【摘要】 目的评价放疗晚期肝外胆道系统肿瘤的疗效。方法对28例手术不可切除的肝外胆道系统肿瘤采用放化疗,其中胆囊癌13例,肝外胆管癌15例。15例采用常规放疗,中位照射剂量45Gy(30~60Gy),13例采用三维适形放疗(3DCRT)多野(3~5个野)照射或加量,中位照射剂量55Gy(50~70Gy)。12例单纯放疗,16例放化结合。化疗方案为氟尿嘧啶500mg,2次/周,或氟尿嘧啶500mg+顺铂30mg,1次/周,疗程3~6个周期。结果全部患者近期有效率14%。全组中位生存期9.4个月(2~28个月)。1、2年生存率分别为38%、15%;其中1年生存率胆囊癌为46%,肝外胆管癌为27%,3DCRT为42%,常规放疗为33%,单纯放疗为37%,放疗+化疗为31%;<50Gy的为29%,≥50Gy的为45%。只有照射剂量(≥50Gy)对1年生存率有影响(χ2=5.31,P=0.023)。急性消化道反应1~2级为57%,3级为18%,仅有25%的出现1~2级血液毒性反应。结论对晚期肝外胆道系统肿瘤采用放化疗可取得一定疗效,且副作用可耐受。更多还原

【Abstract】 Objective To evaluate the effect of radiochemotherapy for unresectable extra-hepatic bile duct cancinoma. Methods Form June 1993 to August 2003, 28 unresectable extra-hepatic bile duct carcinoma treated by radiochemotherapy were analyzed. There were 13 gallbladder carcinoma and 15 bile duct carcinoma. The radiotherapy regimen consisted of conventional radiation therapy group(15 patients,with a median dose of 45Gy, range 30-60Gy) and three-dimensional conformal radiation therapy group(13 patients, with a median dose of 55Gy , range 50-70Gy). Among these patients, 12 patients were treated by radiotherapy alone( RT), 16 patients treated by radiochemotherapy(CRT), with a chemotherapy regimen consisting of 5-Fu 500mg twice weekly or 5-Fu 500mg + DDP 30mg once weekly for 3-6 cycles. Results The CR+PR, SD and PD rate was 14%, 64%, and 21%, respectively. The overall 1-,2-year survival rate was 38% and 15%, with a median survival time of 9.4 months. The 1-year survival of gallbladder cancer and extra-hepatic bile duct cancer was 46% and 27%;of 3DCRT and conventional radiotherapy was 42% and 33%;of those radiation dose less than 50Gy and more than 50Gy was 29% and 45%;of RT alone and radiochemotherapy was 37% and 31%, respectively. There was significance difference in overall survival between those RT dose less than 50Gy and more than 50Gy,(P=0.023). Grade 1-2 and Grade 3 acute gastrointestinal toxicity was 57% and 18%, respectively. Only 25% patients suffered grade 1-2 hematology toxicity. Conclusion Radiochemotherapy shows moderate effect for unresectable extra-hepatic bile duct cancer with acceptable side effects.更多还原