【摘要】 目的:探讨肝动脉介入化疗并栓塞结合γ射线适形放射治疗原发和转移性肝癌的疗效,并和单纯介入法进行疗效比较。方法:94例不能手术的肝癌患者随机分为介入加放疗组(综合组)与单纯介入组(对照组)。综合组44例中39例先行碘油、顺铂、明胶海绵等经肝动脉化疗栓塞1-3次后,再进行γ射线适形放疗,用50%-70%等剂量线包绕计划靶区,单次剂量为400-500cGy/次,3次/周,共计9-12次,肿瘤边缘总剂量达40-60Gy;5例先行体部伽玛刀放疗,休息2-3周后,行1-3次介入治疗。用COX模型对综合组进行预后分析。结果:治疗后综合组3个月总有效率(近期疗效)为77.2%(34/44),1、3、5年生存率分别为70.4%(31/44)、43.2%(19/44)、20.5%(9/44)。对照组3个月总有效率(近期疗效)为52.0%(26/50),1、3、5年生存率分别为46.0%(23/50)、14.0%(7/50)、8.0%(4/50),两组生存率比较差异有显著性(P<0.05)。结论:肝动脉介入化疗并栓塞结合γ射线适形放射治疗原发和转移性肝癌是安全、有效的方法。肿瘤直径、数目、child分级是影响预后的主要因素。更多还原

【Abstract】 Objective:To analyze the reponse and tolerance of patients with hepatocellular carcinoma(HCC)treated by γ-ray three-dimensional fractionated stereotactic conformal radiotherapy(FSCR)combined with transcatheter arterial chemoembolization(TACE),and to compare effect of the transcatheter arterial chemoembolization(TACE)alone with that of TACE combined with FSCR for patients with primary or metastasis liver carcinoma.Methods:A total of 94 patients with HCC were randomly divided into TACE alone group and TACE combined with FSCR group.Fifty of the 94 patients who were treated with TACE alone and forty-four were treated with TACE plus FSCR.thirty-nine of the 44 patients were treated with TACE firstly,TACE was performed using lipiodol,cisplatin,followed by gelatin spong cubes,γ-ray conformal radiotherapy was performed after 1-3 times TACE was given,50%-70% isodose include PTV,dosage of 4-5Gy/fractions,3 times one week,a total of 9-12 fractions was used,total dose in tumor margins was 40-60Gy.Five of the 44 patients were treated with TACE for 1-3 times after γ-ray conformal radiotherapy 2-3 weeks.Cox proportional hazard model was used to analyze the prognostic factors.Results:The total effective rate after three months and overall survival rates after 1,3,5 years in TACE combined with FSCR group(77.2%,70.4%,43.2%,20.5%)were significantly higher than that in TACE alone group(52.0%,46.0%,14.0%,8.0%,P<0.05).Conclusion:γ-ray conformal radiotherapy combined with transcatheter arterial chemoembolization(TACE)was a safe and effective trentment for liver cancer.In TACE combined with FSCR group,the number and diameter of tumor,child-pugh classification were the key factors in clinical prognosis.更多还原