IMRT与γ刀联合TACE术治疗原发性肝癌的疗效比较

 目的 比较调强放疗(IMRT))与伽马刀(γ刀)联合经肝动脉化疗栓塞(TACE)术治疗原发性肝癌(PHC)的疗效。方法 选择自2012-03至2014-06武警总医院收治的PHC患者94例,按照随机数表将患者分为对照组和观察组,每组47例。对照组患者行IMRT联合TACE术治疗,而观察组患者行γ刀联合TACE术治疗。对比分析两组患者的近期及远期疗效、药物不良反应发生情况及血清中甲胎蛋白(AFP)水平。结果 治疗1个月后,观察组有效率为82.98%(39/47),明显高于对照组的57.45%(27/47) ,且差异具有统计学意义(P<0.05);与治疗前相比,两组患者治疗后血清中AFP水平明显下降,而观察组患者血清中AFP水平显著低于对照组,且差异均具有统计学意义(P<0.05或P<0.01);观察组患者药物不良反应发生率为14.89%(7/47)明显低于对照组的25.53%(12/47),且差异具有统计学意义(P<0.05); 两组患者在治疗后6个月及12个月的生存率之间的差异无统计学意义(P>0.05),而治疗后24个月,观察组患者的生存率显著高于对照组(P<0.05)。结论 相对于IMRT联合TACE术,伽马刀联合TACE术治疗原发性肝癌具有较高的近期及远期疗效,不仅可以有效降低药物毒物反应发生率,而且可以显著抑制血清AFP水平,值得推广应用。

Clinical comparative study of intensity-modulated radiotherapy and gamma knife combined with TACE for the treatment of primary hepatic carcinoma

Objective To compare the clinical curative effect of the gamma knife (γ knife) and intensity-modulated radiotherapy(IMRT) combined with transcatheter hepaticarterial chemoembolization (TACE) for primary hepatic carcinoma.Methods According to the stochastic indicator,94 cases of PHC patients betweem March 2012 and June 2014 were equally divided into control group and observation group.Patients in control group were treated with intensity-modulated radiotherapy combined with TACE,while observation group was treated with,γknife combined with TACE.The recent and forward curative effect,occurrence of adverse reactions of drugs and the level of serum alpha fetal protein (AFP) of the two groups were analyzed comparatively.Results After onemonth treatment,the effective rate of observation group was 82.98 ％ (39/47),which was obviously higher than that of control group 57.45％ (27/47)],and the difference was statistically significant (P ＜ 0.05).The level of serum AFP of the two groups declined obviously after treatment,and thatof observation group was significantly lower than in control group.The difference was statistically significant (P ＜0.05 or P ＜0.01).The incidence of adverse reactions in observation group was 14.89％ (7/47),which was significantly lower than in control group25.53％ (12/47)],and the difference was statistically significant (P ＜ 0.05).However,the difference of survival rate after 6 months and 12 months of treatment between the two groups was not of statistical significance (P ＞ 0.05).The survival rate of observation group after 24 months of treatment was significantly higher than that of control group (P ＜ 0.05).Conclusions Compared with intensity-modulated radiotherapy combined with TACE,γknife combined with TACE for the treatment of primary hepatic carcinoma has a better recent and forward curative effect in that it can not only reduce the incidence of toxic reactions of drugs effectively,but significantly inhibit the level of serum AFP,which is worthy of clinical popularization and application.