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探讨光放射立体定向治疗联合肝动脉化疗栓塞(TACE)治疗大肝癌(≥10cm)的安全性和有效性。2006年5月至2013年6月我院收治的不能手术的77例大肝癌患者,患者均在行不完全的肝动脉化疗栓塞术后给予光放射立体定向治疗。平均照射总剂量35.6Gy,50%至55%等剂量曲线覆盖靶区,分次剂量2.6至3.0Gy,每日治疗1次,连续治疗6天后休息1天,总疗程12至14次结束。患者分组方式:肿瘤有包膜的为A组,35例,肿瘤无包膜的为B组42例。治疗结束后4周复查CT或MRI评价近期疗效,其后每1至3个月复查1次评估远期疗效及不良反应。77例患者中达到完全缓解(CR)7例(9.1%),部分缓解(PR)54例(70.1%),稳定(SD)10例(13.0%),进展(PD)6例(7.8%),总反应率(CR+PR)79.2%,中位平均随访17个月。总的1年、3年、5年生存率分别为39.0%、13.0%、2.6%,中位生存时间11.6个月(A组分别为57.1%,22.9%,5.7%,中位生存时间18.3个月;B组分别为23.8%、4.8%、0%,中位生存时间10.8个月(P=0.023))。治疗耐受良好,没有严重的放射诱发的肝病和3级以上的不良反应。肿瘤是否具有包膜是影响生存的预后因素。光放射立体定向治疗联合肝动脉化疗栓塞治疗不可手术切除的大肝癌是一种安全有效的治疗手段,值得临床推广。
To investigate the safety and efficacy of light-emitting stereotactic radiotherapy combined with transcatheter arterial chemoembolization (TACE) in the treatment of large hepatocellular carcinoma (≥10cm). From May 2006 to June 2013, 77 patients with severe hepatocellular carcinoma who were inoperable in our hospital were treated with light-emitting stereotactic radiotherapy after incomplete hepatic artery chemoembolization. The average irradiation dose of 35.6Gy, 50% to 55% of the isodose curve covering the target area, sub-dose 2.6-3.0Gy, daily treatment 1, 6 days after continuous treatment for 1 day rest, the total course of 12 to 14 ends. Patient grouping: the tumor has a capsule of group A, 35 cases, tumor non-capsule group B 42 cases. Four weeks after the end of the treatment, CT or MRI was used to evaluate the short-term effect, followed by a review every 1 to 3 months to evaluate the long-term efficacy and adverse reactions. Seven patients (9.1%) achieved complete remission (CR), 54 (70.1%) had partial remission (PR), 10 (13.0%) had stabilization (SD) and 6 (7.8% , The total response rate (CR + PR) 79.2%, the median average follow-up of 17 months. The overall 1-year, 3-year and 5-year overall survival rates were 39.0%, 13.0%, 2.6% and median survival time was 11.6 months (57.1%, 22.9%, 5.7% in group A, 18.3 Month; group B were 23.8%, 4.8%, 0% respectively, median survival time was 10.8 months (P = 0.023)). The treatment is well tolerated, with no serious radiation-induced liver disease and grade 3 or higher adverse reactions. Whether the tumor has an envelope is a prognostic factor for survival. Stereotactic light irradiation combined with transcatheter arterial chemoembolization in the treatment of unresectable large hepatocellular carcinoma is a safe and effective treatment and is worthy of clinical promotion.