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目的观察立体适形放射治疗(3DCRT)联合肝动脉化疗栓塞(TACE)治疗肝细胞性肝癌(HCC)的疗效和患者的耐受性。方法46例HCC患者,先采用TACE治疗1～3次,再进行3DCRT。2Gy/次,每天1次,每周5d。肿瘤剂量30～54Gy,总疗程3～6周。放疗结束后采用世界卫生组织(WHO)标准评价疗效,采用美国国立癌症研究所(NCI)的毒性标准和美国放射治疗肿瘤组(RTOG)的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46例患者中,部分缓解(PR)8例,稳定(SD)35例,进展(PD)3例。全组患者中位生存时间16个月,1、2、3年生存率分别为60.9%、39.1%和28.3%。1、2、3年局部控制率分别为73.9%、56.5%和39.1%。1、2、3年远处转移率分别为15.2%、21.7%和34.8%。单因素分析表明,T分期、广州会议分期、门脉癌栓(PVT)、放疗前肝硬化Child Pugh分级和肿瘤照射剂量对生存率的影响有统计学意义。Cox多因素分析显示,肿瘤照射剂量和肝硬化Child Pugh分级是HCC患者预后的独立影响因素。5例患者发生急性肝脏毒副反应,1级2例,3级3例。3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。10例出现1或2级外周血白细胞降低。2例出现放射性肝病。结论3DCRT联合TACE综合治疗HCC安全、有效,值得进一步研究。
Objective To observe the efficacy and tolerability of stereotactic radiotherapy (3DCRT) combined with transcatheter arterial chemoembolization (TACE) in the treatment of hepatocellular carcinoma (HCC). Methods Forty-six patients with HCC were treated with TACE for 1 ~ 3 times before 3DCRT. 2Gy / time, once a day, 5days a week. Tumor dose 30 ~ 54Gy, the total course of 3 to 6 weeks. And other side effects after radiotherapy using World Health Organization (WHO) criteria for evaluating the efficacy of using the US National Cancer Institute (NCI) and the American standard of toxicity Radiation Therapy Oncology Group (RTOG) toxicity evaluation criteria of evaluation of acute and chronic liver toxicity Toxic reaction. Results Among 46 patients, partial remission (PR) in 8 cases, stable (SD) in 35 cases and progression (PD) in 3 cases. The median survival time of all patients was 16 months, and the 1, 2, 3-year survival rates were 60.9%, 39.1% and 28.3% respectively. The local control rates in 1, 2 and 3 years were 73.9%, 56.5% and 39.1% respectively. The distant metastasis rates at 1, 2 and 3 years were 15.2%, 21.7% and 34.8% respectively. Univariate analysis showed that the effect of T stage, Guangzhou meeting staging, portal vein tumor thrombus (PVT), Child Pugh cirrhosis classification and tumor radiation dose on survival rate were statistically significant. Cox multivariate analysis showed that tumor radiation dose and Child Pugh classification of cirrhosis were independent prognostic factors in HCC patients. Five patients developed acute liver toxicity, grade 1 in 2 and grade 3 in 3. A grade 1 acute upper gastrointestinal injury occurred in 3 cases, of which 1 case had mild upper gastrointestinal bleeding. 10 cases of grade 1 or 2 peripheral white blood cells decreased. 2 cases of radiation-induced liver disease. Conclusion The combination of 3DCRT and TACE in the treatment of HCC is safe and effective, which deserves further study.