射波刀治疗复发性肝癌患者的效果及预后分析

李欢; 孙静; 张弢; 范毓泽; 孙颖哲; 何卫平; 段学章

doi:10.3969/j.issn.1001-5256.2017.12.016

射波刀治疗复发性肝癌患者的效果及预后分析

DOI: 10.3969/j.issn.1001-5256.2017.12.016

中国人民解放军第三〇二医院肿瘤放射治疗中心

基金项目:

基金项目:北京市海淀区预防医学会(2016HDPMA09)；

详细信息

中图分类号: R735.7
计量
- 文章访问数: 2676
- HTML全文浏览量: 52
- PDF下载量: 421
- 被引次数: 0
出版历程
- 收稿日期: 2017-06-13
- 出版日期: 2017-12-20

Effect of Cyber Knife radiosurgery on survival rate of patients with recurrent liver cancer after surgery

Radiotherapy Center of Oncology, 302 Hospital of PLA

Research funding:

摘要

摘要: 目的分析射波刀立体定向放射治疗切除术后、消融术后复发性肝癌的效果和影响生存率的相关因素。方法对2011年1月-2014年1月于中国人民解放军三○二医院行射波刀治疗的34例术后复发性肝癌患者进行回顾性分析,计算患者放疗后的生存率和生存时间,分析影响其生存的相关因素。肿瘤靶区（GTV）为1.4751082.075 cm3,中位值162.99 cm3,分割剂量720 Gy/次（中位值9 Gy）,照射次数28次（中位值5次）,肿瘤剂量2460 Gy（中位值45 Gy）,每日照射1次。主要观察指标为近期疗效、毒副作用、远期疗效。Log-rank检验分析生存相关影响因素,计数资料组间比较采用χ2检验和Fisher精确检验。结果放疗后患者1、2、3年总体生存率分别为91.2%、70.6%和44.1%,中位生存期34个月。1、2、3年的无进展生存率分别为55.9%、38.2%、29.4%。术后≤1年（早期）及>1年（晚期）复发组经放疗后1、2、3年总体生存率分别为89%、73.7%、57.9%和93%、73....
- 肝肿瘤 /
- 复发 /
- 放射外科手术 /
- 存活率分析
Abstract: Objective To investigate the clinical effect of Cyber Knife radiosurgery, a type of stereotactic body radiotherapy, in the treatment of recurrent liver cancer after resection or ablation, as well as the effect of clinical factors on survival rate. Methods A retrospective analysis was performed for the clinical data of 34 patients with recurrent liver cancer after surgery who were treated with Cyber Knife radiosurgery. The patients' survival rate and survival time after radiotherapy were calculated, and the influencing factors for survival were analyzed.The gross tumor volume of tumor target was 1. 475-1082. 075 cm3 ( median 162. 99 cm3) . The fraction dose was 7-20 Gy ( median 9 Gy) , the number of times of irradiation was 2-8 times ( median 5 times) , and the tumor dose was 24-60 Gy ( median 45 Gy) once a day. The major indices for observation were short-term outcome, toxic and side effects, and long-term outcome. The log-rank test was used to analyze the surviral-related factors. The chi-square test and fisher test were used for comparison of categorical data between groups. Results The 1-, 2-, and 3-year overall survival rates after radiotherapy were 91. 2%, 70. 6%, and 44. 1%, respectively, and the median survival time was 34 months. The 1-, 2-, and 3-year progression-free survival rates were 55. 9%, 38. 2%, and 29. 4%, respectively.There were no significant differences in 1-, 2-, and 3-year overall survival rates after radiotherapy between the ≤1-year ( early) postoperative group and the > 1-year ( late) postoperative group ( 89%/73. 7%/57. 9% vs 93%/73. 3%/33. 3%, χ2= 0. 354, P = 0. 368) .The univariate analyses showed that sex, age, time to postoperative recurrence, diameter and number of recurrent lesions, liver function classification, alpha-fetoprotein level, and chemotherapy were not significantly associated with patients' survival after radiotherapy. Conclusion Cyber Knife radiosurgery is safe and effective in the treatment of recurrent liver cancer, with the advantages of good local control of liver cancer, a high overall survival rate, noninvasiveness, few side effects, and good tolerability, and thus provides a new direction for the treatment of intrahepatic recurrence of primary liver cancer.
- liver neoplasms /
- recurrence /
- radiosurgery /
- survival analysis

HTML全文

参考文献(23)

[1]HONG SN, LEE SY, CHOI MS, et al.Comparing the outcomes of radiofrequency ablation and surgery in patients with a single small hepatocellular carcinoma and well-preserved hepatic function[J].J Clin Gastroenterol, 2005, 39 (3) :247-252.

[2]FAN J, ZHOU J, YANG XR.Surgical treatment of hepatocellular carcinoma in the precision medicine era[J].Chin J Dig Surg, 2017, 16 (1) :22-27. (in Chinese) 樊嘉, 周俭, 杨欣荣.精准医学时代的肝癌外科治疗[J].中华消化外科杂志, 2017, 16 (1) :22-27.

[3]ZHANG CS, ZHANG JL, LI XH, et al.Is radiofrequency ablation equal to surgical re-resection for recurrent hepatocellular carcinoma meeting the Milan criteria a meta-analysis[J].J Buon, 2015, 20 (1) :223-230.

[4]BENEDICT SH, YENICE KM, FOLLOWILL D, et al.Stereotactic body radiation therapy:the report of AAPM Task Group 101[J].Med Phys, 2010, 37 (8) :4078-4101.

