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目的 探讨肝动脉化疗栓塞 (TACE)后采用三维适形放射治疗 (3DCRT)原发性肝癌的疗效。方法 82例肝癌中 41例TACE +3DCRT(综合组 ) ,41例单纯TACE(对照组 )。TACE先将氟尿嘧啶 1 0 0 0～ 1 2 50mg和羟基喜树碱 2 0～ 30mg注入动脉 ,再将顺铂 60～ 80mg和丝裂霉素 1 4～ 2 0mg(或表阿霉素 50～ 60mg)与超液化碘油 1 0～ 30ml充分混合成乳剂注入 ,再用 1～ 2mm明胶海绵颗粒栓塞肝动脉。 2个组TACE均进行 1～ 3次。 3DCRT采用 6MVX射线 ,计划靶体积 (PTV)≤ 2 1 6cm3者单次剂量为 5～ 8Gy ,总剂量为DT4 0～ 56Gy;PTV >2 1 6cm3者单次剂量为 4Gy,总剂量 36～ 44Gy ;二者均隔日 1次。结果 综合组近期有效率 (CR +PR)为 87.8% ,对照组为 58.5 %。两组差异有显著性意义(χ2 =8.94,P <0 .0 1 )。 1、2、3年生存率综合组分别为 73 .2 %、58.7%和 41 .9% ,对照组分别为 54 .8%、2 7.3 %和 1 2 .8% ,两组差异有显著性意义 (χ2 =5 .52 ,P <0 .0 5)。综合组 3DCRT前PTV≤ 2 1 6cm3者与PTV >2 1 6cm3者相比 ,前者 3年生存率大于后者 (53 .8%∶2 0 .0 % ;χ2 =4.72 ,P <0 .0 5)。肝功能A级和B级 3年生存率分别为 56 .3 %和 1 4 .3 % ,差异有显著性意义 (χ2 =5 .49,P <0 .0 5)。结论 TACE +3DCRT治疗不宜手术的原发
Objective To investigate the effect of three-dimensional conformal radiation therapy (3DCRT) on primary hepatic carcinoma after transcatheter arterial chemoembolization (TACE). Methods TACE + 3DCRT in 41 cases of 82 cases of hepatocellular carcinoma (TACE + 3DCRT) and 41 cases of simple TACE (control group). TACE first fluorouracil 100 ~ 120mg and hydroxy camptothecin 20 ~ 30mg into the artery, and then cisplatin 60 ~ 80mg and mitomycin 14 ~ 20mg (or epirubicin 50 ~ 60mg ) And ultra-liquefied iodine oil 10 ~ 30ml fully mixed into the emulsion injection, then 1 ~ 2mm gelatin sponge particles embolization of the hepatic artery. TACE in both groups was performed 1 ~ 3 times. 3DCRT using 6MV X-ray, the planned target volume (PTV) ≤ 2 1 6cm3 a single dose of 5 ~ 8Gy, a total dose of DT4 0 ~ 56Gy; PTV> 216cm3 single dose 4Gy, a total dose of 36 ~ 44Gy; Both are once every other day. Results The comprehensive effective rate (CR + PR) was 87.8% in the control group and 58.5% in the control group. There was significant difference between the two groups (χ2 = 8.94, P <0.01). The 1-year, 2-year and 3-year survival rates were 73.2%, 58.7% and 41.9% in the control group and 54.8%, 23.3% and 12.2% in the control group, respectively Significance (χ2 = 5 .52, P <0. 05). The 3-year survival rate of the former group was higher than that of the latter (53.8%: 2.00%; χ2 = 4.72, P <0.05), compared with those with PTV> 216cm3 ). The three-year survival rates of grade A and grade B were 56.3% and 14.3% respectively, with significant difference (χ2 = 5.59, P <0.05). Conclusion TACE + 3DCRT should not be treated by surgery