Zeng Zhao-Chong, Fan Jia, Tang Zhao-You, Zhou Jian, Qin Lun-Xiu, Wang Jian-Hua, Sun Hui-Chuan, Wang Bin-Liang, Zhang Jian-Ying, Jiang Guo-Liang, Wang Yu-Qi
Radiation Oncology, Fudan University, Zhongshan Hospital, Shanghai 200032, China.
Int J Radiat Oncol Biol Phys. 2005 Feb 1;61(2):432-43. doi: 10.1016/j.ijrobp.2004.05.025.
To evaluate the potential role of external beam radiation therapy (EBRT) in the treatment of patients with hepatocellular carcinoma (HCC) who have portal vein (PV) and/or inferior vena cava (IVC) tumor thrombi.
One hundred fifty-eight patients with HCC who had PV and/or IVC tumor thrombus were reviewed and analyzed by Kaplan-Meier and Cox regression analysis. Forty-four patients with HCC who received local limited EBRT (in addition to other treatment modalities) were classified as the EBRT group. The total radiation dose was 36-60 Gy (median, 50 Gy) and was focused on the tumor thrombi. One hundred fourteen patients with HCC who did not receive EBRT were selected from hospitalized patients with HCC who had PV and/or IVC thrombi during the same period; these were classified as the non-EBRT group, and their intrahepatic tumors were treated with transarterial chemoembolization or resection, on the basis of the patients' status. Parameters observed included survival rates and the tumor thrombus response to EBRT as seen on CT scan or MRI.
Of the 44 patients who received EBRT, 15 (34.1%) showed complete disappearance of tumor thrombi, 5 (11.4%) were in partial remission, 23 (52.3%) were stable in their tumor thrombi, and 1 (2.3%) showed disease progression at the end of the study period. The median survival was 8 months, and the 1-year survival rate was 34.8% in the EBRT group. In the non-EBRT group, the median survival and 1-year survival rates were 4 months and 11.4%, respectively. In stepwise multivariate analysis, EBRT showed a strongly protective value (relative risk = 0.324, p < 0.001). Survival was not related to intrahepatic tumor status in the non-EBRT patients. However, in the EBRT group, poorer prognosis was significantly related to intrahepatic multifocal or diffusion lesions, and the most common reason for death was liver failure caused by uncontrolled intrahepatic disease.
Although EBRT is palliative in intent, it is preferred for prolonging survival in the treatment of tumor thrombi.
评估外照射放射治疗（EBRT）在治疗伴有门静脉（PV）和/或下腔静脉（IVC）肿瘤血栓的肝细胞癌（HCC）患者中的潜在作用。
对158例伴有PV和/或IVC肿瘤血栓的HCC患者进行回顾性分析，并采用Kaplan-Meier法和Cox回归分析。44例接受局部局限性EBRT（联合其他治疗方式）的HCC患者被归为EBRT组。总放射剂量为36 - 60 Gy（中位数为50 Gy），照射重点为肿瘤血栓。从同期住院的伴有PV和/或IVC血栓的HCC患者中选取114例未接受EBRT的患者，归为非EBRT组，根据患者情况对其肝内肿瘤采用经动脉化疗栓塞或切除术治疗。观察参数包括生存率以及CT扫描或MRI显示的肿瘤血栓对EBRT的反应。
在44例接受EBRT的患者中，15例（34.1%）肿瘤血栓完全消失，5例（11.4%）部分缓解，23例（52.3%）肿瘤血栓稳定，1例（2.3%）在研究期末疾病进展。EBRT组的中位生存期为8个月，1年生存率为34.8%。在非EBRT组中，中位生存期和1年生存率分别为4个月和11.4%。在逐步多因素分析中，EBRT显示出强烈的保护作用（相对风险 = 0.324，p < 0.001）。非EBRT患者的生存与肝内肿瘤状态无关。然而，在EBRT组中，较差的预后与肝内多灶性或弥漫性病变显著相关，最常见的死亡原因是肝内疾病失控导致的肝衰竭。
尽管EBRT旨在缓解症状，但在治疗肿瘤血栓方面，它更有利于延长生存期。
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