Local radiotherapy with or without transcatheter arterial chemoemboliziation for patients with unresectable hepatocellular carcinoma
Local radiotherapy with or without transcatheter arterial chemoemboliziation for patients with unresectable hepatocellular carcinoma
复制标题
DOI：
10.1016/s0360-3016(00)00462-4
复制
发表时间：
2000-05-01
影响因子：
7
通讯作者：
Horng, CF
中科院分区：
文献类型：
--
作者：
Cheng, JCH;Chuang, VP;Horng, CF
目的：评价不可切除肝细胞癌（HCC）患者单独局部放疗或辅助经导管动脉化疗栓塞（TACE）的治疗结果、失败模式和预后因素。方法与材料：1994年3月至1997年12月，25例不可切除的肝癌患者行部分肝脏局部放疗。Child-Pugh A级肝硬化23例，b级肝硬化2例，肝肿瘤平均直径10.3 cm。平均辐射剂量为46.9 +/- 5.9 Gy，每日1.8-2 Gy。16例患者在放疗前和/或放疗后，同时使用利碘醇和化疗药物混合伊瓦隆或明胶泡沫颗粒进行化疗栓塞治疗。经皮乙醇注射治疗1例。对所有患者进行治疗相关毒性、生存和失败模式的监测。结果：中位随访23个月，11例存活，14例死亡。治疗后的中位生存期为19.2个月，2年生存率为41%。25例患者中仅有3例出现局部肝肿瘤进展。复发见于肝内或肝外。2年本地、区域和肝外无进展生存率分别为78%、46%和39%。本地控制排名最高。Okuda期患者的生存期明显长于II期和III期患者（p = 0.02）。T4病变患者（p = 0.02）或单独放疗患者（p = 0.003）的生存期明显缩短。T4疾病（p = 0.03）和预处理α胎蛋白水平超过200 ng/ml （p = 0.03）与区域无进展生存期显著差相关。治疗前有无门静脉血栓患者的局部无进展生存期（p = 0.0001）和肝外无进展生存期（p = 0.005）均有显著差异。卫星结节的存在对局部无进展生存期（p = 0.04）和肝外无进展生存期（p = 0.03）的影响更大。肝肿瘤直径大于6cm或门静脉血栓患者生存期较短。放射性肝病（RILD）和胃肠道出血是最常见的治疗相关毒性。结论：放疗是治疗不可切除肝癌的有效方法。其影响似乎在接受辐射的地点更为突出。与单独放疗相比，TACE联合放疗能更好地控制HCC，这可能是由于选择预后良好的患者进行联合治疗。在下一阶段治疗不可切除HCC的研究中，应该建立剂量-体积模型。(C) 2000 Elsevier Science Inc.；
Purpose: To evaluate the treatment outcome, patterns of failure, and prognostic factors for patients with unresectable hepatocellular carcinoma (HCC) treated with local radiotherapy alone or as an adjunct to transcatheter arterial chemoembolization (TACE).Methods and Materials: From March 1994 to December 1997, 25 patients with unresectable HCC underwent local radiotherapy to a portion of the liver. Twenty-three patients were classified as having cirrhosis in Child-Pugh class A and 2 in class B. Mean diameter of the treated hepatic tumor was 10.3 cm. Mean dose of radiation was 46.9 +/- 5.9 Gy in a daily fraction of 1.8-2 Gy. Sixteen patients were also treated with Lipiodol and chemotherapeutic agents mixed with Ivalon or Gelfoam particles for chemoembolization, either before and/or after radiotherapy. Percutaneous ethanol injection therapy (PEIT) was given to one patient. All patients were monitored for treatment-related toxicity and for survival and patterns of failure.Results: In a median follow-up period of 23 months, 11 patients were alive and 14 dead. The median survival duration from treatment was 19.2 months with a 2-year survival of 41%. Only 3 of 25 patients had local progression of the treated hepatic tumor. The recurrences were seen within the liver or extrahepatic. The 2-year local, regional, and extrahepatic progression-free survival rates were 78%, 46%, and 39%, respectively. The local control ranked the highest. Patients with Okuda Stage I disease had significantly longer survival than those with Stage II and III (p = 0.02). Patients with T4 disease (p = 0.02) or treated with radiotherapy alone (p = 0.003) had significantly shorter survival. T4 disease (p = 0.03) and pretreatment alpha-fetoprotein level of more than 200 ng/ml (p = 0.03) were associated with significantly worse regional progression-free survival. A significant difference was observed in both regional progression-free survival (p = 0.0001) and extrahepatic progression-free survival (p = 0.005) between patients with and without portal vein thrombosis before treatment. The presence of satellite nodules had a significantly worse impact on regional progression-free survival (p = 0.04) and extrahepatic progression-free survival (p = 0.03). Patients with hepatic tumor more than 6 cm in diameter or portal vein thrombosis tended to have shorter survival. Radiation-induced liver disease (RILD) and gastrointestinal bleeding were the most common treatment-related toxicities.Conclusion: Radiotherapy is effective in the treatment of patients with unresectable HCC. Its effect appeared to be more prominent within the site to which radiation was given. The combination of TACE and radiation was associated with better control of HCC than radiation given alone, probably due to the selection of patients with favorable prognosis for the combined treatment. A dose-volume model should be established in the next phase of research in the treatment of unresectable HCC. (C) 2000 Elsevier Science Inc.