原发性肝癌介入治疗适形放射治疗及综合治疗前瞻性探究.docVIP

原发性肝癌介入治疗适形放射治疗及综合治疗前瞻性探究【摘要】 目的 比较单纯介入肝动脉化疗栓塞(TACE)、单纯适形放射治疗(3DCRT)、TACE+3DCRT对原发性肝癌(PHC)的疗效。方法 67例PHC患者随机分为3个组,A组25例(TACE1~5次,平均3.2次),B组20例(3DCRT45~60 Gy,平均50 Gy),C组22例(TACE+3DCRT,先行TACE1~4次,平均3次,休息4~8周后3DCRT;TACE和3DCRT方法与A,B组相同)。介入化疗先将氟脲嘧啶1000~1250 mg和羟基树碱20~30 mg后将顺铂60~80 mg和丝裂霉素14~20 mg(或阿霉素50~60 mg)与超液化碘油10~30 mg充分混合成乳剂缓慢注入,再用1~2 mm明胶海绵颗粒栓塞肝动脉。适形放疗采用6MV-X直线加速器治疗。结果 1、2、3年生存率A组分别为61.3%、34.0%、19.8%;B组分别为53.1%、31.3%、18.8%;C组分别为74.8%、57.0%、40.4%。C组A组和B组(Logrank检验,PABC、PAC、PBC0.05)发症主要为发热,C组A组B组(χ2检验,PA组B组(t检验和方差分析,PB组A组(χ2检验,PTACE3DCRT)和肝功能不全(TACE+3DCRT3DCRTTACE)。 【关键词】 肝肿瘤/治疗;肝肿瘤/放射疗法;栓塞,治疗性 Foresightedness research of three dimensional conformal radiotherapy and complex therapy for primary hepatic cancer LU Yuan-quan.Tumor radiotherapy department.The First people”s Hospital of Shang Qiu He nan 476100,China 【Abstract】 Objective To compare the therapeutic effects of transcatheter hepatic chemoembolization (TACE)alone、three dimensional conformal radiotherapy(3DCRT)alone,and TACE+3DCRT.Methods 67 patients with primary hepatic cacer were randomized divided into three groups:A-25patients were treated with 1-5 times of TACE alone;B-20 patients,radiotherapy with 3DCRT 45-60 Gy average 50 Gy;Group c-22 patients,TACE plus radiotherapy,at the first time were received 1-4 times of TACE by radiotherapy,then with 3DCRT after a rest of 4-8 week.for TACE,1000-1250 mg 5-fluorouracil and 20-30 mg hydroxyeamptothecine were perfused into the hepatic arteries,then 60-80 mg cisplatin and 14-20 mg mitomycin(or 50-60 mg epirubicin)and iodized oil 10-30 ml were given to embolized the hepatic arteries which was then followed by 1-2 mm gelform spieces.For 3DCRT,radiation was given by 6MV X-ray.Results The overall survivals at 1-,2-and 3-years were 61.3%,34.0%and 19.0%for A-group TACE alone,53.1%,31.3%and 18.8%for B-group 3DCRT;74.8%,57.0%and 40.4%for C-group TACE+3DCRT.The differences in the survivals are statistically significant(P216 cm?3者,靶区单次剂量为4 Gy,每周1、3、5治疗,总剂量为DT36~44 G