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目的观察局部125I粒子植入放疗联合肝动脉化疗栓塞(TACE)治疗肝细胞性肝癌疗效和患者耐受性。方法56例患者先采用TACE治疗1-3次,再行CT引导下125I粒子植入放疗。125I粒子植入12周后采用世界卫生组织标准评价疗效,采用美国国立癌症研究所毒性标准和美国放疗肿瘤组毒副反应评价标准评价急慢性肝脏毒副反应及其他毒副反应。结果56例中部分缓解18例,稳定36例,进展2例。全组中位生存时间31个月,1、3年生存率分别为88%、54%。1、3年局部控制率分别为93%、70%。1、3年远处转移率分别为9%、13%。单因素分析表明T分期、门脉癌栓、放疗前肝硬化Child-pugh分级、肿瘤数目和125I粒子空间排列对生存率有影响。多因素分析显示125I粒子空间排列、肿瘤数目和肝硬化Child-pugh分级是患者预后独立影响因素。5例发生急性肝脏毒副反应,1级2例,3级3例。9例出现1级上消化道急性损伤,其中1例出现轻度上消化道出血,8例表现为恶性、呕吐。10例出现1、2级外周血白细胞降低。2例出现放射性肝病。结论局部125I粒子植入放疗联合TACE综合治疗安全、有效,值得进一步研究。
Objective To observe the curative effect and patient tolerance of local 125I particle radiotherapy combined with transcatheter arterial chemoembolization (TACE) in the treatment of hepatocellular carcinoma. Methods Fifty-six patients were treated with TACE for 1-3 times, followed by CT-guided 125I implantation. Twelve weeks after implantation of 125I seeds, the WHO standard was used to evaluate the curative effect. The acute and chronic side effects and other side effects of acute and chronic liver toxicity were evaluated using the toxicity standards of the National Cancer Institute and the American Toxicity and Radiation Oncology Group. Results In 56 cases, 18 cases were partially relieved, 36 cases were stable, and 2 cases were advanced. The median survival time of 31 months, 1, 3-year survival rates were 88%, 54%. The local control rates in 1 and 3 years were 93% and 70% respectively. The distant metastasis rates in 1 and 3 years were 9% and 13% respectively. Univariate analysis showed that T stage, portal vein tumor thrombus, Child-pugh classification of liver cirrhosis before radiotherapy, the number of tumors and 125I particle spatial arrangement had an impact on the survival rate. Multivariate analysis showed that the spatial distribution of 125I particles, the number of tumors and Child-pugh classification of cirrhosis were independent prognostic factors. 5 cases of acute liver toxicity, grade 1 in 2 cases, grade 3 in 3 cases. A grade 1 acute upper gastrointestinal injury occurred in 9 cases, of which 1 case had mild upper gastrointestinal bleeding and 8 cases showed malignant and vomiting. 10 cases of grade 1 and 2 peripheral blood leukopenia. 2 cases of radiation-induced liver disease. Conclusion Local 125I particle radiotherapy combined with TACE is safe and effective and worth further study.