Chia-Hsien Cheng J, Chuang V P, Cheng S H, Lin Y M, Cheng T I, Yang P S, Jian J J, You D L, Horng C F, Huang A T
Department of Radiation Oncology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan.
Int J Cancer. 2001 Aug 20;96(4):243-52. doi: 10.1002/ijc.1022.
The purpose of our study was to evaluate the outcome, patterns of failure, and toxicity for patients with unresectable hepatocellular carcinoma (HCC) treated with radiotherapy, transcatheter arterial chemoembolization (TACE), or combined TACE and radiotherapy. Forty-two patients with unresectable HCC were treated with combined radiotherapy and TACE (TACE+RT group, 17 patients), radiotherapy alone (RT group, 9 patients), or with TACE alone (TACE group, 16 patients). Mean dose of radiation was 46.9 +/- 5.8 Gy in a daily fraction of 1.8 to 2 Gy, directed only to the cancer-involved areas of the liver. TACE was performed with a combination of Lipiodol, doxorubicin, cisplatin, and mitomycin C, followed by Gelfoam or Ivalon embolization. Tumor size was smaller in the TACE group (mean: 5.4 cm) compared with the TACE+RT group (8.6 cm) and the RT group (13.1 cm) (P = 0.0003). The median follow-up was 24 months in the TACE+RT group, 28 months in the RT group, and 23 months in the TACE group. Survival was significantly worse for patients treated with radiotherapy alone due to the selection bias of patients with more advanced disease and compromised condition in this group. In contrast, the TACE+RT and TACE groups had comparable survival (two-year rates: TACE+RT 58%, TACE 56%, P = 0.69). The local control rate for the treated tumors was similar in the TACE+RT and TACE groups (P = 0.11). The intrahepatic recurrence outside the treated tumors was common and similar between these two groups (P = 0.48). The extrahepatic progression-free survival was significantly shorter for patients in the TACE+RT group than in the TACE group (two-year rates: TACE+RT 36%, TACE 100%, P = 0.002). Seven patients died from complications of treatment. Local radiotherapy may be added to treat patients with unresectable HCC, and the control of progression of the treated tumors was promising even in patients with large hepatic tumors. Survival of patients with combined TACE and radiotherapy was similar to that with TACE as the only treatment, while a significant portion of the patients treated with radiotherapy developed extrahepatic metastasis.
我们研究的目的是评估接受放射治疗、经动脉化疗栓塞术（TACE）或TACE联合放射治疗的不可切除肝细胞癌（HCC）患者的治疗结果、失败模式和毒性反应。42例不可切除HCC患者接受了TACE联合放射治疗（TACE+RT组，17例）、单纯放射治疗（RT组，9例）或单纯TACE治疗（TACE组，16例）。放射治疗的平均剂量为46.9±5.8 Gy，每日分次剂量为1.8至2 Gy，仅针对肝脏中涉及肿瘤的区域。TACE采用碘油、阿霉素、顺铂和丝裂霉素C联合进行，随后用明胶海绵或异丁基-2-氰基丙烯酸正丁酯栓塞。与TACE+RT组（平均8.6 cm）和RT组（平均13.1 cm）相比，TACE组的肿瘤体积较小（平均5.4 cm）（P = 0.0003）。TACE+RT组的中位随访时间为24个月，RT组为28个月，TACE组为23个月。由于该组中疾病更晚期且身体状况较差的患者存在选择偏倚，单纯接受放射治疗的患者生存率明显较差。相比之下，TACE+RT组和TACE组的生存率相当（两年生存率：TACE+RT组58%，TACE组56%，P = 0.69）。TACE+RT组和TACE组治疗肿瘤的局部控制率相似（P = 0.11）。这两组治疗肿瘤外的肝内复发很常见且相似（P = 0.48）。TACE+RT组患者的肝外无进展生存期明显短于TACE组（两年生存率：TACE+RT组36%，TACE组100%，P = 0.002）。7例患者死于治疗并发症。局部放射治疗可用于治疗不可切除HCC患者，即使对于大肝肿瘤患者，治疗肿瘤进展的控制也很有前景。TACE联合放射治疗患者的生存率与仅采用TACE治疗的患者相似，而接受放射治疗的患者中有很大一部分发生了肝外转移。
