原发性小肝癌三维适形放疗的疗效评价

目的：观察三维适形放射治疗原发性小肝癌的临床疗效。方法：对32例原发性小肝癌患者在CT定位下以5mm层厚靶区连续扫描，静脉双期碘造影剂增强扫描，精确定位治疗靶区并调整剂量分布,使100％等剂量曲线包绕100％PTV剂量体积。照射剂量－时间－分次为48－63Gy-12-18d-6-9次，以Varian600C/D直线加速器实现放疗计划。结果：1个月后13例部分缓解（40．6％）；3个月后16例部分缓解（50％）；装卸后17例部分缓解（53．1％）；1年后4例部分缓解（12．5％），28例完全缓解（８７．５％）。随访3年，1年后生存率为100％，3年后1例死亡，死亡原因为脑出血，经统计分析，治疗前后肝功能无显著变化（P＝0．15），治疗后甲胎蛋白较治疗前显著降低（P＝0．025）。结论：三维适形放射治疗是原发性小肝癌有效的无创治疗手段。

Evaluation of three-dimensional conformal radiation therapy for small primary hepatocellular carcinoma.

OBJECTIVE: To evaluate the therapeutic effect of three-dimensional conformal radiation therapy (3D-CRT) on small hepatocellular carcinoma. METHODS: Between May 1998 and Dec 2002, 32 patients with small primary hepatocellular carcinoma underwent 3D-CRT (mean total dose of 55 Gy, ranging from 48 to 63 Gy, given in 6 to 9 fractions completed within 12 to 18 d). The clinical target volumes (CTVs) were covered with 100% isodose curve, using 6 MV X-ray. CT studies before and during a follow-up period of 3 years after 3D-CRT were conducted to evaluate the therapeutic effects, with alpha-feto-protein (AFP) levels also tested. RESULTS: Completed remission of the tumor occurred in 87.5% (28/32) of the cases, and partial remission (PR) was obtained in 12.5% (4/32) of the cases after one year. The 1-year survival rate at stage III was 100%, and 2- and 3-year survival rates were both 97%, with death occurring only in one case because of cerebral hemorrhage. AFP levels of these patients with hepatocellular carcinoma were all significantly decreased (P=0.025). CONCLUSION: 3D-CRT is an effective method in the treatment of patients with small primary hepatocellular carcinoma.