肝动脉栓塞化疗联合放疗治疗原发性肝癌的疗效分析

目的:分析肝动脉栓塞化疗（TACE）联合放射治疗对不能手术的原发性肝癌的疗效与不良反应。方法:2010年1月至2012年12月TACE联合放疗治疗25例原发性肝癌患者（治疗组），单纯TACE 治疗原发性肝癌27例（对照组）。TACE选择肝脏肿瘤供血血管，注入氟尿苷500-1000mg和/或顺铂40-60mg，吡柔比星20-40mg+碘化油5-20ml混悬剂，大肝癌合用明胶海绵1/3条，剪成碎末栓塞血管。研究组TACE 1-2次后2-3周，行三维适形放疗，总剂量DT 30-60Gy/15-30f，1.8-2Gy/(f·d)，5次/周。结果:治疗组25例共计TACE术60次，平均2.4（1-6）次，完成总剂量DT 30-60Gy/15-30f，2例患者的远处转移灶同时放疗；对照组27例共计TACE术83次，平均3.07（1-8）次。52名患者均可评价疗效。治疗组与对照组的有效率为88.0%和25.9%，中位生存时间为22和5个月，平均生存时间为(14.62±1.86)和(7.47±1.29)个月，组间差异非常显著（P=0.0024）。6、12、18、24个月生存率有显著性差异（P<0.05）。52例患者栓塞化疗并发症有呕吐8例，腹痛16例，发热18例，3例出现Ⅳ度白细胞抑制，无肝肾功能损害，放疗期间未观察到毒副反应。结论:TACE联合放射治疗较单纯TACE对晚期原发性肝癌疗效好，毒副反应未增加。

Efficacy combined transcatheter arterial chemoembolization(TACE)and radiotherapy for advanced primary liver cancer

Objective:To analyse therapeutic effect and side-effect on the combined transcatheter arterial chemoembolization (TACE) and radiotherapy for advanced primary liver cancer.Methods:All 52 cases of advanced liver cancer were divided into two groups.Therapy group 25 cases were treated by TACE combined radiotherapy，control group 27 cases by TACE.The median surviral time (MST)，12，24-months survival rate and average survival time(AST) between two groups were compared.Results:In therapy group and controlgroup，average TACE were 2.4（1-6） and 3.07（1-8） times，RR was 88% and 25.9%，MST was 22 and 5 months，AST was （14.62±1.86） and （7.47±1.29） months (P=0.0024),12，24-months survival rate were (54.31±10.95)% and (19.94±7.91)%，(45.26±12.31)% and (10.64±6.51)%(P<0.05）.Among 52 cases of TACE，complication were 8 cases of vomiting，abdominal pain of 16 cases，fever 18 of cases.Adverse reactions included 3 cases of Ⅳ degree neutropenia inhibition.There was no side-effect of radiotherapy.Conclusion:The efficacy of TACE combined radiotherapy is superior to that of TACE.The side-effect is moderate.It is an effective therapy for advanced liver cancer.