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目的评价大分割三维适形放射治疗(3DCRT)对原发性肝癌的疗效,探讨其预后影响因素。方法对128例原发性肝癌进行大分割3DCRT。按UICC/AJCC分期,T3期83例,T4期45例,均为N0。合并有门脉癌栓(PVTT)34例,无PVTT94例。根据肝硬化Child-Pugh分级,A级108例,B级20例。大体肿瘤体积(GTV)为(458.92±429.8)cm3,中位值304.5cm3;每次分割剂量4~8Gy,照射次数7~15次;肿瘤剂量38~74Gy,每周3次,隔日一次。结果7例患者大分割3DCRT后3个月内死亡,诊断为放射性肝病,未能评价疗效。总有效(CR+PR)率为55.4%(67/121),1,2,3年生存率分别为65.0%、43.3%和33.1%。T分期、GTV、PVTT和Child-Pugh分级对预后的影响有统计学意义(P均<0.01),GTV和Child-Pugh分级是独立的预后因子(P=0.044和0.015,RR=1.001和2.528)。结论UICC/AJCCT分期和PVTT对肝癌大分割3DCRT的生存率有影响,GTV和Child-Pugh分级是独立预后因子。
Objective To evaluate the curative effect of 3DCRT on primary hepatocellular carcinoma (HCC) and to explore the prognostic factors. Methods 128 patients with primary liver cancer were divided 3DCRT. According to the UICC / AJCC staging, 83 cases were in stage T3 and 45 cases were in stage T4, all of them were N0. Thirty-four patients with portal vein tumor thrombus (PVTT) and 94 without PVTT were included. According to Child-Pugh classification of liver cirrhosis, A-class 108 cases, B-class 20 cases. The gross tumor volume (GTV) was (458.92 ± 429.8) cm3, the median was 304.5 cm3; the dose was 4 ~ 8 Gy each time, the number of irradiation was 7-15 times; the dose of tumor was 38-74 Gy, three times a week, every other day. Results Seven patients died within 3 months after segmentation of 3DCRT. Radiological liver disease was diagnosed. The curative effect was not evaluated. The total effective (CR + PR) rate was 55.4% (67/121), and the 1, 2, 3-year survival rates were 65.0%, 43.3% and 33.1%, respectively. T stage, GTV, PVTT and Child-Pugh classification had statistical significance (P <0.01), GTV and Child-Pugh classification were independent prognostic factors (P = 0.044 and 0.015, RR = 1.001 and 2.528) . Conclusions UICC / AJCCT staging and PVTT have an impact on the survival rate of 3DCRT in liver cancer. GTV and Child-Pugh classification are independent prognostic factors.