伴有门静脉主干瘤栓的肝细胞癌：门静脉支架置入及经动脉化疗栓塞术后的三维适形放疗治疗

Hepatocellular carcinoma with main portal vein tumor thrombus: treatment with 3-dimensional conformal radiotherapy after portal vein stenting and transarterial chemoembolization.

作者信息

Zhang Xue-Bin, Wang Jian-Hua, Yan Zhi-Pin, Qian Sheng, Du Shi-Suo, Zeng Zhao-Chong

机构信息

Department of Radiology, Zhong Shan Hospital, Fudan University, Fenglin Road, Shanghai, China.

出版信息

Cancer. 2009 Mar 15;115(6):1245-52. doi: 10.1002/cncr.24139.

DOI:10.1002/cncr.24139

PMID:19156918

Abstract

BACKGROUND

Hepatocellular carcinoma (HCC) with main portal vein tumor thrombus (MPVTT) is often associated with poor prognosis. We retrospectively assessed the effectiveness of percutaneous transhepatic portal vein stenting and transarterial chemoembolization (PTPVS-TACE) combined with or without 3-dimensional conformal radiotherapy (3-DCRT) for HCC with MPVTT.

METHODS

Forty-five patients with HCC complicated by MPVTT were treated with PTPVS-TACE. Among them, 16 patients (group A) received 3-DCRT with 30-60Gy as daily 2Gy fractions. The remaining 29 patients (group B) received no radiotherapy. The tumor responses, complications, stent patency rates, and cumulative survival rates were evaluated, and the Kaplan-Meier method and log-rank test were used for survival analysis.

RESULTS

No severe complications were associated with PTPVS-TACE and 3-DCRT. The objective response rate (CR and PR) was 35.6%. The 60-, 180-, and 360-day cumulative stent patency rates were 93.3%, 62.2%, and 34.6% in group A, and 58.6%, 21.7%, and 10.8% in group B, respectively, showing significant difference between the 2 groups (P<.01). The mean patency time was 475.20+/-136.97 and 199.58+/-61.40 days, respectively. The 60-, 180-, and 360-day cumulative survival rates were 93.8%, 81.3%, and 32.5%, respectively, for group A, 86.2%, 13.8%, and 6.9%, respectively, for group B. Significant statistical differences were detected between the 2 groups (P<.01).

CONCLUSIONS

These findings suggest that sequential therapy by PTPVS-TACE-3-DCRT is possibly an effective treatment modality for HCC complicated by main portal vein tumor thrombus.

摘要

背景

伴有主门静脉肿瘤血栓（MPVTT）的肝细胞癌（HCC）通常预后较差。我们回顾性评估了经皮经肝门静脉支架置入术和经动脉化疗栓塞术（PTPVS-TACE）联合或不联合三维适形放疗（3-DCRT）治疗伴有MPVTT的HCC的有效性。

方法

45例HCC合并MPVTT患者接受了PTPVS-TACE治疗。其中，16例患者（A组）接受了3-DCRT，剂量为30-60Gy，每日分2Gy照射。其余29例患者（B组）未接受放疗。评估肿瘤反应、并发症、支架通畅率和累积生存率，并采用Kaplan-Meier法和对数秩检验进行生存分析。

结果

PTPVS-TACE和3-DCRT未引起严重并发症。客观缓解率（CR和PR）为35.6%。A组60天、180天和360天的累积支架通畅率分别为93.3%、62.2%和34.6%，B组分别为58.6%、21.7%和10.8%，两组间差异有统计学意义（P<0.01）。平均通畅时间分别为475.20±136.97天和199.58±61.40天。A组60天、180天和360天的累积生存率分别为93.8%、81.3%和32.5%，B组分别为86.2%、13.8%和6.9%。两组间差异有统计学意义（P<0.01）。