原发性肝癌射波刀（Cybe-knife）治疗后肝损伤的研究

发布时间：2018-06-21 06:25

本文选题：原发性肝癌 + 放射治疗　；参考：《广西医科大学》2015年硕士论文

【摘要】：目的：探讨射波刀(Cyber-knife)治疗肝癌对患者肝功能变化的影响,并分析射波刀后肝损伤的转归情况。方法：回顾性分析2009年8月～2012年12月104例肝功能Child-Pugh分级为A-B级的肝癌患者从射波刀治疗前到治疗后5个月内肝功能生化指标、凝血功能指标以及肝功能Child-Pugh分级的变化,观察治疗后出现肝损伤的情况以及转归,用配对t检验对肝功能变化进行分析,生存率计算采用Kapan-Meier法。结果：治疗后2个月复查CT,近期有效率(CR+PR)为80.8%。中位生存期为19个月。射波刀治疗后的1-2月(3-10周)患者天冬氨酸转氨酶升高,血清白蛋白下降,肝功能Child-Pugh积分增高,与治疗前比较差异均有统计学意义(P0.05),而在治疗后3个月左右(11-22周)上述指标有所改善。观察期间,出现Child-Pugh积分升高的有41例(39.4%),17例(16.3%)Child-Pugh分级进展,出现肝脏毒性反应(2-3级)的24例(23.1%),无4级肝脏毒性反应。结论：射波刀治疗肝癌可引起肝损伤,以治疗后1～2个月肝损伤最明显,但总体损伤均较轻微且治疗后3个月左右可以逐渐恢复。对于肝功能Child-Pugh A-B级的肝癌患者行射波刀治疗其肝功能可以承受。目的:探讨原发性巧癌射波刀治疗后肝损伤发生的影响因素,指导巧癌的射波刀治疗,避免和减少肝损害的发生。方法:2009年8月~2012年12月肝功能Child-Pugh A~B级的行射波刀治疗的肝癌患者104例,放疗剂量28~55Gy/2~6f,分割剂量8~16Gy/f。观察射波刀治疗后5个月内出现肝损伤的情况,运用卡方检验(chi-square test)或t检验(t-test)对一般临床因素及剂量学参数与治疗后肝损伤的发生做统计分析。一般临床因素包括;性别、年龄、ECOG评分、TNM分期、口静脉癌栓、邸V感染情况、治疗前谢ild-Pugh分级、GTV、放疗剂量及分割剂量,剂量学参数包括;NVL、V_5、V_10、V_15、V_20、V_25及V_30。采用logistic回归分析对有意义的因素进行多因素分析,筛选出有统计学意义的独立影响因素。结果:射波刀治疗后5个月内出现CMd-Pu班分级进展的有17例,出现肝脏毒性反应(2~3级)的24例,未见4级肝脏毒性反应。各临床因素及剂量学参数与射波刀后Child-Pugh分级进展无关,而GTV、V_5、V_10、V_15、V_20、V_25及V_30与治疗后肝脏毒性(2~3级)的发生有关,多因素分析结果显示,仅V_25为其独立影响因素(P0.05)。V_25预测肝脏放射耐受剂量R0C曲线下面积为0.775(%%CI:0.672~0.878),根据Youden指数最大的切点,确定最佳界值为31.5%。结论:V25是肝癌患者射波刀放疗后出现肝脏毒性反应(2~3级)的主要影响因素,可W作为一种有效的剂量学参数来评估射波刀治疗后肝损伤的风险。
[Abstract]:Objective: to investigate the effect of Cyber-knife-treated liver function on liver function in patients with liver cancer, and to analyze the outcome of liver injury after wave knife. Methods: the changes of liver function biochemical index, coagulation function index and Child-Pugh grade of liver function in 104 patients with liver cancer with Child-Pugh grade A-B grade from August 2009 to December 2012 were analyzed retrospectively. The changes of liver function were analyzed by paired t test. The survival rate was calculated by Kapan-Meier method. Results: 2 months after treatment, the effective rate of CT was 80.8%. The median survival time was 19 months. The aspartate aminotransferase increased, the serum albumin decreased and the Child-Pugh score of liver function increased. There were significant differences between before treatment and before treatment (P 0.05), and the above indexes were improved at about 3 months after treatment for 11 to 22 weeks. During the observation period, there were 41 cases with elevated Child-Pugh score and 17 cases with Child-Pugh grade progression in 17 cases with Child-Pugh grade, and 24 cases with hepatic toxicity reaction of 2-3 grade). No grade 4 hepatic toxicity reaction was found. Conclusion: the liver injury can be induced by wave knife therapy, especially after 1 ~ 2 months of treatment, but the total injury is mild and can gradually recover 3 months after treatment. The liver function of patients with liver function Child-Pugh A-B liver cancer treated with wave knife is acceptable. Objective: to investigate the influencing factors of liver injury after radiofrequency knife therapy for primary carcinoma of carcinoma, to guide the treatment of carcinoma with wave knife, and to avoid and reduce the occurrence of liver damage. Methods: from August 2009 to December 2012, 104 patients with liver cancer with Child-Pugh Agna B grade were treated with radiosurgery at a dose of 2855 Gy / 2 and 816 Gy / f, respectively. To observe the occurrence of liver injury within 5 months after treatment with wave knife, chi-square test or t test were used to analyze the general clinical factors and dose parameters and the occurrence of liver injury after treatment. General clinical factors included gender, age, ECOG score, TNM stage, oral vein tumor embolus, V infection, GTV before treatment, radiotherapy dose and fractionation dose, dosimetric parameters including NVLV V 10 V 10 V 15 V 20 V 20 V 5 and V 30. The significant factors were analyzed by logistic regression analysis, and the independent influential factors were screened out. Results: there were 17 cases with CMd-Pu grade progression and 24 cases with hepatic toxic reaction grade 2 / 3 within 5 months after radiosurgery. No grade 4 hepatic toxic reaction was found. The clinical factors and dosimetry parameters were not related to the Child-Pugh classification after the wave knife, but the GTVV _ 5 / V _ (10) / V _ (15) / V _ (20) / V _ (25) and V _ (30) were related to the occurrence of liver toxicity after treatment. Only V _ (25) is its independent influencing factor (P _ (0.05) n 路V _ s _ 25) for predicting the area under the R0C curve of liver radiation tolerance dose is 0.775g ~ (-1) CI: 0.672 ~ (0.878). According to the maximum tangent point of Youden index, the best threshold is determined to be 31.5 ~ (th). Conclusion V25 is the main influencing factor of hepatic toxicity after radiosurgery in patients with liver cancer. W can be used as an effective dosimetric parameter to evaluate the risk of liver injury after radiosurgery.
【学位授予单位】：广西医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R735.7

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