大剂量三维适形放疗治疗合并门静脉癌栓的肝细胞癌的疗效。

Effectiveness of high-dose three-dimensional conformal radiotherapy in hepatocellular carcinoma with portal vein thrombosis.

机构信息

Department of Radiation Oncology, Korea University Medical Center, Seoul, Korea.

出版信息

Jpn J Clin Oncol. 2012 Aug;42(8):721-9. doi: 10.1093/jjco/hys082. Epub 2012 Jun 11.

DOI:10.1093/jjco/hys082

PMID:22689916

Abstract

OBJECTIVE

To evaluate the treatment outcome of three-dimensional conformal radiotherapy in hepatocellular carcinoma patients with portal vein thrombosis, concerning survival and treatment response of thrombosis.

METHODS

Forty-five patients with hepatocellular carcinoma who had portal vein thrombosis treated from March 2005 to March 2011 were the subjects of this study. The median total dose was 61.2 Gy (range 38-65 Gy). A daily radiation dose of 1.8-2.5 Gy was administered at a frequency of five fractions per week. The clinical target volume included portal vein thrombosis with or without primary tumour with clinical consideration.

RESULTS

Three of the 45 patients (6.7%) showed complete remission of portal vein thrombosis, 25 patients (55.6%) showed partial response, 14 patients (31%) had stable disease and 3 patients (6.7%) had progressive disease. The median and the 1-year survival rate of the responders (complete remission + progressive disease) were 16.7 months and 63.7%, respectively, and those of the non-responders were 8 months and 28.2%, respectively (P= 0.003). A univariate analysis revealed that thrombosis response, Eastern Cooperative Oncology Group performance status, maximum tumour size, tumour bilaterality, Cancer of the Liver Italian Program stage, Okuda stage, hepatic arterial infusion, hepatitis B 'e' antigen and hepatitis C antibody were statistically significant prognostic factors affecting survival. In a multivariate analysis, thrombosis response, Cancer of the Liver Italian Program stage and Okuda stage were found to be statistically significant. No clinically significant radiation-induced liver disease was noted. One grade 3 late complication (duodenal ulcer) was reported.

CONCLUSIONS

High-dose three-dimensional conformal radiotherapy yielded a response rate of 62.3%. It is a safe and effective treatment prolonging the survival of hepatocellular carcinoma patients with portal vein thrombosis.

摘要

目的

评估三维适形放疗治疗伴有门静脉血栓形成的肝细胞癌患者的疗效，包括血栓形成的生存和治疗反应。

方法

本研究纳入了 2005 年 3 月至 2011 年 3 月期间接受治疗的 45 例伴有门静脉血栓形成的肝细胞癌患者。中位总剂量为 61.2Gy（范围 38-65Gy）。每天的放射剂量为 1.8-2.5Gy，每周 5 次分割。临床靶区包括伴有或不伴有原发肿瘤的门静脉血栓形成，临床考虑在内。

结果

45 例患者中有 3 例（6.7%）门静脉血栓完全缓解，25 例（55.6%）部分缓解，14 例（31%）病情稳定，3 例（6.7%）病情进展。反应者（完全缓解+进展）的中位生存期和 1 年生存率分别为 16.7 个月和 63.7%，无反应者分别为 8 个月和 28.2%（P=0.003）。单因素分析显示，血栓反应、东部肿瘤协作组体力状态、最大肿瘤大小、肿瘤双侧性、意大利肝癌计划分期、Okuda 分期、肝动脉灌注、乙型肝炎“e”抗原和丙型肝炎抗体是影响生存的有统计学意义的预后因素。多因素分析显示，血栓反应、意大利肝癌计划分期和 Okuda 分期是有统计学意义的。未观察到有临床意义的放射性肝损伤。报告了 1 例 3 级迟发性并发症（十二指肠溃疡）。