癌症进展
癌癥進展
암증진전
Oncology Progress
2015年
5期
523-528
,共6页
大肝癌%调强放疗%安全性
大肝癌%調彊放療%安全性
대간암%조강방료%안전성
large hepatocellular carcinoma%intensity-modulated radiotherapy%safety
目的：探讨调强放射治疗（intensity-modulated radiotherapy，IMRT）治疗原发性大肝癌（large hepato-cellular carcinoma，LHCC）的安全性及可行性。方法回顾性总结21例采用逆向IMRT计划系统，应用8 mV直线加速器，95%等剂量曲线包绕计划靶体积（planning target volume，PTV），剂量分割为（60～70）Gy/（20～35）F，（2~3）Gy/F，每周5 F，中位剂量60 Gy的原发性LHCC患者的临床资料。根据通用不良事件评价标准和实体瘤的疗效评价标准评价不良反应和近期疗效。结果21例患者接受IMRT治疗期间，有5例（23.81%）出现3级不良反应，15例（71.43%）出现1～2级肝毒性反应，仅有1例（4.76%）出现放射诱导的肝病（radiation in-duced liver disease，RILD），且8周后复查肝功能已恢复正常。放疗前、放疗后及放疗后2个月患者的肝功能Child-Pugh分级均无明显的差异（P＞0.05），平均AFP水平呈下降趋势。放疗后2个月评价近期疗效，总有效率为42.9%，疾病控制率为81%，4例（19%）患者在放疗过程中或结束后立即出现疾病进展（progressive dis-ease，PD）；门静脉癌栓、巴塞罗那临床肝癌分期（Barcelona Clinic Liver Cancer，BCLC）和肝功能Child-Pugh分级与放疗有效率相关。结论 IMRT治疗LHCC的安全性良好，患者的不良反应小，可耐受，近期疗效较满意。
目的：探討調彊放射治療（intensity-modulated radiotherapy，IMRT）治療原髮性大肝癌（large hepato-cellular carcinoma，LHCC）的安全性及可行性。方法迴顧性總結21例採用逆嚮IMRT計劃繫統，應用8 mV直線加速器，95%等劑量麯線包繞計劃靶體積（planning target volume，PTV），劑量分割為（60～70）Gy/（20～35）F，（2~3）Gy/F，每週5 F，中位劑量60 Gy的原髮性LHCC患者的臨床資料。根據通用不良事件評價標準和實體瘤的療效評價標準評價不良反應和近期療效。結果21例患者接受IMRT治療期間，有5例（23.81%）齣現3級不良反應，15例（71.43%）齣現1～2級肝毒性反應，僅有1例（4.76%）齣現放射誘導的肝病（radiation in-duced liver disease，RILD），且8週後複查肝功能已恢複正常。放療前、放療後及放療後2箇月患者的肝功能Child-Pugh分級均無明顯的差異（P＞0.05），平均AFP水平呈下降趨勢。放療後2箇月評價近期療效，總有效率為42.9%，疾病控製率為81%，4例（19%）患者在放療過程中或結束後立即齣現疾病進展（progressive dis-ease，PD）；門靜脈癌栓、巴塞囉那臨床肝癌分期（Barcelona Clinic Liver Cancer，BCLC）和肝功能Child-Pugh分級與放療有效率相關。結論 IMRT治療LHCC的安全性良好，患者的不良反應小，可耐受，近期療效較滿意。
목적：탐토조강방사치료（intensity-modulated radiotherapy，IMRT）치료원발성대간암（large hepato-cellular carcinoma，LHCC）적안전성급가행성。방법회고성총결21례채용역향IMRT계화계통，응용8 mV직선가속기，95%등제량곡선포요계화파체적（planning target volume，PTV），제량분할위（60～70）Gy/（20～35）F，（2~3）Gy/F，매주5 F，중위제량60 Gy적원발성LHCC환자적림상자료。근거통용불량사건평개표준화실체류적료효평개표준평개불량반응화근기료효。결과21례환자접수IMRT치료기간，유5례（23.81%）출현3급불량반응，15례（71.43%）출현1～2급간독성반응，부유1례（4.76%）출현방사유도적간병（radiation in-duced liver disease，RILD），차8주후복사간공능이회복정상。방료전、방료후급방료후2개월환자적간공능Child-Pugh분급균무명현적차이（P＞0.05），평균AFP수평정하강추세。방료후2개월평개근기료효，총유효솔위42.9%，질병공제솔위81%，4례（19%）환자재방료과정중혹결속후립즉출현질병진전（progressive dis-ease，PD）；문정맥암전、파새라나림상간암분기（Barcelona Clinic Liver Cancer，BCLC）화간공능Child-Pugh분급여방료유효솔상관。결론 IMRT치료LHCC적안전성량호，환자적불량반응소，가내수，근기료효교만의。
Objective To evaluate the safety and feasibility of intensity-modulated radiotherapy (IMRT) in 21 pa-tients with primary large hepatocellular carcinoma (LHCC). Method 21 cases with LHCC were treated with IMRT, with a radiation therapy delivered with a 8 mV linear accelerator by inverse treatment planning, and dose fractions were (60~70) Gy/ (20~35) F, (2~3) Gy/F, 5 F/w, with a median dose of 60 Gy, prescribed to the PTV encl. 95% iso-dose. The treatment-related toxicity and tumor remission were assessed according to CTCAE 3.0 and RECIST 1.1, re-spectively. Result Among 21 patients who received IMRT, 5 patients (23.81%) developed ≥grade 3 toxicities, 15 pa-tients (71.43%) developed grade 1 to 2 liver toxicities, and there was only one patient (4.76%) who had radiation-in-duced liver disease (RILD), and was recovered as evidenced by normal laboratory liver function results after eight weeks. There was no significant difference in Child-Pugh classi fi cation before and after radiotherapy (P>0.05) as well as in 2 months after the completion of radiotherapy, and an decreasing trend was observed in mean AFP. Two months after treatment, the overall response rate of the 21 patients who received IMRT was 42.9%, and the local tu-mor control rate was 81%, while 4 patients (19%) had progressive disease during or immediately after radiotherapy. Through the chi-square test, significant association between portal vein thrombosis, BCLC staging and Child-Pugh classification and radiotherapy response was observed. Conclusion Intensity-modulated radiotherapy in patients with large hepatocellular carcinoma is safe and tolerable, with low toxicity and satisfactory response.
