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目的 分析比较Ⅱ期不能手术的原发性肝癌施行超分割放射治疗辅以肝动脉插管化疗、肝动脉结扎 (A组 6 5例 )与常规分割放射治疗辅以肝动脉插管化疗、肝动脉结扎 (B组 6 5例 )的疗效。方法 全组 130例均经剖腹探查判定不能手术。分期为Ⅱ期 ,且经病理学诊断。分组系根据探查时间顺序采用单、双号的原则。 2个组均先化疗后放射 ,且 6d/周化疗 ,3d/周超分割或 5d/周常规分割放射治疗交替夹心。肝动脉化疗采用顺铂 10mg滴注。放射治疗采用 6～ 8MVX射线或60 Coγ射线 ,超分割采用 2 5 0cGy/次 ,2次 /d。结果 A组的甲胎蛋白定量下降一半者占 89.7% (35 / 39) ,B组占6 7.6 % (2 5 / 37)。A组 1、3、5生存率为 90 .8%、6 3.1%、2 3.1% ,B组分别为 73.9%、4 1.5 %、9.2 % ,A组高于B组 (P <0 .0 5 )。A组的PR率、Ⅱ步手术切除占总例数的比例分别为 90 .8%、35 .4 % ,B组分别为 70 .8%、12 .3% ,A组高于B组 (P <0 .0 1)。两组主要不良反应相近 (P >0 .0 5 )。结论 超分割放射治疗辅以肝动脉插管化疗、肝动脉结扎 ,系治疗不能手术肝癌有效、合理的治疗方案。该方案能有效地减轻症状、缩小瘤体、提高手术切除率、延长生存期 ,且操作较为简单易行。
Objective To compare and contrast the treatment of primary hepatocellular carcinoma with unresectable stage II with hyperfractionated radiotherapy plus hepatic artery catheterization and hepatic artery ligation (group A, 65 cases) with routine fractionated radiotherapy plus hepatic arterial catheterization and chemotherapy Ligation (B group 65 cases) curative effect. Methods All 130 cases were diagnosed by laparotomy can not be operated. Stage Ⅱ, and pathological diagnosis. Grouping is based on the probing order of time using single and double number principle. Radiotherapy was performed in both groups before chemotherapy, with 6 days / week of chemotherapy, 3d / week of superfractionation or 5 days / week of conventional fractionated radiotherapy. Hepatic artery chemotherapy with cisplatin 10mg infusion. Radiotherapy using 6 ~ 8MVX rays or 60 Co gamma rays, superfractionated with 250cGy / times, 2 times / d. Results A group of Alpha-fetoprotein decreased by half, accounting for 89.7% (35/39), B group accounted for 7.66% (25/37). The 1,3,5 survival rates in group A were 90.8%, 61.1% and 23.1% respectively, while those in group B were 73.9%, 41.5% and 9.2% respectively, and those in group A were higher than those in group B (P <0.05) ). The rate of PR in group A and the total number of resection in stage Ⅱ were 90.8% and 35.4% respectively, while those in group B were 70.8% and 12.3% respectively, and those in group A were higher than those in group B <0 .0 1). The two groups had similar adverse reactions (P> 0.05). Conclusion Ultrafractionated radiotherapy combined with hepatic arterial catheterization and ligation of the hepatic artery is an effective and rational treatment for incapable hepatocellular carcinoma. The scheme can effectively relieve the symptoms, reduce the tumor, improve the resection rate, prolong the survival period, and the operation is relatively simple and easy.