不能手术的原发性肝癌介入治疗与介入加放疗的疗效比较

目的：观察不能手术的原发性肝癌患者,单纯肝动脉栓塞化疗（TACE）与肝动脉栓塞化疗联合直线加速器放射治疗的疗效及不良反应。方法：116例不能手术的原发性肝癌患者,63例行肝动脉栓塞化疗（介入组）,53例行TACE联合放疗（联合组）。TACE灌注化疗药物为：丝裂霉素（MMC）10-20mg,氟尿嘧啶（5-Fu）1000-1500mg,表阿霉素（E-ADM）30-50mg,栓塞剂为40%超液态碘化油5-20ml。直线加速器治疗用10MV-X,95%等剂量线包绕PTV,40-60Gy/8-25F,3-5F/wk。结果：介入组及联合组2年局部控制率分别为30.2%、43.6%,3年局部控制率分别为24.4%、37.9%,两组比较有显著的统计学意义（P〈0.05）;2年生存率分别为30.1%、42.9%,3年生存率分别为21.5%、32.6%,2年总生存率比较两组差异无统计学意义（P=0.056）,3年总生存率比较两组差异有统计学意义（P=0.034）。联合组发现2例放射诱发的肝病。结论：不能手术的原发性肝癌介入治疗加放疗比单纯放疗疗效好。

Effects of transcatheter arterial chemoembolization combined with or without radiotherapy on patients with advanced unresectable hepatocellular carcinoma

Objective：To evaluate effects of transcatheter arterial chemoembolization（TACE） combined with or without radiation therapy on patients with advanced unresectable hepatocellular carcinoma.Methods：From July 2005 to June 2008,116 patients with advanced unresectable hepatocellular carcinoma were divided into 2 groups,63 cases were treated with TACE（TACE group）,53 cases,were treated with TACE and accelerator（Combined group）,53 cases.For TACE,20 mg mitomycin C,1000-1500 mg 5-fluorouracil and 60-80 mg cisplatin were perfused into the hepatic arteries,10-20 mliodized oil was given to emobolized the hepatic arteries,and each patient was treated with 2-3 sessions.For combined group,10MV-X was used,≥95% isodose included PTV,and the total treatment doses was 40-60Gy,3-5 times per week.Average dose of liver 25Gy,V30Gy30%;Results：For TACE group and combined group,the 2 year local control rates were 30.2% and 43.6%,respectively.and 3year local control rates were 24.4%,37.9%,（P0.05）.For TACE group,2 and 3 year survival rates were 30.1% and 21.5% respectively,and for combined group,they were 21.5% and 32.6% respectively.There was no significant differences for 2 year survival rates（P=0.056）,but there was a statistically significant difference for 3 year survival rates（P=0.034）.Combined group was found 2 case with radiation induced liver disease（RILD）,TACE group was no one was found with RILD.Conclusion：The efficacy of TACE combined with radiotherapy was better than TACE alone for advanced unresectable hepatocellular carcinoma.The toxicity was similar,and clinically acceptable.