计差异,不良反应以放疗组最少见。结论:对于局部晚期肝癌,单纯放疗、单纯TACE、放疗联合TACE均可改善近期疗效、PFS和OS，以放疗联合TACE为最佳，精确放疗稍优于单纯TACE。

Clinical efficacy of radiotherapy,TACE and combined protocol in the treatment of local advanced hepatocelluar cancer

Objective:To assess the clinical efficacy of precise radiotherapy,TACE,radiotherapy combined with transcatheter arterial chemoembolization(TACE) for locally advanced liver cancer.Methods:Data of 45 patients of IIIb-IVa locally advanced stage liver cancer were retrospective analysed,and objective response rate,toxicity,overall suvival time(OS)and progress free survival time(PFS)were compared.Radiotherapy(RT) group were 10 cases,TACE group 8 patients,radiotehapy combined TACE treatment group(Comb group) 13 cases and 14 cases were palliative care group.Results:Objective response rates among RT group(6/10),TACE group(3/8) and Comb group(8/13) were 60%,38%,62%,respectively,the difference of three groups had statistical significance(P=0.041).There was statistical significance between TACE group and RT group(P=0.028),between TACE and Comb group(P=0.021).Statistical significance was not found between RT group and Comb group(P＞0.05).Median OS and PFS of RT group,TACE group,Comb group,palliative care group were 7,7,22 months and 4,3,13 months,respectively.Statistical significance were found in OS in four groups(P＜0.001) and the same as PFS in three treatment groups(P＜0.001).Difference of OS between RT group and Comb group(P=0.013) had statistical significance,the same as TACE group and Comb group(P＜0.001).Difference of PFS had statistical significance between RT group and Comb group(P=0.004),the same as TACE group and Comb group(P＜0.001).Difference of OS and PFS was not statistical significant between RT group and TACE group.Serious toxicity were not observed in three treatment groups.Adverse reaction of gastrointestinal tract (P=0.737) and hepatitis B virus replication(P=0.13) had no statistical significance among three treatment groups.Statistical significance of three groups was found on other side effects such as fever(P＜0.001),bellyache(P＜0.001) and hypohepatia(P=0.007) and these side effects were seldom found in radiotherapy group.Conclusion:Precise radiotherapy,TACE,radiotherapy combined with TACE treatment could improve the objective response rate,PFS and OS in treatment of locally advanced liver carcinoma.Combined therapy was the best,and precise radiotherapy was superior to TACE.