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目的评价三维适形放射治疗结合经皮肝动脉化疗栓塞治疗肝细胞癌伴门静脉癌栓的疗效。方法对36例不能手术切除的肝细胞癌伴门静脉癌栓患者,采用三维适形放射治疗结合经皮肝动脉化疗栓塞进行治疗,放射治疗采用常规分割,总量介于36~60 Gy之间,观察近期疗效,用Kaplan-Meier法进行生存分析。结果肿瘤缓解率为47.2%,1,2,3年累积生存率分别是55.5%、38.9%和22.2%,中位生存期11.2个月。放射性肝炎是最常见的并发症。结论介入治疗联合三维适形放疗治疗肝细胞癌伴门静脉癌栓有较好的疗效。对何种治疗剂量较为合适以及治疗方法先后顺序的选择,还需进一步探讨。
Objective To evaluate the efficacy of three-dimensional conformal radiotherapy combined with percutaneous transhepatic arterial chemoembolization in the treatment of hepatocellular carcinoma with portal vein tumor thrombus. Methods Thirty-six patients with unresectable hepatocellular carcinoma and portal vein tumor thrombus were treated with three-dimensional conformal radiotherapy and percutaneous transhepatic arterial chemoembolization. Radiotherapy was performed by conventional method and the total volume was between 36 and 60 Gy. Short-term efficacy was observed and Kaplan-Meier survival analysis was performed. Results The tumor remission rate was 47.2%. The cumulative survival rates at 1, 2 and 3 years were 55.5%, 38.9% and 22.2%, respectively. The median survival time was 11.2 months. Hepatitis B is the most common complication. Conclusion Interventional therapy combined with three-dimensional conformal radiotherapy for hepatocellular carcinoma with portal vein tumor thrombus has a good curative effect. What kind of treatment dose is more appropriate and the choice of the order of treatment needs further study.