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目的:探讨介入栓塞治疗结合三维适形放疗(3D-CRT)治疗不能手术切除的原发性肝癌的疗效,探讨其预后影响因素。方法:46例不能手术切除的原发性肝患者先行动脉介入栓塞治疗1～4次,治疗后再行3D-CRT。结果:46例患者中完全缓解(CR)5例,部分缓解(PR)28例,总有效率(CR+PR)71.7%(33/46)。46例患者均获随访,中位生存期为17个月,1和2年生存率分别为47.9%(23/48)和33.3%(16/48)。单因素分析结果显示,肿瘤数目、肿瘤直径和肝外转移对生存期有显著影响,χ2值分别为4.042、4.255和9.671,P值分别为0.047、0.039和0.002。16例患者出现乏力、恶心和呕吐等毒副作用,均可耐受,6例出现Ⅰ～Ⅱ级肝损伤,经保肝治疗后恢复。结论:动脉介入栓塞治疗结合3D-CRT治疗不能手术切除的原发性肝癌有较好的疗效,且不良反应可以耐受;肿瘤数目、肿瘤直径、肝外转移是影响预后的主要因素。
Objective: To investigate the efficacy of interventional embolization combined with three-dimensional conformal radiotherapy (3D-CRT) in the treatment of unresectable primary liver cancer and to explore the prognostic factors. Methods: Forty-six patients with unresectable primary liver disease were treated with arterial embolization 1 ~ 4 times before treatment with 3D-CRT. Results: Among the 46 patients, 5 were completely relieved (CR), 28 were partly relieved (PR), and the total effective rate (CR + PR) was 71.7% (33/46). All 46 patients were followed up for a median survival of 17 months. The 1-year and 2-year survival rates were 47.9% (23/48) and 33.3% (16/48), respectively. Univariate analysis showed that the number of tumors, tumor diameter and extrahepatic metastasis had significant effects on the survival, χ2 values were 4.042, 4.255 and 9.671, P values were 0.047, 0.039 and 0.002 respectively.16 patients had fatigue, nausea and Vomiting and other toxic side effects, can be tolerated, 6 cases of grade Ⅰ ~ Ⅱ liver injury, after treatment of liver recovery. Conclusion: Arterial interventional embolization combined with 3D-CRT in the treatment of unresectable primary liver cancer has better curative effect and adverse reactions can be tolerated. The number of tumor, tumor diameter and extrahepatic metastasis are the main factors affecting the prognosis.