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目的观察介入加X线立体定向放射治疗不能手术的原发性肝癌的疗效和副作用。方法分析我院 1997年 6月至 1999年 7月收治的 36例原发性肝癌行介入加X线立体定向放射治疗的情况 ,采用Seldinger技术穿刺股动脉 ,经肝动脉给予灌注化学药物治疗 (TAI) ,CF 30 0mg,5 FU10 0 0～ 15 0 0mg ,CDDP 6 0～ 80mg ,ADM 6 0～ 80mg(或MMC 10～ 2 0mg)。TAI后或 2次TAI之间给予立体定向放射治疗。分割剂量视情况为 5～ 8Gy ,总次数 5～ 8次不等 ,70 %～ 90 %的等剂量线包括靶区 ,立体定向放疗DT 40～ 5 0Gy。结果 3个月后病变达CR 9例 ,PR 2 5例 ,NR 1例 ,PD 1例 ,总有效率为 94%。 6个月后复查CT示 :CR 11例 ,PR 2 4例 ,NR 0例 ,PD 1例 ,总有效率为 97%。 1年生存率为85 % ,2年生存率为 6 8%。直径 5cm以下癌灶完全缓解 (CR)达 91% (10 / 11) ,5cm以上者CR为 1/ 2 5。10例患者AFP值在治疗后 6个月内下降至正常 ,P <0 0 1。WHOⅠ、Ⅱ级骨髓抑制发生率为 47% ,急性胃肠道放射反应占 5 4%。结论不能切除的原发性肝癌经介入加X线立体定向放射治疗可达到满意的缓解症状 ,延长生存期 ,提高生活质量的目的
Objective To observe the efficacy and side effects of primary liver cancer that can not be operated by interventional X-ray stereotactic radiotherapy. Methods Thirty-six cases of primary hepatic carcinoma treated with interventional X-ray stereotactic radiotherapy from June 1997 to July 1999 in our hospital were analyzed. Seldinger technique was used to puncture the femoral artery and the hepatic artery was given perfusion chemotherapy (TAI). ), CF 30 0mg, 5 FU100-150 mg, CDDP 60-80 mg, ADM 60-80 mg (or MMC 10-200 mg). Stereotactic radiotherapy is given after TAI or twice between TAIs. The split dose is 5-8Gy, and the total number is 5-8 times. The 70%-900% isodose line includes the target area and the stereotactic radiotherapy DT 40-5OGy. Results After 9 months, there were 9 cases of CR, 25 cases of PR, 1 case of NR, and 1 case of PD. The total effective rate was 94%. After 6 months, CT examination showed 11 cases of CR, 4 cases of PR, 0 cases of NR, and 1 case of PD. The total effective rate was 97%. The 1-year survival rate was 85%, and the 2-year survival rate was 68%. The complete remission (CR) of tumors below 5 cm in diameter (CR) was 91% (10 / 11), CR was 1/2 in those over 5 cm, and the AFP value of 10 patients dropped to normal within 6 months after treatment. P <0 0 1 . The incidence of WHOI and II bone marrow suppression was 47%, and acute gastrointestinal radiation reactions accounted for 54%. Conclusion The unresectable primary liver cancer can be satisfactorily relieved by interventional X-ray stereotactic radiotherapy, prolonging the survival period and improving the quality of life.