体部伽玛刀治疗原发性肝癌的临床疗效和不良反应

发布时间：2018-10-05 19:33

【摘要】：目的:收集行体部伽玛刀治疗原发性肝癌患者的临床资料,分析其治疗方案及近期疗效,为原发性肝癌患者的临床治疗提供参考依据。方法:选择633例无法行手术治疗的原发性肝癌患者行伽玛刀治疗,按照国际抗癌联盟(UICC)公布的TNM分期方法,有明确TNM分期的患者351例,其中T3期患者251例(71.5%,251/351),T4期患者57例(16.2%,57/351)。每次分割剂量为200~600cGy,照射次数为2~13次,每日或隔日照射,每周5次,40%~85%等剂量曲线覆盖计划靶区(PTV)。治疗结束后2~3个月45例患者行影像学及肿瘤标志物等复查,观察肿瘤直径变化情况,评价其近期疗效。结果:伽玛刀治疗期间,229例(36.2%)患者发生了不良反应,100例(15.8%)患者出现白细胞降低,137例(21.6%)患者出现血小板降低。出院时601例患者病情好转,22例无明显变化,5例病情加重,5例死亡。接受累积剂量为3 000cGy~和3 500cGy~组患者症状好转比例均高于累积剂量3 000cGy组(P0.05)。45例出院患者随访,2~3个月的部分缓解(PR)患者占80%(36/45),稳定(SD)患者占20%(9/45),总有效率为80%(36/45)。不同肿瘤直径、单次剂量和累积剂量组有效率比较差异无统计学意义(P0.05)。结论:体部伽玛刀治疗原发性肝癌患者不良反应发生的比例较低,近期有效率较为理想;体部伽玛刀治疗原发性肝癌患者是一种安全有效的治疗方法。
[Abstract]:Objective: to collect the clinical data of patients with primary liver cancer treated with body gamma knife, and to analyze its treatment scheme and short-term curative effect, and to provide reference for clinical treatment of patients with primary liver cancer. Methods: a total of 633 patients with primary liver cancer who could not be treated by operation were treated with gamma knife. According to the TNM staging method published by (UICC), 351 patients with definite TNM staging were selected, among whom 251 patients with T3 stage (71.5 / 251 / 351) and 57 patients with T4 stage (16.2 / 351). Each partition dose is 200,600cGy, the radiation frequency is 2t 13 times, daily or every other day, 5 times a week, 40% 85% isodose curve covers the planned target area (PTV). From 2 to 3 months after treatment, 45 patients were examined with imaging and tumor markers to observe the change of tumor diameter and evaluate the short-term curative effect. Results: during the period of gamma knife therapy, 229 (36.2%) patients had adverse reactions, 100 (15.8%) patients had leukopenia and 137 (21.6%) patients had thrombocytopenia. At the time of discharge, 601 patients had improved and 22 patients had no obvious change. 5 cases had aggravation and 5 cases died. The rate of symptom improvement in the cumulative dose of 3 000 cGy ~ and 3 500 cGy ~ was higher than that in the cumulative dose 3 000cGy group (P0.05) .45 patients who were followed up for 2 ~ 3 months accounted for 80% (36 / 45) of partial remission (PR) and 20% (9 / 45) of stable (SD). The total effective rate was 80% (36 / 45). There was no significant difference in effective rate between different tumor diameter, single dose and cumulative dose group (P0.05). Conclusion: the rate of adverse reactions in patients with primary liver cancer treated by body gamma knife is low, and the short-term effective rate is ideal, which is a safe and effective treatment method for patients with primary liver cancer.
【作者单位】：吉林大学公共卫生学院流行病与卫生统计学教研室;武警上海市总队医院肿瘤放射诊疗中心;广东省深圳市海博科技有限公司;西藏自治区昌都惠恒发展有限公司;
【基金】：吉林省卫计委科研基金资助课题(20165044)
【分类号】：R735.7

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