三维适形和伽玛刀治疗肝癌的剂量分布特点及放射性肝损伤对比研究

目的探索三维适型放射治疗（3DCRT）和立体定向放射治疗（SBRT）对原发性肝癌治疗的剂量分布特点及肝脏的损伤。方法对2008年4月～2010年06月治疗的48例原发性肝癌患者，其中接受3DCRT的22例，接受SBRT的26例进行回顾性分析，比较剂量分布特点和肝功能的变化。结果3DCRT靶区内剂量均匀性好，但正常肝组织受照体积过大，发生放射性肝损伤几率高；SBRT由于其特殊的剂量分布特点能更好的提高肿瘤靶区剂量，降低正常组织的损伤，从而减少放射性肝损伤的发生，但高剂量区均匀性较3DCRT差。结论原发性肝癌的放射治疗要根据患者的治疗目的，肝脏功能的情况和患者个人情况选择不同的治疗方式。

Comparison of Dose Distribution Character and Radiation-induced Liver Injury between 3-dimensional Conformal and Gamma Knife Radiotherapy

Objective To explore the dose distribution character and liver injury induced by 3-dimentional conformal radiotherapy （3DCRT） or stereotactic radiotherapy （SBRT） for primary hepatic carcinoma treatment. Methods A retrospective review was conducted in 48 patients treated from April 2008 to June 2010, who suffered primary hepatic carcinoma. Among the 48 cases, 22 cases were treated with 3DCRT and the other 26 with SBRT. The dose distribution character and radiation-induced liver injury were compared between the two gYoups. Results The dose distribution of 3DCRT in the target area is average, but more normal liver tissue is under radiation, which leads to higher rate of liver injury induced by radiation. While SBRT, because of its unique dose distribution character, increases the dose in tumor target and decreased the injury to normal tissue. Although lower the rate of radiation-induced liver injury, SBRT is not as good as 3DCRT when it comes to average dose distribution. Conclusion Radiotherapies for primary hepatic carcinoma should be performed separately according to different therapeutic objectives, liver functional conditions and personal conditions of individual patients.