原发性肝癌放疗进展--门脉癌栓的放疗.ppt

其中326例患者放疗方式为三维适形放疗，大多数放疗总量大于45Gy。 * * 5 5 In recently years, with improvements in medical care and advances in technologies, many novel methods and therapies are widely used for HCC, although its prognosis is still dismal. For example, if HCC is a single tumor or in early stage, it is candidate for surgical treatments, such as resection or radiofrequency ablation, even liver trsplantation, that may get long-term survival. If the tumor is multiple or the liver function is not good, The TACE may be first choice, which may prolong the patients survival. Only for those advanced or later stage HCC, who accompanied with portal vein tumor thrombus, there is almost no available therapy for them and it has poor prognosis and high mortality. 针对此，众多专家提出打破以治疗手段进行分科的体制, 建立以病种分科的新体系,--=建立肝癌诊治中心、多学科治疗中心/小组等 * * 门脉癌栓的诊断 CT中多表现为门静脉管腔增粗，腔内低密度充盈缺损、强化； 间接征象有门静脉管壁强化、侧支循环形成及门静脉海绵样改变。 MRI癌栓在T1WI像呈等信号或低信号，在T2WI像上为高信号， GdDTPA增强后信号强度无明显变化。 PVTT的转归 PVTT自然中位生存率≤3个月。 其转归： (1)肝内广泛转移： (2)肝外转移： (3)继发性门静脉高压： (4)肝功能衰竭： 门静脉癌栓 -- 影响肝癌预后的主要因素 结果 The 1-, 2-, and 3-year pFS for the SG were 32.3, 11.2, and 6.1%, respectively. The 1-, 2-, and 3-year PFS for the RG were 42.2, 24.3, 17.3 %, respectively (p=0.018) . The median and 10.0 months for the SG (p=0.029). OSs were 12.3 months for the RG The 1-, 2-, and 3-year OSs were 51.6, 28.4, and 19.9 %, respectively, for the RG and 40.1, 17.0, and 13.6 %, respectively, for the SG 肝癌合并门静脉癌栓 (PVTT )行3DCRT与外科手术相比有较好的中位生存期、无进展生存率及总生存率。 不同部位癌栓的生存时间比较 n=19 n=45 n=50 中位生存：3 个月 生存率（％） 下腔静脉癌栓 门脉分支癌栓 门脉主干癌栓 B A C Figure 1: CT scan in a 31-year-old man with HCC. A: White arrows show a large tumor, which was surrounded by “satellite” lesions. Portal vein trunk and its branches were involved. B: Two months after the completion of EBRT, the main tumor dramatically disappeared, and the portal vein as directed by black arrows is clearly appeared. C: After combined with TACE, Lipiodol deposits were found in the “satellite” lesions, which could not be treated with EBRT.