目的 评估肝细胞肝癌合并门静脉癌栓患者经肝动脉化疗栓塞(transcatheter arterial chemoembolization， TACE)联合体外放疗(external-beam radiation therapy， EBRT)的安全性和有效性。方法 收集我院肿瘤中心2011-01至2013-12行TACE联合门静脉癌栓放疗的肝细胞肝癌53例。放疗方式包括三维适形放疗、伽马刀放疗及调强适形放疗，放疗剂量分割主要包括60 Gy/30F、60 Gy/20F和60 Gy/12F。收集患者性别、年龄、ECOG评分、肝炎病毒感染情况、Child-Pugh分级、治疗前AFP水平、门脉癌栓位置、TACE与EBRT先后顺序、放疗的等效生物学剂量、癌栓疗效、患者1年生存情况及治疗相关毒副反应。结果 门静脉癌栓患者经治疗CR 6例，PR 22例，SD 20例，PD 5例，总体有效率(CR+PR)为52.8%(28/53)，总生存时间为3.5～27.1个月，中位生存时间为11.4个月，平均生存时间为17.5个月。ECOG评分、癌栓是否累及门静脉主干，以及癌栓经过联合治疗后的疗效影响患者的1年生存率。当患者首先行肝动脉化疗栓塞治疗时，腹痛、腹泻、消化道出血及转氨酶升高等不良反应发生率较高。结论 TACE联合门静脉癌栓放射治疗是肝癌合并门脉癌栓的有效治疗手段。首先行癌栓放疗，可以减轻不良反应。
Abstract
Objective To assess the efficacy of combined treatment of TACE and EBRT in patients who were diagnosed as having hepatocellular carcinoma with portal vein tumor thrombosis and the relationships between patients’ characters and the therapeutic efficacy.Methods Fifty-three patients who were diagnosed as having hepatocellular carcinoma with portal vein thrombosis from January 1th, 2011 to December 31th,2013 were studied retrospectively. They were treated with local EBRT to PVTT and TACE to intrahepatic diseases. 3D-CRT,γ-knife and IMRT were included in the EBRT and PVTT and lymph nodes in portal hilar region were defined as the target volume. 60 Gy per 30 fractions,60 Gy per 20 fractions and 60 Gy per 12 fractions were used as the dose fractions. We collected the patients’ gender, age, ECOG score, hepatitis virus infection, Child-Pugh classification, AFP level, PVTT position, TACE and EBRT sequence, the radiation biological equivalent dose, curative effect of tumor thrombus, 1 year survival rate and treatment related adverse events.Results Twelve cases were evaluated as CR,22 as PR,20 as SD,5 as PD after these treatments respectively. The total response rate was 52.8% (28/53). Survival time ranged from 3.5 to 27.1 month for all patients, median survival time was 17.5 month. The one-year survival rates were different between groups with different ECOG, location of PVTT and treatment efficacy,and the results were significant. The toxicities were severe when TACE was performed first.Conclusions Combined treatment with local EBRT to PVTT and TACE to intrahepatic lesions is effective to those who are diagnosed as having HCC with PVTT. EBRT should be utilized firstly when the portal vein is obstructed totally.
关键词
肝细胞肝癌 /
门静脉癌栓 /
介入化疗栓塞治疗 /
体外放射治疗
Key words
hepatocellular carcinoma /
portal vein tumor thrombosis /
transarterial chemoembolization /
external beam radiotherapy
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参考文献
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