[5]CHEN AP, SETSER A, ANADKAT MJ, et al.Grading dermatologic adverse events of cancer treatments:the common terminology criteria for adverse events version 4.0[J].J Am Acad Dermatol, 2012, 67 (5) :1025-1039.

[6]XU XJ, ZHANG Q, PAN JS, et al.Clinical efficacy and adverse reactions of body gamma knife in treatment of primary liver cancer[J].J Jilin Univ:Med Edit, 2017, 43 (2) :402-407. (in Chinese) 徐雪晶, 张倩, 潘绵顺, 等.体部伽玛刀治疗原发性肝癌的临床疗效和不良反应[J].吉林大学学报:医学版, 2017, 43 (2) :402-407.

[7]CHOI D, LIM HK, RHIM H, et al.Percutaneous radiofrequency ablation for recurrent hepatocellular carcinoma after hepatectomy:longterm results and prognostic factors[J].Ann Surg Oncol, 2007, 14 (8) :2319-2329.

[8]MA MING, NIU TT, SHAO L, et al.Hepatic transcatheter arterial chemoembolization combined with stereotactic radia tion therapy of primary liver cancer[J].Trauma Crit Med, 2017, 5 (1) :32-35. (in Chinese) 马明, 牛婷婷, 邵亮, 等.肝动脉化疗栓塞术联合立体定向放疗治疗较大原发性肝癌临床研究[J].创伤与急危重病医学, 2017, 5 (1) :32-35.

[9]LLOVET JM, BRUIX J.Systematic review of randomized trials for unresectable hepatocellular carcinoma:chemoembolization improves survival[J].Hepatology, 2003, 37 (2) :429-442.

[10]REAL MI, LLOVET JM, MONTANA X, et al.Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma[J].Lancet, 2002, 359 (9319) :1734-1739.

[11]SHAO L, SHI YX, ZHU HX, et al.Clinical observation of therapeutic effect of primary liver cancer treated by stereotactic radiotherapy combined with kanglaite injection[J].Clin J Med Offic, 2017, 45 (3) :313-315. (in Chinese) 邵亮, 施艳新, 朱慧心, 等.立体定向放射治疗联合康莱特注射液治疗原发性肝癌临床研究[J].临床军医杂志, 2017, 45 (3) :313-315.

[12]BENSON AB, D'ANGELICA MI, ABRAMS TA, et al.Hepatobiliary cancers, version 2.2014[J].J Natl Compr Canc Netw, 2014, 12 (8) :1152-1182.

[13]HUANG WY, JEN YM, LEE MS, et al.Stereotactic body radiation therapy in recurrent hepatocellular carcinoma[J].Int J Radiat Oncol Biol Phys, 2012, 84 (2) :355-361.

[14]LU MD, YIN XY, XIE XY, et al.Percutaneous thermal ablation for recurrent hepatocellular carcinoma after hepatectomy[J].Br JSurg, 2005, 92 (11) :1393-1398.

[15]YANG W, CHEN MH, YIN SS, et al.Radiofrequency ablation of recurrent hepatocellular carcinoma after hepatectomy:therapeutic efficacy on early and late-phase recurrence[J].AJR Am J Roentgenol, 2006, 186 (5 Suppl) :s275-s283.

[16]ZHOU Y, SUI C, LI B, et al.Repeat hepatetomy for recurrent hepatocelluar carcinoma after hepatectomy:a local experience and a systematic review[J].Word J Surg Oncol, 2010, 8 (1) :55.

[17]MARELLI L, STIGLIANO R, TRIANTOS C, et al.Transarterial therapy for hepatocellular carcinoma:Which technique is more effective?A systematic review of cohort and randomized studies[J].Cardiovasc Intervent Radiol, 2007, 30 (1) :6-25.

[18]BOUZA C, LOPEZ-CUADRADO T, ALCAZAR R, et al.Metaanalysis of percutaneous radiofrequency ablation versus ethanol injection in hepatocellular carcinoma[J].BMC Gastroenterol, 2009, 9 (1) :31.

[19]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.

[20]LIANG BY.Surgical treatment strategy for hepatocellular carcinoma and prevention and treatment for postoperative tumor recurrence[D].Wuhan:Huazhong Univ Sci Tech, 2012. (in Chinese) 梁宾勇.原发性肝癌外科治疗方法选择及术后肿瘤复发防治的临床和实验研究[D].武汉:华中科技大学, 2012.

[21]ZHOU L, RUI JA, WANG SB, et al.Early recurrence in large hepatocellular carcinoma after curative hepatic resection:prognostic significance and risk factors[J].Hepatogastroenterology, 2014, 61 (135) :2035-2041.

[22]FENG AJ, LIU YQ.Effects of laparoscopic hepatectomy and open hepatectomy on C-reactive protein and blood coagulation function in patients with primary liver cancer[J/CD].Chin J Liver Dis:E-lectronic Edition, 2017, 9 (1) :75-78. (in Chinese) 冯爱军, 刘艳芹.腹腔镜规则肝叶切除和开腹对原发性肝癌患者C-反应蛋白和凝血功能的影响[J/CD].中国肝脏病杂志:电子版, 2017, 9 (1) :75-78.

[23]LIANG HH, XUE P, CHEN MS, et al.Risk factors of survival for recurrent hepatocellular carcinoma treated by percutaneous radiofrequency ablation[J].Chin J Surg, 2010, 48 (10) :738-742. (in Chinese) 梁惠宏, 薛平, 陈敏山, 等.经皮射频消融治疗复发性肝癌的预后分析[J].中华外科杂志, 2010, 48 (10) :738-742.

施引文献

资源附件(0)

访问统计