三维适形放疗联合肝动脉化疗栓塞治疗肝癌伴门静脉癌栓的效果观察
|
摘要
目的:观察三维适形放疗(3-DCRT)联合肝动脉化疗栓塞(TACE)治疗原发性肝细胞癌(HCC)伴门静脉癌栓(PVTT)的临床效果及不良反应。方法:64例HCC伴PVTT患者根据治疗意愿分为两组,对照组(n=32)仅采用TACE治疗,观察组(n=32)采用3-DCRT联合TACE治疗。观察两组治疗6个月后的临床疗效,详细记录两组治疗后第6、12、18及24个月时的生存率,比较两组患者治疗期间各种不良反应发生情况。结果:观察组治疗有效率(71.9%)明显高于对照组(53.1%),差异有统计学意义(P<0.05);观察组患者治疗后的第12、18及24个月的生存率(81.3%,65.6%,46.9%)均明显高于对照组(56.3%,31.3%,18.8%),差异均有统计学意义(P<0.05);两组白细胞计数下降、低热、肝肾功能损伤、胃肠道反应及肝区疼痛等不良反应发生率比较,差异均无统计学意义(P>0.05)。结论:3-DCRT联合TACE治疗HCC伴PVTT效果显著,可明显提高患者生存率,且不会增加不良反应发生率。
Objective:To observe the clinical efficacy and adverse reactions of three-dimensional conformal radiotherapy(3-DCRT)combined with transcatheter hepatic arterial chemoembolization(TACE)in the treatment of hepatocellular carcinoma(HCC)with portal vein tumor thrombosis(PVTT).Method:64 patients of HCC with PVTT were divided into two groups according to their treatment intentions,the control group(n=32)was treated with TACE only,and the observation group(n=32)was treated with 3-DCRT combined with TACE.The clinical efficacy of two groups after 6 months of treatment were observed,and the survival rate of 6,12,18,and 24 months after treatment of two groups were detailed recorded,and the incidence of adverse reactions in two groups of patients during treatment were compared.Result:The efficiency of observation group(71.9%)was significantly higher than that of the control group(53.1%),the difference was statistically significant(P<0.05).The survival rate in the observation group after 12,18,and 24 months(81.3%,65.6%,46.9%)were significantly higher than those of the control group(56.3%,31.3%,18.8%),the differences were statistically significant(P<0.05).There were no significant differences about decreased in the white blood cell count,fever,liver and kidney dysfunction,gastrointestinal reaction and liver area pain incidence of adverse reactions between two groups(P>0.05).Conclusion:The treatment of 3-DCRT combined with TACE for HCC with PVTT has a significant effect,can significantly improve the survival rate of patients,and does not increase the incidence of adverse reactions.
Objective:To observe the clinical efficacy and adverse reactions of three-dimensional conformal radiotherapy(3-DCRT)combined with transcatheter hepatic arterial chemoembolization(TACE)in the treatment of hepatocellular carcinoma(HCC)with portal vein tumor thrombosis(PVTT).Method:64 patients of HCC with PVTT were divided into two groups according to their treatment intentions,the control group(n=32)was treated with TACE only,and the observation group(n=32)was treated with 3-DCRT combined with TACE.The clinical efficacy of two groups after 6 months of treatment were observed,and the survival rate of 6,12,18,and 24 months after treatment of two groups were detailed recorded,and the incidence of adverse reactions in two groups of patients during treatment were compared.Result:The efficiency of observation group(71.9%)was significantly higher than that of the control group(53.1%),the difference was statistically significant(P<0.05).The survival rate in the observation group after 12,18,and 24 months(81.3%,65.6%,46.9%)were significantly higher than those of the control group(56.3%,31.3%,18.8%),the differences were statistically significant(P<0.05).There were no significant differences about decreased in the white blood cell count,fever,liver and kidney dysfunction,gastrointestinal reaction and liver area pain incidence of adverse reactions between two groups(P>0.05).Conclusion:The treatment of 3-DCRT combined with TACE for HCC with PVTT has a significant effect,can significantly improve the survival rate of patients,and does not increase the incidence of adverse reactions.
引文
[1]蒋富强,康静波.原发性肝癌伴门静脉癌栓治疗进展[J].实用肝脏病杂志,2013,16(3):286-288.
[2]刘红丹,梁健,邓鑫.三维适形放疗在治疗原发性肝癌中的研究进展[J].实用癌症杂志,2013,28(1):103-104.
[3]朱中山,严文辉,彭新茂,等.TACE联合立体定向放疗对肝癌伴门静脉癌栓患者预后的影响[J].实用癌症杂志,2014,29(6):681-683.
[4]Han K,Kim J H,Yoon H M,et al.Transcatheter arterial chemoembolization for infiltrative hepatocellular carcinoma:Clinical safety and efficacy and factors influencing patient survival[J].Korean J Radiol,2014,15(4):464-471.
[5]中国抗癌协会肝癌专业委员会,中国抗癌协会临床肿瘤学协作专业委员会,中华医学会肝病学分会肝癌学组.原发性肝癌规范化诊治的专家共识[J].临床肝胆病杂志,2009,25(2):83-92.
[6]杨哲.三维适形放疗联合经导管肝动脉化疗栓塞治疗原发性肝癌临床效果分析[J/OL].中国医学前沿杂志(电子版),2015,7(10):56-58.
[7]唐涛,孙祖杰,李强,等.肝癌合并门静脉癌栓介入治疗联合三维适形放疗的疗效观察[J].肿瘤基础与临床,2017,30(2):141-143.
[8]肖鹏,孙一,曹红敏,等.肝癌的三维适形放疗治疗原发性肝癌疗效分析[J].中国实用医药,2015,10(23):113-114.
