基于螺旋断层放疗技术的立体定向放疗治疗肝细胞肝癌的疗效及安全性评价

发布时间：2018-03-26 05:37

  本文选题：肝肿瘤　切入点：放射疗法　出处：《肿瘤》2017年04期

【摘要】：目的:评价基于螺旋断层放疗技术的立体定向放疗(stereotactic body radiation therapy,SBRT)在治疗肝细胞肝癌中的疗效及不良反应。方法:收集复旦大学附属中山医院肿瘤放疗科2012年12月—2015年12月收治的46例肝细胞肝癌患者的临床病理资料和随访资料。所有患者均采用基于螺旋断层放疗技术的SBRT治疗。肿瘤平均直径为2.5 cm(范围:0.9~5.8 cm),采用四维CT(four-dimensional CT,4-DCT)的定位方法。治疗前行图像引导下的匹配校准,总照射剂量为48~50 Gy,分割次数为5~10次,SBRT治疗期间给予保肝和营养支持等对症支持治疗。治疗6个月后采用改良实体瘤疗效评价标准(modified response evaluation criteria in solid tumors,mRECIST)行疗效评价;不良反应评价采用美国国立癌症研究所事件通用术语标准3.0(National Cancer Institute-Common Terminology Criteria for Adverse Events 3.0,NCI-CTC 3.0);生存分析用Kaplan-Meier法。结果:所有患者均完成治疗,治疗后每隔3个月随访1次,其中完全缓解(complete remmision,CR)27例(58.7%),部分缓解(partial response,PR)15例(32.6%),病情稳定(stable disease,SD)2例(4.3%),疾病进展(progressive disease,PD)2例(4.3%),总有效率(CR+PR)为91.3%。自放疗之日开始计算生存率,46例患者的1年、2年和3年的生存率分别为95.4%、75.7%和69.9%。不良反应方面,仅有5例出现Ⅰ度骨髓抑制,2例出现Ⅱ度骨髓抑制,2例出现Ⅰ度转氨酶升高。结论:采用螺旋断层放疗是一种安全、有效的治疗手段。对于那些无法手术或射频消融的肝细胞肝癌患者,SBRT是一种行之有效的方法,值得进一步推广。
[Abstract]:Objective: to evaluate the efficacy and side effects of stereotactic body radiation therapy based on spiral tomography in the treatment of hepatocellular carcinoma. Methods: from December 2012 to 2015, the Department of Oncology, Zhongshan Hospital affiliated to Fudan University was collected. The clinicopathological data and follow-up data of 46 patients with hepatocellular carcinoma treated in December. All patients were treated with SBRT based on helical tomography. The mean diameter of the tumor was 2.5 cm (range: 0.95.8cm / cm), and the tumor was determined by four-dimensional CT(four-dimensional CT4-DCT. Image matching and calibration before treatment, The total irradiation dose was 48g / 50 Gy, and the number of fractions was 5g / 10. The therapeutic effect was evaluated by modified response evaluation criteria in solid tumor RECIST (modified response evaluation criteria in solid RECIST) after 6 months of treatment. Adverse reactions were evaluated by 3.0(National Cancer Institute-Common Terminology Criteria for Adverse Events 3.0 and survival analysis by Kaplan-Meier. Results: all patients were treated and followed up every 3 months after treatment. There were 27 cases of complete remission, 15 cases of partial response, 15 cases of partial response, 2 cases of stable disease, 2 cases of progressive disease and 2 cases of progressive disease. The total effective rate was 91.3%. The survival rate of 46 patients was calculated from the day of radiotherapy. The adverse reactions were 95.4% and 69.9%, respectively. There were only 5 cases of grade 鈪，

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