三维适形放疗联合肝动脉化疗栓塞术治疗中晚期肝癌的临床研究

目的探讨三维适形放射治疗(Three-dimensional conformal radiotherapy,3DCRT)联合肝动脉化疗栓塞术(hepatic arterial chemoembolization,TACE)治疗中晚期肝癌的可行性及优势。方法选取60例确诊的无手术指征的中晚期肝癌患者,先行TACE,将导管置于肝固有动脉,灌注5-氟脲嘧1 000 mg+羟基喜树碱20 mg,然后用微导管超选肿瘤供血动脉,将超液化碘油10 ml与吡柔比星30 mg制成碘油化疗乳剂,对肿瘤进行栓塞;而后再注入细微颗粒对肿瘤血管进行栓塞,如PVA颗粒或明胶海绵颗粒,造影复查肿瘤供血动脉消失。3~4周后复查上腹部CT、肝肾功能、血常规,如果肿块体积过大,须再次行TACE治疗,待肿块缩小后,再进行3DCRT;TACE平均为3~5次。所有患者均行3DCRT。结果放疗结束1个月后评价疗效,其中完全缓解(CR)11例,部分缓解(PR)34例,无变化(NC)12例,进展(PD)3例,总有效率(CR+PR)为75%,1年生存率80%,2年生存率35%,3年生存率13.3%,死于非肿瘤相关疾病6例(10%),至随访日生存者5例(8.3%)。全组中位生存时间16个月。结论 3DCRT联合TACE治疗中晚期肝癌是一种安全有效的方法,它能更好地杀灭肿瘤细胞、明显提高肿瘤局控率、延长生存期、提高生存质量,是治疗中晚期肝癌理想、有效的一种方法,值得临床推广应用。

Clinical effect of Three-dimensional conformal radiotherapy combined with TACE for the middle and advanced-stage hepatic cancer

Objective To investigate the feasibility and advantage of the Three-dimensional conformal radiotherapy （3DCRT） combined with hepatic arterial chemoembolization （TACE） in the treatment of patients with locally advanced hepatic cancer.Methods Sixty patients with locally advanced hepatic cancer who were absence of operative indication were included in the study.All of patients were treated by the TACE,5-FU 1 000 mg ＋ hydroxy camptothecin 20 mg were poured into proper hepatic artery with catheter.Then,liquefied lipiodol 10 ml ＋ Pirarubicin 30 ml were used to embolism the feeding artery of tumor with microtuble.Last,microparticle,such as PVA or gelatin sponge,was poured into tumor vessel for embolism,while opacification reviewed the disappearance of feeding artery of tumor.After 3 ～ 4 weeks,CT of upper abdome,liver and renal function,blood were reviewed.If the volume of tumor was large,patients were treated by TACE again until the tumor became small.After 3 ～ 5 times of TACE,all patients were treated with 3DCRT.Results After 1 month of radiotherapy ended,the CR,PR,NC and PD were 10 cases,31 cases,11 cases and 2 cases,respectively.The total effective rate （CR ＋ PR） was 68.3％.The survival rates of 1 year,2 years and 3 years were 80％,35％,13.3％,respectively.Six （10％） patients died due to other diseseas.Five （8.3％） patients were alive.The medium survival duration was 16 months.Conclusion 3DCRT in combination with TACE in the treatment of patients with locally advanced hepatic cancer is safe and effective,which can kill tumor cells more effectively and improve the local-control rate and survival rate and the quality of life.The treatment method is worth to practise,which is an ideal treated model for locally advanced hepatic cancer.