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目的分析原发性肝癌常规分割三维适形放疗后发生放射性肝病的相关因素,以指导原发性肝癌放疗计划的制定,减少或避免放射性肝病的发生。方法对88例原发性肝癌患者采用常规分割三维适形放疗(1.8～2.2 Gy/次,15～33次,30～66 Gy,中位剂量46 Gy)。对性别、年龄、病理类型、病理分型、肿瘤最大直径、肿瘤部位、肝动脉栓塞化疗、门静脉癌栓、肝门淋巴结、HBV、腹水、疗效、肝硬化、Child-Pugh肝功能分级、PTV体积、PTV边缘剂量、正常肝脏平均剂量以及肝脏受照射的体积剂量(包括V_5、V_(10)、V_(15)、V_(20)、V_(25)、V_(30)、V_(35)、V_(40)、V_(45))与放射性肝病之间的关系进行分析。结果88例原发性肝癌发生放射性肝病16例,其中死亡9例。单因素分析发现年龄、HBV、腹水、Child-Pugh肝功能分级、门静脉癌栓、肿瘤最大直径、PTV体积与放射性肝病的发生有关。Logistic回归分析发现HBV和Child-Pugh肝功能分级是影响放射性肝病发生的独立预后因素。结论放射性肝病的病死率较高,在制定原发性肝癌三维适形放疗计划时,应充分考虑患者的HBV状况和Child-Pugh肝功能分级,以减少放射性肝病的发生。
Objective To analyze the related factors of radiation induced liver disease after conventional three - dimensional conformal radiotherapy of primary liver cancer, so as to guide the formulation of radiotherapy plans for primary liver cancer and reduce or avoid the occurrence of radiation - induced liver disease. Methods Eighty-eight patients with primary liver cancer underwent conventional three-dimensional conformal radiotherapy (1.8-2.2 Gy / time, 15-33 times, 30-66 Gy, median dose 46 Gy). According to gender, age, pathological type, pathological classification, maximum tumor diameter, tumor location, hepatic arterial chemoembolization, portal vein tumor thrombus, hilar lymph node, HBV, ascites, efficacy, cirrhosis, Child-Pugh liver function classification, PTV volume , The marginal dose of PTV, the average dose of normal liver and the volume of irradiated liver (including V 5, V 10, V 15, V 20, V 25, V 30, V 35, V_ (40), V_ (45)) and the relationship between radiation-induced liver disease. Results 88 cases of primary liver cancer occurred in 16 cases of liver disease, including 9 deaths. Univariate analysis found that age, HBV, ascites, Child-Pugh liver function grading, portal vein tumor thrombus, maximum tumor diameter, PTV volume and the occurrence of radiation-induced liver disease. Logistic regression analysis found that liver function classification of HBV and Child-Pugh was an independent prognostic factor for the occurrence of liver cirrhosis. Conclusions The mortality rate of radiation-induced liver disease is high. When formulating the three-dimensional conformal radiation therapy plan of primary liver cancer, the patient’s HBV status and Child-Pugh liver function classification should be taken into full consideration to reduce the incidence of radiation-induced liver disease.