目的 观察肝动脉栓塞化疗(TACE)联合直线加速器或全身伽玛刀治疗不能手术的原发性肝癌(PHC)的疗效及毒副反应.方法 2005年7月至2008年6月,108例不能手术的PHC患者中50例行TACE联合直线加速器放疗(加速器组),58例行TACE联合全身伽玛刀放疗(伽玛刀组).TACE灌注化疗药物包括丝裂霉素(MMC)10～20mg、氟尿嘧啶(5-FU)1000～1500mg、表阿霉素(E-ADM)30～50mg,栓塞剂为40％超液态碘化油5～20ml.直线加速器治疗用6MV-X,95％等剂量线包绕PTV,40～60Gy/15～25f,3～5f/周；伽玛刀治疗用月亮神立体定向伽玛射线旋转聚焦全身放射治疗系统(LUNATM-260),40％～60％等剂量线包绕PTV,单次剂量3～6Gy,3～5f/周,照射总量30～50Gy.联合应用TACE为1～3个疗程.结果 加速器组及伽玛刀组的中位生存期分别为14个月和16个月,中位肿瘤进展时间(TTP)分别为7.6个月和8.1个月；2年局部控制率分别为45.4％和43.6％(X2=0.020,P=0.887),3年局部控制率分别为36.5％和37.9％(X2=0.040,P=0.841)；2年生存率分别为41.1％和39.6％(X2=0.021,P=0.885),3年生存率分别为34.3％和30.2％(X2=0.368,P=0.544).加速器组中出现1例放射诱发的肝病,伽玛刀组未见相关病例.结论 直线加速器和伽玛刀联合TACE治疗PHC均安全可靠,疗效相当.%Objective To evaluate the effects of transcatheter arterial chemoembolization (TACE) combined with radiation therapy on patients with advanced unresectable primary hepatocellular carcinoma ( PHC ). Methods From July 2005 to June 2008,108 patients with advanced unresectable PHC were divided into 2 groups. Fifty patients were treated with linear accelerator combined with TACE(accelerator group) , and 58 patients were treated with body gamma knife combined with TACE( gamma knife group). For accelerator group, 6MV-X ray was used, ≥95% isodose included PTV, and the total treatment dosage was 40-60Cy with 3-5 times per week. For gamma knife stereotaxis radiation therapy, the planning of treatment was 3-6Cy per-fraction,3-5 times per week and the total treatment dosage was 30-50Gy. For TACE, 10-20mg mitomycin, 1000-1500mg fluorouracil and 30-50mg epirubicine were perfused into the hepatic arteries, 5-20ml mioldized oil were given to emobolized the hepatic arteries,and each patient was treated with 1-3 sessions. Results For accelerator group and gamma knife group, the median survival time were 14 months and 16 months,and the median time-to-progression were 7. 6 months and 8. 1 months. The 2-year local control rates were 45.4% and 43. 6% ,and the 3-year local control rates were 36. 5% and 37. 9% respectively. There was no statistical significant difference between 2 groups(x-2 =0.020,P=0. 887;x2 =0.040,P=0.841). For accelerator group,2-and 3-year overall survival rates were 41. 1% and 39.6%, respectively. For gamma knife group,they were 34. 3% and 30. 2% .respectively. There was not significant difference in 2-and 3-year survival rates between 2 groups(x2 = 0.021, P = 0. 885 ;x2 = 0. 368, P = 0. 544 ). Accelerator group was found 1 case with radiation induced liver disease ( RILD) , while RILD in gamma knife group was not found. Conclusion The efficacy and toxieity of TACE combined with linear accelerator or gamma knife for advanced unresectable PHC were similar.
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