[9]Kim J Y,Chung S M,Choi B O,et al.Hepatocellular carcinoma with portal vein tumor thrombosis:improved treatment outcomes with external beam radiation therapy[J].Hepatol Res,2011,41(9):813-824.
[10]Koo J E,Kim J H,Lim Y S,et al.Combination of transarterial chemoembolization and three-dimensional conformal radiotherapy for hepatocellular carcinoma with inferior vena cava tumor thrombus[J].Int J Radiat Oncol Biol Phys,2010,78(1):180-187.
[11]张立洁,彭泉,芦东徽,等.三维适形放疗联合TACE治疗肝癌并发门静脉癌栓疗效的Meta分析[J].实用肝脏病杂志,2015,18(3):254-257.
[12]王向前,蔡晶,张一心,等.三维适形放疗联合肝动脉化疗栓塞治疗肝癌伴门脉癌栓的疗效及预后分析[J].南通大学学报(医学版),2013,33(5):372-375.
[13]陈大朝,王艺辉,纪荣佳,等.TACE联合放疗治疗原发性肝癌合并门静脉癌栓改善患者生存质量[J].现代肿瘤医学,2017,25(1):96-99.
[14]田慧,何振坤,徐庆杰,等.TACE联合放疗治疗原发性肝癌的疗效及对生存质量的影响[J].中国老年学杂志,2013,33(20):4987-4989.
[15]张平,李春田.3DCRT联合TACE对晚期原发性肝癌的疗效观察[J].中国医药导刊,2017,19(6):563-564.
[16]张健,龚少娟,宋卫华,等.肝动脉化疗TACE联合3DCRT治疗HCC伴PVTT患者的疗效[J].浙江临床医学,2016,18(12):2191-2192,2195.
[17]刘合代,丁罡,张明,等.肝动脉栓塞化疗联合放疗治疗原发性肝癌的疗效分析[J].现代肿瘤医学,2015,23(9):1258-1261.
[18]彭国林,蒋益兰,邓兰,等.三维适形放疗联合肝动脉化疗栓塞术对原发性肝癌患者临床疗效、生存率及γ-GT、AFP的影响[J].肝脏,2016,21(5):378-379.
[2]刘红丹,梁健,邓鑫.三维适形放疗在治疗原发性肝癌中的研究进展[J].实用癌症杂志,2013,28(1):103-104.
[3]朱中山,严文辉,彭新茂,等.TACE联合立体定向放疗对肝癌伴门静脉癌栓患者预后的影响[J].实用癌症杂志,2014,29(6):681-683.
[4]Han K,Kim J H,Yoon H M,et al.Transcatheter arterial chemoembolization for infiltrative hepatocellular carcinoma:Clinical safety and efficacy and factors influencing patient survival[J].Korean J Radiol,2014,15(4):464-471.
[5]中国抗癌协会肝癌专业委员会,中国抗癌协会临床肿瘤学协作专业委员会,中华医学会肝病学分会肝癌学组.原发性肝癌规范化诊治的专家共识[J].临床肝胆病杂志,2009,25(2):83-92.
[6]杨哲.三维适形放疗联合经导管肝动脉化疗栓塞治疗原发性肝癌临床效果分析[J/OL].中国医学前沿杂志(电子版),2015,7(10):56-58.
[7]唐涛,孙祖杰,李强,等.肝癌合并门静脉癌栓介入治疗联合三维适形放疗的疗效观察[J].肿瘤基础与临床,2017,30(2):141-143.
[8]肖鹏,孙一,曹红敏,等.肝癌的三维适形放疗治疗原发性肝癌疗效分析[J].中国实用医药,2015,10(23):113-114.
[9]Kim J Y,Chung S M,Choi B O,et al.Hepatocellular carcinoma with portal vein tumor thrombosis:improved treatment outcomes with external beam radiation therapy[J].Hepatol Res,2011,41(9):813-824.
[10]Koo J E,Kim J H,Lim Y S,et al.Combination of transarterial chemoembolization and three-dimensional conformal radiotherapy for hepatocellular carcinoma with inferior vena cava tumor thrombus[J].Int J Radiat Oncol Biol Phys,2010,78(1):180-187.
[11]张立洁,彭泉,芦东徽,等.三维适形放疗联合TACE治疗肝癌并发门静脉癌栓疗效的Meta分析[J].实用肝脏病杂志,2015,18(3):254-257.
[12]王向前,蔡晶,张一心,等.三维适形放疗联合肝动脉化疗栓塞治疗肝癌伴门脉癌栓的疗效及预后分析[J].南通大学学报(医学版),2013,33(5):372-375.
[13]陈大朝,王艺辉,纪荣佳,等.TACE联合放疗治疗原发性肝癌合并门静脉癌栓改善患者生存质量[J].现代肿瘤医学,2017,25(1):96-99.
[14]田慧,何振坤,徐庆杰,等.TACE联合放疗治疗原发性肝癌的疗效及对生存质量的影响[J].中国老年学杂志,2013,33(20):4987-4989.
[15]张平,李春田.3DCRT联合TACE对晚期原发性肝癌的疗效观察[J].中国医药导刊,2017,19(6):563-564.
[16]张健,龚少娟,宋卫华,等.肝动脉化疗TACE联合3DCRT治疗HCC伴PVTT患者的疗效[J].浙江临床医学,2016,18(12):2191-2192,2195.
[17]刘合代,丁罡,张明,等.肝动脉栓塞化疗联合放疗治疗原发性肝癌的疗效分析[J].现代肿瘤医学,2015,23(9):1258-1261.
[18]彭国林,蒋益兰,邓兰,等.三维适形放疗联合肝动脉化疗栓塞术对原发性肝癌患者临床疗效、生存率及γ-GT、AFP的影响[J].肝脏,2016,21(5):378-379.