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目的观察调强适形放疗联合热疗治疗介入后原发性肝癌的临床疗效,并探讨放疗剂量及毒副反应。方法 2009年3月至2011年8月收治的44例原发性肝癌患者,所有患者均已行2～4周期介入治疗,介入治疗后采用非随机对照研究的方法,按患者意愿分为2组,2组年龄、性别、卡氏评分、Childpugh分级、肿瘤直径、介入周数比较,差异均无统计学意义(P均>0.05)。放疗组20例患者采取单纯调强适形放疗;联合组24例患者采取调强适形放疗联合深部聚焦热疗,每次均于放疗结束后2h内进行。结果联合组肿瘤消退有效率(CR+PR)79.2%(19/24),其中CR33.3%(8/24),PR45.8%(11/24);放疗组肿瘤消退有效率50.0%(10/20),其中CR20.0%(4/20),PR30.0%(6/20)。联合组有效率高于放疗组,差异有统计学意义(P<0.05)。各种治疗毒副反应发生率2组比较差异无统计学意义。结论调强适形放疗联合热疗较单纯放疗可显著提高介入后原发性肝癌的局部有效率,是治疗原发性肝癌的有效手段,且不增加毒副反应。
Objective To observe the clinical effect of intensity-modulated conformal radiotherapy combined with hyperthermia in the treatment of primary liver cancer after interventional therapy and to explore the radiation dose and toxicity. Methods Forty-four patients with primary liver cancer who were treated from March 2009 to August 2011 were enrolled in this study. All patients were treated with 2 ~ 4 cycles of interventional therapy. After interventional therapy, they were divided into two groups according to their wishes: There was no significant difference between the two groups in age, sex, Karnofsky score, Childpugh classification, tumor diameter and the number of interventional weeks (all P> 0.05). Twenty patients in the radiotherapy group were treated with simple intensity-modulated conformal radiotherapy. Twenty-four patients in the combined group received intensity-modulated conformal radiotherapy combined with deep-focus hyperthermia, each within 2 hours after the end of radiotherapy. Results The effective rate of tumor regression in the combined group was 79.2% (19/24), of which CR 33.3% (8/24) and PR 45.8% (11/24). The effective rate of tumor regression in radiotherapy group was 50.0% 10/20), CR20.0% (4/20), PR30.0% (6/20). The combined group was more effective than radiotherapy group, the difference was statistically significant (P <0.05). The incidence of various side effects of treatment was no significant difference between the two groups. Conclusions Intensity modulated conformal radiotherapy combined with hyperthermia can significantly improve the local effective rate of primary hepatocellular carcinoma after intervention compared with radiotherapy. It is an effective treatment for primary hepatocellular carcinoma without increasing toxicity.