28例不能手术的肝外胆道系统肿瘤放化疗疗效分析

目的 评价放疗晚期肝外胆道系统肿瘤的疗效。方法 对28例手术不可切除的肝外胆道系统肿瘤采用放化疗，其中胆囊癌13例，肝外胆管癌15例。15例采用常规放疗，中位照射剂量45Gy（30～60Gy），13例采用三维适形放疗（3DcRT）多野（3～5个野）照射或加量，中位照射剂量55Gy（50～70Gy）。12例单纯放疗，16例放化结合。化疗方案为氟尿嘧啶500mg，2次／周，或氟尿嘧啶500mg＋顺铂30mg，1次／周，疗程3～6个周期。结果 全部患者近期有效率14％。全组中位生存期9．4个月（2～28个月）。1、2年生存率分别为38％、15％；其中1年生存率胆囊癌为46％，肝外胆管癌为27％，3DCRT为42％，常规放疗为33％，单纯放疗为37％，放疗＋化疗为31％；〈50Gy的为29％，≥50Gy的为45％。只有照射剂量（≥50Gy）对1年生存率有影响（X^2=5．31，P=0．023）。急性消化道反应1～2级为57％，3级为18％，仅有25％的出现1～2级血液毒性反应。结论 对晚期肝外胆道系统肿瘤采用放化疗可取得一定疗效，且副作用可耐受。

Radiochemotherapy for unresectable extra-hepatic bile duct carcinoma: analysis of 28 patients

Objective To evaluate the effect of radiochemotherapy for unresectable extra-hepatic bile duct cancinoma. Methods Form June 1993 to August 2003, 28 unresectable extra-hepatic bile duct carcinoma treated by radiochemotherapy were analyzed. There were 13 gallbladder carcinoma and 15 bile duct carcinoma. The radiotherapy regimen consisted of conventional radiation therapy group(15 patients,with a median dose of 45Gy, range 30-60Gy) and three-dimensional conformal radiation therapy group(13 patients, with a median dose of 55Gy , range 50-70Gy). Among these patients, 12 patients were treated by radiotherapy alone( RT), 16 patients treated by radiochemotherapy(CRT), with a chemotherapy regimen consisting of 5-Fu 500mg twice weekly or 5-Fu 500mg + DDP 30mg once weekly for 3-6 cycles. Results The CR+PR, SD and PD rate was 14%, 64%, and 21%, respectively. The overall 1-,2-year survival rate was 38% and 15%, with a median survival time of 9.4 months. The 1-year survival of gallbladder cancer and extra-hepatic bile duct cancer was 46% and 27%;of 3DCRT and conventional radiotherapy was 42% and 33%;of those radiation dose less than 50Gy and more than 50Gy was 29% and 45%;of RT alone and radiochemotherapy was 37% and 31%, respectively. There was significance difference in overall survival between those RT dose less than 50Gy and more than 50Gy,(P=0.023). Grade 1-2 and Grade 3 acute gastrointestinal toxicity was 57% and 18%, respectively. Only 25% patients suffered grade 1-2 hematology toxicity. Conclusion Radiochemotherapy shows moderate effect for unresectable extra-hepatic bile duct cancer with acceptable side effects.