Sun Heng-Wen, Chen Long-Hua, Wei Chuan-Jun, Zheng Xiao-Kang, Li Qi-Sheng, Guan Jian
Department of Radiation Oncology, Nanfang Hospital, Southern Medical University, Guangzhou, China.
Nan Fang Yi Ke Da Xue Xue Bao. 2009 Jun;29(6):1133-6.
To evaluate the outcomes of patients with unresectable massive primary liver cancer (PLC) receiving three-dimensional conformal radiotherapy (3-DCRT) combined with transcatheter arterial chemoembolization (TACE).
From January 2001 to December 2004, 84 patients with unresectable massive PLC (tumor size> or =10 cm) received 3-DCRT combined with TACE, including 49 cases in UICC/AJCC T(3) stage and 35 cases in T(4) stages. Lymph node metastasis was found in none of the patients, and portal vein tumor thrombosis (PVTT) was detected in 30 cases. Child-Pugh grade A of liver cirrhosis was present in 64 cases and grade B in 20 cases. The mean value of GTV was 705-/+430 cm(3) (170-2099 cm(3)). Following injections of fluorouracil and hydroxycamptothecine into the target artery of the tumor, the mixture of carboplatin, mitomycin (or pirarubicin) and super-liquefactive iodized oil was injected into the target artery. Gelatin sponge was used to embolize the artery. The procedure was repeated every 1.5-2 months according to the condition of the patients, and each patient received 1-3 such procedures. 3-DCRT was performed in all the patients, who received a total dose of 53.6-/+6.6 Gy (4-6 Gy per fraction at the interval of 48 h), and 3 fractions were given every week.
Eight patients died in 3 months after 3-DCRT and were not evaluated. The total response rate (CR+PR) in these patients was 68.9% (51/74). The overall survival rates at 1, 2 and 3 years were 55.4%, 24.7% and 15.4%, respectively. T stage, GTV, PVTT and fraction size had no significant impact on the overall survival. Child-Pugh grade was found to have significant impact on the patients' survival (P=0.035, RR=2.440).
3-DCRT combined with TACE has definite therapeutic effect on advanced massive PLC, and Child-Pugh grade is an independent prognostic factor in such cases.
评估不可切除的巨大原发性肝癌（PLC）患者接受三维适形放疗（3-DCRT）联合经动脉化疗栓塞术（TACE）的疗效。
2001年1月至2004年12月，84例不可切除的巨大PLC患者（肿瘤大小≥10 cm）接受3-DCRT联合TACE治疗，其中UICC/AJCC T(3)期49例，T(4)期35例。所有患者均未发现淋巴结转移，30例检测到门静脉癌栓（PVTT）。64例患者为Child-Pugh A级肝硬化，20例为B级。大体肿瘤体积（GTV）的平均值为705±430 cm³（170 - 2099 cm³）。向肿瘤靶动脉内注入氟尿嘧啶和羟基喜树碱后，再将卡铂、丝裂霉素（或吡柔比星）与超液化碘油的混合液注入靶动脉。用明胶海绵栓塞动脉。根据患者情况每1.5 - 2个月重复1次该操作，每位患者接受1 - 3次。所有患者均进行3-DCRT，总剂量为53.6±6.6 Gy（每次分割剂量4 - 6 Gy，间隔48小时），每周给予3次分割剂量。
8例患者在3-DCRT后3个月内死亡，未进行评估。这些患者的总缓解率（CR + PR）为68.9%（51/74）。1年、2年和3年的总生存率分别为55.4%、24.7%和15.4%。T分期、GTV、PVTT和分割剂量对总生存无显著影响。发现Child-Pugh分级对患者生存有显著影响（P = 0.035，RR = 2.440）。
3-DCRT联合TACE对晚期巨大PLC有确切治疗效果，Child-Pugh分级是此类病例的独立预后因素。
