以三度空间顺形放射治疗的方式治疗广泛性.pdfVIP

以三度空間順形放射治療的方式治療廣泛性 肝癌合併肝門靜脈腫瘤栓塞 THREE DIMENSIONAL CONFORMAL RADIOTHERAPY FOR PORTAL VEIN TUMOR THROMBOSIS IN ADVANCED HEPATOCELLULAR CARCINOMA 1 2 2 1 3 1 林志陵 劉千如 呂志得 廖麗瑛 杜興洋 王朝欣 1 2 3 台北市立仁愛醫院消化內科 放射腫瘤科 放射診斷科 Purpose • Hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) has poor prognosis: median survival only 2 months without any treatment. • The aim of this study was to investigate the efficacy and prognostic factors of 3-D conformal radiotherapy for PVTT in unresectable HCC. • The primary endpoint: the overall survival of patients. • The secondary endpoint : the overall response of tumors. Patients and Methods (1) • Eligibility criteria – Unresectable parenchymal tumor with PVTT unsuitable for subsequent TACE – Karnofsky performance status 70% – Child-Pugh classification A or B – No uncontrollable pleural effusion or ascites – No prior operation for liver tumors or the PVTT • The presence of PVTT was confirmed by – low attenuation intraluminal material that expands the portal vein on enhanced CT scan and ultrasonography – ‘thread and streaks’ sign which reflects intraportal tumor growth Patients and Methods(2) • Radiotherapy protocols – Include the gross tumor thrombosis in the main portal trunk and/or major branches with 1.5-2 cm margin – Hepatic tumor was included only if the tumor was directly involved with the portal vein – Total dose, mean:4760+440 cGy • Follow-ups and response criteria – The effect of radiotherapy to PVTT was assessed 2-4 weeks after the completion of treatment by color-dopplar ultrasonography and/or