Cupino Andrew C, Hair Clark D, Angle John F, Caldwell Stephen H, Rich Tyvin A, Berg Carl L, Northup Patrick G, Al-Osaimi Abdullah M S, Argo Curtis K
Gastrointest Cancer Res. 2012 Jan;5(1):13-7.
Transcatheter arterial chemoembolization (TACE) improves survival in patients with unresectable hepatocellular carcinoma (HCC). Partial liver radiotherapy with modern techniques has been shown to be safe. The purpose of this study was to evaluate the survival value of external beam radiation therapy (EBRT) with concurrent chemotherapy combined with TACE.
A University of Virginia Interventional Radiology patient log was used to identify patients treated with TACE ± another modality from 1999 through 2005. During this time, 44 patients received TACE for unresectable HCC, and 7 of these received adjuvant EBRT. Univariate analysis and multivariable proportional hazards survival modeling were used to identify factors impacting survival.
We compared 37 patients receiving TACE alone to 7 receiving TACE and EBRT (5 with concurrent capecitabine). Unadjusted mean transplant-free survival times were TACE only = 376 days (standard error [SE] = 63 days), TACE + EBRT = 879 days (SE = 100 days). EBRT, TNM stage, and MELD score were important predictors for survival on univariate analysis (p < .10). The adjusted hazard ratio for transplant or death in the TACE + EBRT group was 0.15 (0.02-0.95, p = .026).
EBRT with concurrent chemotherapy following TACE is feasible and well tolerated with modern treatment techniques. Further research should be directed toward determining the potential overall survival benefit of adjuvant EBRT with chemotherapy following TACE for hepatocellular carcinoma.
经动脉化疗栓塞术（TACE）可提高不可切除肝细胞癌（HCC）患者的生存率。现代技术下的部分肝脏放疗已被证明是安全的。本研究的目的是评估外照射放疗（EBRT）联合化疗并结合TACE的生存价值。
利用弗吉尼亚大学介入放射科患者日志，确定1999年至2005年期间接受TACE ± 其他治疗方式的患者。在此期间，44例患者因不可切除的HCC接受了TACE治疗，其中7例接受了辅助EBRT。采用单因素分析和多变量比例风险生存模型来确定影响生存的因素。
我们将37例单纯接受TACE治疗的患者与7例接受TACE和EBRT治疗的患者（5例同时接受卡培他滨治疗）进行了比较。未经调整的平均无移植生存时间为：单纯TACE = 376天（标准误[SE] = 63天），TACE + EBRT = 879天（SE = 100天）。单因素分析显示，EBRT、TNM分期和终末期肝病模型（MELD）评分是生存的重要预测因素（p < 0.10）。TACE + EBRT组移植或死亡的调整后风险比为0.15（0.02 - 0.95，p = 0.026）。
TACE后联合化疗的EBRT在现代治疗技术下是可行的且耐受性良好。应进一步开展研究，以确定TACE后辅助EBRT联合化疗对肝细胞癌患者潜在的总生存获益。
