肝动脉栓塞化疗联合立体定向放射治疗原发性肝癌的疗效分析

目的:分析肝动脉栓塞化疗（TACE）联合立体定向放射治疗（SBRT）不能手术的原发性肝癌的疗效及毒副反应。方法:96例不能手术的原发性肝癌患者，TACE联合SBRT治疗44例（研究组），单纯TACE治疗52例（对照组）。TACE灌注化疗药物为:氟尿嘧啶（5-FU）（1 000~1 500）mg和/或顺铂［DDP（40~60）mg］，表阿霉素（E-ADM）（30~50）mg，栓塞剂为超乳化碘油（3~18）ml。SBRT采用月亮神立体定向伽玛射线旋转聚焦全身放射治疗系统，≥50%等剂量线包绕PTV，单次剂量3~6Gy，5次/周，照射总量30~50Gy。结果:研究组和对照组的TACE平均次数分别为2.0（1~6）和3.6（1~7）。中位生存期分别为18.1个月和10.6个月。两组2年局部控制率分别为42.5%、32.8%，3年局部控制率分别为35.8%、22.5%，两组比较有显著的统计学意义（P=0.044，P=0.040）。2年生存率分别为40.5%、29.2%，3年生存率分别为32.2%、20.3%，2年、3年总生存率比较两组均有统计学差异（P=0.048，P=0.032）。研究组发现2例放射诱发的肝病。结论:TACE联合SBRT比单纯TACE对不能手术的原发性肝癌治疗疗效好，毒副反应未增加。

Clinical effects of transcatheter arterial chemoembolization combined with stereotactic body radiation therapy on patients with unresectable hepatocellular carcinoma

Objective:To analyse the therapeutic effects and side -effect of the transcatheter arterial chemoembo-lization(TACE)combined with stereotactic body radiation therapy (SBTR)for patients with unresectable hepatocel-lular carcinoma.Methods:All 96 cases of advanced hepatocellular carcinoma were divided into 2 groups,44 cases in therapy group treated with TACE and SBTR,52 cases in control group treated with TACE alone.For TACE,(30 ~50) mg epirubicin,(1 000 ~1 500)mg 5 -fluorouracil and /or (40 ~60)mg cisplatin were perfused into the hepatic arter-ies,(3 ~18)ml iodized oil was given to emobolized the hepatic arteries.For SBRT,LUNA -260 whole body -gamma knife radiosurgery was used,≥50% isodose curve included PTV,and the total treatment dose was 30 ~50Gy/5 ~12f,5 times per week.Average dose of liver <23Gy,V30 <30%.Results:For therapy group and control group,average TACE were 2.0(1 ~6)and 3.6(1 ~7)times.Medium survival time(MST)were 18.1 and 10.6 months respective-ly.The 2 year's local control rates were 42.5% and 32.8% respectively,and 3 year's local control rates were 35.8%, 22.5%(P =0.044,P =0.040).For therapy group,2 and 3 years survival rates were 40.5% and 32.2% respective-ly,and for control group,they were 29.2% and 20.3% respectively.All of them showed a statistically significant differences for 2 and 3 year's survival rates(P =0.048,P =0.032).There were 2 cases with radiation induced liver disease(RILD)in therapy group.Conclusion:The efficacy of TACE combined with SBRT is superior to that of TACE alone for advanced hepatocellular carcinoma.The side -effect is moderate and clinical acceptable.