Shim Su Jung, Seong Jinsil, Han Kwang Hyub, Chon Chae Yoon, Suh Chang Ok, Lee Jong Tae
Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.
Liver Int. 2005 Dec;25(6):1189-96. doi: 10.1111/j.1478-3231.2005.01170.x.
In order to determine the effect of additional radiotherapy (RT) after an incomplete transcatheter arterial chemoembolization (TACE) in an unresectable hepatocellular carcinoma (HCC), the treatment results of patients receiving TACE plus RT were analyzed and compared with those treated with TACE alone.
One hundred and five patients with an unresectable HCC were treated with TACE from January 1992 to December 2002. In 73 of these patients, the TACE was incomplete. Among them, TACE was repeatedly performed in 35 patients (TACE group), and the remaining 38 patients were also treated with local RT (TACERT group). The patients were either in stage III or IVa, Eastern Cooperative Oncology Group 2 or less, and Child-Pugh class A or B. The average frequency of TACE prior to RT was 2 and the RT was started within 7-10 days after the TACE.
The 2-year survival rate was significantly higher in the TACERT than in the TACE group (36.8 % vs. 14.3%, P=0.001). According to the tumor size, the 2-year survival rates in the TACERT and TACE groups were 63% vs. 42% in 5-7 cm (P=0.22), 50% vs. 0% in 8-10 cm (P=0.03), and 17% vs. 0% in larger than 10 cm (P=0.0002) respectively.
There was a significantly improved survival rate in the TACERT group of unresectable HCC patients than in the TACE group, particularly in case of tumors > or =8 cm in diameter. Therefore, RT in addition to TACE is strongly recommended for patients with an unresectable HCC.
为了确定在不可切除的肝细胞癌（HCC）中，经导管动脉化疗栓塞术（TACE）不完全后追加放疗（RT）的效果，分析接受TACE联合RT治疗的患者的治疗结果，并与单纯接受TACE治疗的患者进行比较。
1992年1月至2002年12月期间，105例不可切除的HCC患者接受了TACE治疗。其中73例患者的TACE不完全。在这些患者中，35例患者反复进行TACE（TACE组），其余38例患者同时接受局部RT（TACERT组）。患者处于III期或IVa期，东部肿瘤协作组（ECOG）评分为2分或更低，且肝功能为Child-Pugh A级或B级。RT前TACE的平均次数为2次，RT在TACE后7 - 10天内开始。
TACERT组的2年生存率显著高于TACE组（36.8%对14.3%，P = 0.001）。根据肿瘤大小，TACERT组和TACE组在肿瘤直径5 - 7 cm时的2年生存率分别为63%对42%（P = 0.22），在8 - 10 cm时分别为50%对0%（P = 0.03），在大于10 cm时分别为17%对0%（P = 0.0002）。
不可切除的HCC患者中，TACERT组的生存率显著高于TACE组，尤其是对于直径≥8 cm的肿瘤。因此，强烈推荐对不可切除的HCC患者在TACE基础上联合RT治疗。
