三维适形放疗联合经动脉化疗栓塞治疗肝细胞癌
[Three-dimensional conformal radiotherapy combined with transcatheter arterial chemoembolization for hepatocellular carcinoma].
作者信息
Zhou Zhen-hua, Liu Lu-ming, Cheng Wen-wu, Meng Zhi-qiang, Lin Jun-hua, Chen Zhen, Zhang Xiao-jian, Jiang Guo-liang
机构信息
Department of Integrative Chinese and Western Medicine, Fudan University Cancer Hospital, Shanghai 200032, China.
出版信息
Zhonghua Zhong Liu Za Zhi. 2006 Mar;28(3):222-6.
OBJECTIVE
To evaluate the response and tolerance in hepatocellular carcinoma (HCC) patients treated by three-dimensional conformal radiotherapy (3DCRT) combined with. transcatheter arterial chemoembolization (TACE).
METHODS
Fourty-six HCC patients confirmed by cytology or histology were studied. All patients underwent TACE 1 to 3 courses. Then they received 3DCRT after an interval of about one month. 3DCRT was given with the field covering the tumor with a generous margin. 6 MV X-ray was used. The total dose was 30 - 54 Gy, in daily 2 Gy fractions. Immediate response was recorded according to the WHO criteria carried out by serial CT scan one month after 3DCRT. Irradiation toxicities were scored by the RTOG criteria. Acute liver toxicity was graded according to the common toxicity criteria (CTC) of National Cancer Institute. Late toxicity was focused on radiation-induced liver disease (RILD).
RESULTS
Partial response was observed in 8 (17.4%) patients. Stable disease and progressive disease was observed in 35 (76.1%) patients and 3 (6.5%) patients, respectively. No complete response was observed at the time of the response evaluation. The overall survival rate at 1-, 2- and 3-year was 60.9%, 39.1% and 28.3%, respectively, with a median survival period of 16 months. The 1-, 2- and 3-year local progression-free rate was 73.9%, 56.5% and 39.1%, respectively. The 1-, 2- and 3-year distant metastasis rate was 15.2%, 21.7% and 34.8%. Univariate analysis showed that favorable prognostic predictors for survival were: T3 stage, CACA 2001 stage I, absence of portal thrombosis, Child-Pugh grade A and irradiation dose of >45 Gy. Irradiation dose and liver cirrhosis were identified by Cox-regression analysis as independent predictors for survival. Two patients experienced CTC grade 1 acute hepatic toxicity and three patients experienced grade 3 acute hepatic toxicity. Two patients developed RILD. Three patients experienced RTOG grade 1 acute gastrointestinal complication and one patient experienced acute gastrointestinal bleeding. Five patients experienced RTOG grade 1 leucopenia, and five patients experienced grade 2 leucopenia.
CONCLUSION
3DCRT combined with TACE is safe and effective for HCC. It is worthy of a further dose escalation study.
目的
评估三维适形放疗（3DCRT）联合经动脉化疗栓塞术（TACE）治疗肝细胞癌（HCC）患者的疗效及耐受性。
方法
对46例经细胞学或组织学确诊的HCC患者进行研究。所有患者均接受1至3个疗程的TACE治疗。然后在间隔约1个月后接受3DCRT。3DCRT照射野覆盖肿瘤并留足够的边缘。采用6 MV X线。总剂量为30 - 54 Gy，每日2 Gy分次照射。根据3DCRT后1个月进行的系列CT扫描，按照WHO标准记录近期疗效。按照RTOG标准对放疗毒性进行评分。急性肝毒性根据美国国立癌症研究所的常见毒性标准（CTC）进行分级。晚期毒性主要关注放射性肝病（RILD）。
结果
8例（17.4%）患者出现部分缓解。35例（76.1%）患者病情稳定，3例（6.5%）患者病情进展。在疗效评估时未观察到完全缓解。1年、2年和3年的总生存率分别为60.9%、39.1%和28.3%，中位生存期为16个月。1年、2年和3年的局部无进展率分别为73.9%、56.5%和39.1%。1年、2年和3年的远处转移率分别为15.2%、21.7%和34.8%。单因素分析显示，生存的良好预后预测因素为：T3期、CACA 2001 I期、无门静脉血栓形成、Child-Pugh A级和照射剂量>45 Gy。通过Cox回归分析确定照射剂量和肝硬化是生存的独立预测因素。2例患者出现CTC 1级急性肝毒性，3例患者出现3级急性肝毒性。2例患者发生RILD。3例患者出现RTOG 1级急性胃肠道并发症，1例患者出现急性胃肠道出血。5例患者出现RTOG 1级白细胞减少，5例患者出现2级白细胞减少。
结论
3DCRT联合TACE治疗HCC安全有效。值得进一步进行剂量递增研究。
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