Efficacy and prognostic factors of intensity-modulated radiotherapy for large primary hepatocellular carcinoma
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摘要:
目的探讨调强放射治疗对不适宜手术以及射频消融、介入等其他局部治疗无效的原发性大肝癌的临床疗效及预后影响因素。方法回顾性分析2008年4月-2011年8月武警总医院肿瘤内科收治的29例接受调强放疗的原发性大肝癌患者的临床资料。单次剂量26 Gy,5 F/w,总剂量5070 Gy。观察近期疗效及预后。生存率计算采用Kaplan-Meier法,差异性检验采用Log-rank法,并采用Cox回归模型进行多因素分析。结果完全缓解率3.57%,部分缓解率32.14%,疾病稳定率53.57%,进展率10.72%,总体中位无进展生存时间(PFS)6.43个月,中位生存期(OS)11.43个月,1、2年生存率分别为46.79%和25.23%。单因素分析显示肿瘤缓解率为PFS的独立预后因子,Cox多因素分析显示PFS的独立预后因子为肿瘤缓解率和处方剂量,OS的独立预后因素为肿瘤缓解率、肿瘤直径、肿瘤体积。常见放疗急性不良反应为胃肠道不适、放射性肝损伤及骨髓抑制。结论调强放疗对于不能手术治疗及其他局部治疗无效的原发性大肝癌是一个安全、有效的选择。
Abstract:Objective To investigate the efficacy of intensity- modulated radiotherapy( IMRT) in treating large primary hepatocellular carcinoma( LHCC) which is unsuitable for surgery or has poor response to radiofrequency ablation,interventional therapy,and other local treatments,and to identify the prognostic factors for survival. Methods We retrospectively analyzed the clinical data of 29 LHCC patients who received IMRT from April 2008 to August 2011. There were five fractions per week and the dose for each fraction was 2 to 6 Gy; the total dose was 50 to 70 Gy. The short- term efficacy and prognosis were observed and analyzed. The Kaplan- Meier method was used to calculate survival rates and the log- rank test was used for survival difference analysis. Multivariate analysis was performed using the Cox regression model. Results The complete remission,partial remission,stable disease,and disease progression rates were 3. 57%,32. 14%,53. 57%,and 10. 72%,respectively. The overall median progression- free survival( PFS) time was 6. 43 months,and the median overall survival( OS) time was 11. 43 months. The 1- and 2- year survival rates were 46. 79% and 25. 23%,respectively. Univariate analysis showed tumor response rate was an independent prognostic factor for PFS. The Cox proportional hazard model suggested the tumor response rate and prescribed dose were the independent prognostic factors for PFS. In addition,the independent prognostic factors for OS included tumor response rate,tumor diameter,and tumor volume. The common acute radiotherapy toxicities included gastrointestinal discomfort,radiation- induced liver damage,and myelosuppression. Conclusion IMRT is a safe and effective option for the LHCC patients who are unsuitable for surgery or in the cases that other local therapies fail.
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Key words:
- liver neoplasms /
- radiotherapy,intensity-modulated /
- prognosis
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[1]KE CQ,PENG EL.Non-Surgical treatment of primary liver cancer[J].China Med Herald,2013,10(14):32-35.(in Chinese)柯传庆,彭恩兰.原发性肝癌的非手术治疗[J].中国医药导报,2013,10(14):32-35. [2]FAN RF,CHAI FL,HE GX,et al.Surgical resection combined with radiofrequency ablation for multifocal hepatocellular carcinomas in patients with cirrhosis[J].Chin J Min Inv Surg,2007,7(1):17-19.(in Chinese)范瑞芳,柴福禄,贺冠宪,等.手术切除联合射频消融治疗多发性肝癌合并肝硬化[J].中国微创外科杂志,2007,7(l):17-19. [3]PANDEY D,LEE KH,WAI CT,et al.Long term outcome and prognostic factors for large hepatocellular carcinoma(10 cm or more)after surgical resection[J].Ann Surg Oncol,2007,14(10):2817-2823. [4]PAWLIK TM,DELMAN KA,VAUTHEY JN,et al.Tumor size predicts vascular invasion and histologic grade:Implications for selection of surgical treatment for hepatocellular carcinoma[J].Liver Transpl,2005,11(9):1086-1092. [5]MOK KT,WANG BW,LO GH,et al.Multimodality management of hepatocellular carcinoma larger than 10 cm[J].J Am Coll Surg,2003,197(5):730-738. [6]Chinese Medical Surgery Branch Hepatology Group.The choose of surgical treatment for hepatocellular carcinoma[J].J Abdominal Surg,2008,28(5):262-264.(in Chinese)中华医学会外科学分会肝脏学组.肝细胞肝癌外科治疗方法的选择[J].腹部外科,2008,28(5):262-264. [7]LEE SG,HWANG S,JUNG JP,et al.Outcome of patients with huge hepatocellular carcinoma after primary resection and treatment of recurrent lesions[J].Br J Surg,2007,94(3):320-326. [8]Ministry of Health of the People's Republic of China.Diagnosis,management,and treatment of hepatocellular carcinoma(v2011)[J].J Clin Hepatol,2011,27(11):1141-1159.(in Chinese)中华人民共和国卫生部.原发性肝癌诊疗规范(2011年版)[J].临床肝胆病杂志,2011,27(11):1141-1159. [9]WU DH,LIU L,CHEN LH.Therapeutic effects and prognostic factors in three-dimensional conformal radiotherapy combined with transcatheter arterial chemoembolization for hepatocellular carcinoma[J].World J Gastroenterol,2004,10(15):2184-2189. [10]LIANG SX,JIANG GL,ZHU XD,et al.Prognosis factor analysis of three-dimensional conformal radiotherapy in primary liver cancer[J].Chin J Radiat Oncol,2005,27(10):613-615.(in Chinese)梁世雄,蒋国梁,朱小东,等.原发性肝癌大分割三维适形放疗的预后因素分析[J].中华放射肿瘤学杂志,2005,27(10):613-615. [11]ZENG SC.Radiation therapy for hepatocellular carcinoma-current status and perspectives[J].Chin J Cancer Prev Treat,2009,16(13):961-965.(in Chinese)曾少冲.肝细胞肝癌放射治疗现状与展望[J].中华肿瘤防治杂志,2009,16(13):961-965. [12]JANG JW,KAY CS,YOU CR,et al.Simultaneous multitarget irradiation using helical tomotherapy for advanced hepatocellular carcinoma with multiple extrahepatic metastases[J].Int J Radiat Oncol Biol Phys,2009,74(2):412-418. [13]KANG MK,KIM MS,KIM SK,et al.High-dose radiotherapy with intensity-modulated radiation therapy for advanced hepatocellular carcinoma[J].Tumori,2011,97(6):724-731. [14]SEO YS,KIM JN,KEUM B,et al.Radiotherapy for 65 patients with advanced unresectablehepatocellular carcinoma[J].World J Gastroenterol,2008,14(15):2394-2400. [15]DAWSON LA,MCGINN CJ,NORMOLLE D,et al.Escalatedfocal liver radiation and concurrent hepatic artery fluorodeoxyuridine for unresectable intrahepatic malignancies[J].Clin Oncol,2000,18(11):2210-2218. [16]LU HJ,YANG YL,ZHU XD,et al.Three-dimensional conformal radiotherapyfor primaryhepatic cancer[J].Chin J Radiat Oncol,2005,14(1):35-38.(in Chinese)陆海杰,杨云利,朱小东,等.原发性肝癌三维适形放射治疗疗效分析[J].中华放射肿瘤学杂志,2005,14(1):35-38.
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