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目的探讨原发性肝癌(PLC)三维适形放疗(3DCRT)后放射性肝病(RILD)的影响因素,以指导PLC的3DCRT,避免和减少RILD的发生。方法采用8MVX线直线加速器对128例PLC患者进行3DCRT。肿瘤剂量38～74Gy,分割剂量4～8Gy/次,照射7～15次,3次/周,隔日1次。对性别、年龄、T分期、GTV、HBV状况、TACE、门脉癌栓、肝硬化ChildPugh分级、BED和分割剂量与RILD的发生进行统计分析。对具有完整剂量体积直方图(DVH)资料的84例进行统计以找出与RILD发生有关的剂量学因素。结果RILD19例,发生率为14.8%。T分期、GTV、门脉癌栓和肝硬化分级单因素分析与RILD有关,但只有肝硬化分级是独立预后因子(P=0.000)。全肝平均剂量与RILD的发生有关(P=0.027)。当V5、V10和V20≤81%、69%和42%且全肝平均剂量≤28Gy时RILD的发生概率<5%(P=0.029、0.044、0.029和0.043)。结论制定PLC3DCRT计划时,充分考虑患者T分期、GTV、门脉癌栓、肝硬化分级和全肝平均剂量,尤其是肝硬化ChildPugh分级,可减少RILD的发生率。
Objective To investigate the influencing factors of RILD after three dimensional conformal radiation therapy (3DCRT) of primary liver cancer (PLC) to guide the 3DCRT of PLC and avoid and reduce the occurrence of RILD. Methods Eighty-eight PLC patients underwent 3DCRT using an 8 MVX linear accelerator. Tumor dose 38 ~ 74Gy, divided doses of 4 ~ 8Gy / time, irradiation 7 to 15 times, 3 times / week, every other day. Statistical analysis of sex, age, T stage, GTV, status of HBV, TACE, portal vein tumor thrombus, Child Pugh classification of liver cirrhosis, BED and divided dose and RILD were performed. Statistics were performed on 84 patients with complete dose-volume histogram (DVH) data to find the dosimetric factors associated with the occurrence of RILD. Results 19 cases of RILD, the incidence was 14.8%. T stage, GTV, portal vein tumor thrombus and cirrhosis grade univariate analysis were associated with RILD, but only cirrhosis grade was an independent prognostic factor (P = 0.000). The average total liver dose and the occurrence of RILD (P = 0.027). The incidence of RILD was <5% (P = 0.029, 0.044, 0.029, and 0.043) with V5, V10 and V20 ≤ 81%, 69% and 42%, and the mean total liver dose ≤ 28 Gy. Conclusions In the planning of PLC3DCRT, the incidence of RILD can be reduced by fully considering T stage, GTV, portal vein tumor thrombus, cirrhosis grade and average total liver dose, especially Child Pugh classification of cirrhosis.