介入联合三维适形放疗治疗中晚期肝癌的临床研究

目的：通过单纯介入治疗中晚期肝癌与介入联合三维适形放疗对比,来研究介入联合三维适形放疗治疗中晚期原发肝癌的疗效。方法：2001年3月至2006年5月对确诊的57例中晚期原发肝癌患者,随机分为单纯介入组及介入联合三维适形放疗组。介入组30例,联合组27例。介入组采用经导管动脉化疗及栓塞,经皮股动脉穿管,根据肿瘤部位插管至肝固有动脉或左、右肝动脉。灌注化疗药物包括5-FU、顺铂、丝裂霉素、蒽环类药物等,灌注后使用碘油栓塞,4-6周重复,共3-6次。联合组先TACE治疗2次后再局部三维适形放疗（3D-CRT）,一般在第二次介入后一周左右开始放疗。放疗为1次/日,2-2.5GY/次,5次/周,放疗总剂量为Dt52GY-62GY。治疗3个月后影像学复查疗效。结果：介入组CR 0例,PR 20例,NC 8例,PD 2例,CR＋PR为有效,有效率为66.7%;联合治疗组CR2例,PR18例,NC6例,PD1例,有效率为74.1%,P=0.049。远期观察：介入组及联合组0.5,1,2年生存率分别为66.7%,53.3%,43.3%;88.9%,70.7%,55.5%（P=0.023）。所有病例均顺利治疗结束,未出现治疗中断退出。结论：介入联合三维适形放疗治疗能提高中晚期原发肝癌疗效,没有明显增加不良反应。

The clinical research of primary middle and advanced hepatic carcinoma treated by transcatheter arterial chemotherapy and embolization combined with three-dimensional conformal radiotherapy

Objective：To investigate the effect of TACE combined with three dimensional conformal radiotherapy treatment in patient with middle and advanced stage primary liver cancer.Methods：From March 2001 to May 2006,57 patients diagnosed with middle and advanced stage primary hepatic carcinoma,randomized into TACE group and TACE combined with three dimensional conformal radiotherapy group（combination group）.The TACE group was used after the drive pipe artery chemotherapy and embolism,after skin femoral artery poling,according to tumor spot intubate to liver inherent artery or left and right hepatic artery,chemotherapeutics including 5-FU,cisplatinum,mitomycin,THP and so on.After the Injection,researchers uses the iodine oil embolism,4-6 week duplication the total times were 3-6 times.TACE combined group beginning with 2 times intervention and followed by local radiation therapy,three dimensional conformal radiotherapy once a day,2-2.5Gy per time,5 times per week and the total dose was 52-62GY.Results：The efficacy rate（CR＋PR） for the TACE group and the combination group was 66.7% and 74.1%,P=0.049.respectively.The 0.5,1,2 year survival rates were 66.7%,53.3%,43.3%;88.9%,70.7%,55.5%（P=0.023）,respectively.All cases were treated successfully,no patients withdraw during therapy.Conclusion：TACE combined with 3D-conformal radiotherapy can improve the therapeutic efficacy of primary hepatic carcinoma and has no significant increase in adverse effect.