半肝交替调强适形放疗联合张氏抗癌散治疗原发性弥漫性肝癌的临床研究

发布时间：2018-03-17 20:08

  本文选题：张氏抗癌散　切入点：原发性弥漫性肝癌　出处：《湖北中医药大学》2015年硕士论文　论文类型：学位论文

【摘要】：目的:通过观察半肝交替调强适形放疗联合中药张氏抗癌散治疗原发性弥漫性肝癌的近期疗效及毒副作用,探索原发性弥漫性肝癌的有效治疗方案,以期延长原发性弥漫性肝癌患者的生存期,提高生活质量,减轻放疗所致毒副反应,为中西医结合治疗原发性弥漫性肝癌探索新方式。方法:所选78例病例均来自武汉市第五医院肿瘤二科2010年10月至2013年12月期间住院患者,所有病例均符合原发性弥漫性肝癌的诊断。78例患者随机分为A、B两组。A组为中药联合放疗组,B组为单纯放疗组。治疗方法:将两组患者肝脏放疗靶区分为左右半肝,行半肝交替调强适形放疗,剂量为1.7Gy-2Gy/次,5次/周,上午先照射病灶多的一侧半肝,下午照射病灶少的另外一侧半肝,两次照射至少间隔6小时以上,总剂量达到30Gy左右。A组在放疗的基础上施加中药,于放疗前一周开始服用,直至放疗结束后1-3月,B组不服中药,单纯放疗,两组患者放疗方法、剂量相同。治疗前后对患者临床症状积分、近期疗效、生存率、细胞免疫功能、毒副作用等指标进行监测,定期随访患者并记录生存期,将所有数据进行统计学分析。结果:A、B两组按计划完成治疗的患者例数分别是38例、37例。两组患者治疗后临床症状积分评估,两组痊愈率分别为0%(0/38)、0%(0/37),显效率分别为13.16%(5/38)、5.41%(2/37),有效率分别为60.53%(23/38)、37.84%(14/37),无效率分别为26.32%(10/38)、56.76%(21/37),总有效率分别为73.69%(28/38)、43.24%(16/37),经统计学分析,P=0.007,差别有意义。A、B两组完全缓解(CR)率分别为0%(0/38)、0%(0/37),部分缓解(PR)率分别为7.89%(3/38)、5.41%(2/37),无变化(NC)率分别为71.05%(27/38)、72.97%(27/37),进展(PD)率分别为21.05%(8/38)、21.62%(8/37),两组总有效率分别为78.95%(30/38)、78.38%(29/37),两组差别比较,P=0.815,无统计学意义。A、B两组治疗后三月生存率分别为92.11%(35/38)、89.19%(33/37),六月生存率分别为47.37%(18/38)、40.54%(15/37),一年生存率分别为18.42%(7/38)、2.7%(1/37),两组三月生存率、六月生存率差别比较,P分别为0.664、0.551,均无统计学意义;而一年生存率比较,P=0.027,差别有统计学意义。A、B两组治疗前CD3+、CD4+、CD8+、CD4+/CD8+水平相当,差别比较无统计学意义,P值分别为0.967、0.244、0.890、0.882;A、B两组治疗后CD3+、CD4+、CD4+/CD8+均较治疗前升高,A组P值分别为0.000、0.000、0.000,B组P值分别为0.000、0.034、0.000;CD8+较治疗前下降,A组P值为0.000,B组P值为0.000;A、B两组治疗后CD3+、CD4+、CD8+、CD4+/CD8+比较亦有统计学差异,P值分别为0.028、0.046、0.038、0.006。治疗者中产生的主要毒副作用是消化道反应、放射性肝损伤及骨髓抑制,两组I-II级消化道反应的发生率分别为34.21%(13/38)、40.54%(15/37),I-II级放射性肝损伤的发生率分别为21.05%(8/38)、43.24%(16/37),I-II度骨髓抑制的发生率分别为44.74%(17/38)、67.57%(25/37),放射性肝损伤及骨髓抑制差别比较均有统计学意义,P值分别是0.039、0.046;消化道反应差别比较,无统计学意义,P值为0.571。结论:半肝交替调强适形放疗联合中药张氏抗癌散治疗原发性弥漫性肝癌能改善肝癌患者的临床症状,提高患者生活质量和免疫力,延长生存期,减少毒副作用的发生,为中西医结合治疗原发性弥漫性肝癌提供了新的方向。
[Abstract]:Objective: To observe the curative effect of semi liver alternate intensity-modulated radiotherapy combined with traditional Chinese Medicine Zhang kangaisan treatment of primary diffuse liver cancer and side effects, to explore the effective treatment of primary diffuse hepatocellular carcinoma, in order to extend the primary diffuse liver cancer survival of patients, improve the quality of life. Reduce the adverse reactions caused by radiotherapy, combined treatment of primary diffuse hepatocellular carcinoma and explore new ways for traditional Chinese medicine and Western medicine. Methods: 78 cases were collected from the fifth hospital of Wuhan from October 2010 to December 2013 during the two tumor patients, all cases were consistent with primary diffuse liver cancer diagnosis.78 patients were randomly divided into A two, B group.A group for the traditional Chinese medicine combined with radiotherapy group, B group for the radiotherapy group. Treatment methods: two patients of liver radiotherapy is divided into left and right half liver, for semi liver alternate intensity-modulated radiotherapy, the dose was 1.7Gy-2Gy/, 5 times / week, morning One half liver lesions were the first irradiation, irradiation lesions less the other side of the afternoon half liver, two exposure interval of at least 6 hours or more, the total dose reach about 30Gy in the.A group on the basis of radiotherapy applied in traditional Chinese medicine, taking a week before radiotherapy, 1-3 months until the end of radiotherapy, group B with traditional Chinese medicine, simple radiotherapy, dose group two patients before and after treatment. The same method, the clinical symptom score, curative effect, survival rate, cell immune function and side effects were monitored, patients were followed up regularly and record the survival period, all the data were statistically analyzed. Results: A, B two group the number of cases according to the treatment plans were 38 cases, 37 cases. Evaluate the clinical symptom score of two groups of patients after treatment, recovery rate of two groups were 0% (0/38), 0% (0/37), effective rate was 13.16% (5/38), 5.41% (2/37), effective rate was 60.53% (23/38), 37.84% (14/37 no). 鏁堢巼鍒嗗埆涓，

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