The Study Of Three-dimensional Conformal Radiation Therapy In Primary Liver Cancer

Objective:To analyse the clinical recent efficacy and forward efficacy of three-dimensional conformal radiotherapy (3DCRT) combined with other therapeutic on primary hepatocelluar carcinoma, radiotherapy cause acute and chronic injury of the liver and the analytic result of multiple factor was reached for influence on survival rate.Method:The clinical data of92patients with hepatocelluar carcinoma from November2008to March2011in Oncology of PLA105hospital were retrospectively analysed, All cases were identified as unresectable liver cancer(middle-later period) by B Ultrasound、CT、MRI and operation Pathological examination. Patients received3DCRT by Varian linear accelerator and planning system. Set2to6radiation field, single radiation dose was2Gy～4Gy,5times a week, total radiation dose was35～55Gy.26cases received interventional therapy before radiotherapy because of larger diameters,5cases received chemotherapy and oral Xeloda.5cases taking Chinese medicines in the same period,7cases were injected with absolute alcohol and P53virus into the liver tumour, short term efficacy was evaluated by the WHO standards and the level of AFP four weeks after the end of treatment, Normal tissue reaction was evaluated According to the RTOG criteria. long-term efficacy was evaluated by1and2year overall survival.Results:Followed up for2to25months, Median follow-up was21months. the results of short-term efficacy was;24CR and49PR, the total response rate was79.3%(73/92). AFP was detected three months after treatment, the rate of decrease>50%was in49cases, between10%to50%was in12cases,<10%was in18cases, and13cases was increased by different degrees. The survival rates of6months,1-and2-year was73%,42%,26%. the main toxicity and side effect was gastrointestinal reactions,21cases of grade Ⅰ and6cases of was grade Ⅱ (33.3%), all cases were cured after symptomatic treatment; the rate of leukopenia was55.6%:28cases of grade Ⅰ,16cases of grade Ⅱ,1case of grade Ⅲ;3cases had atypical radioactive liver disease after6months (acute liver radiation reaction grade3). COX regression analysis showed that the short-term effect, total dose, distant metastasis or not, clinical staging, tumor diameter, Child classification, all above indicators were relevant to surviving time(P<0.05), but irrelevant to Gender, age, hepatitis B virus infection, AFP value, single radiation dose (SD), with or without portal vein tumor thrombus, the number of lesions (single/multiple); with or without cirrhosis, T, N(P>0.05).Conclusion:our study confirmed that three-dimensional conformal radiotherapy is a useful therapy for primary liver cancer, can improve the short-term effect and prolong survival time, radiotherapy combined with other methods is worth further exploration. Objective:To investigate the clinical efficacy of three-dimensional conformal radiotherapy (3D-CRT) combined with transcatheter arterial chemoembolization (TACE) on primary liver cancer with portal vein tumor thrombus.Method:From November2008to March2011,55HCC patients with PVTT (whom confirmed by abdominal ultrasonography, AFP, liver and kidney function, CT, MRI, pathological biopsy and unresectable) were randomly divided into two groups. Group A has26patients, accepted2-3times TACE treatment2weeks after3DCRT; Group B has29patients, only received TACE treatment. There were no significant difference in AFP, tumor size, degree of liver cirrhosis, The site of portal vein tumor thrombus and Child classification. Short-term effect was evaluated according to therapeutic evaluation of solid tumor. Acute reaction of normal tissue was evaluated by RTOG criterion.Results:Patients were followed up2to25months, the follow-up rate was100.0%. After treatment. PVTT completely disappeared(CR) was7cases in group A and5cases in group B; PVTT decrease(PR) was12cases in group A and11cases in group B.;no significant change of thrombus size(SD) was5cases in group A and7cases in group B; tumour progression(PD) was2cases in group A and6cases in group B. The total response rate(CR+PR) was73.08%in group A,55.17%in group B. Declining rate of AFP≥50%was observed13cases in group A ((50%)) and11cases in group B(37.93%), There were significant differences between the two groups (P<0.05). The12-year survival rates was42.3%(11/26)、26.8%(7/26) in group A,27.6%(8/29)、13.8%(4/29) in group B. The median survival period was16.5 months in, group A(5.4to29.3months),9.8months in group B (6.3to21.7months), P<0.05. Untoward effect:there were13cases of dizziness, fatigue, anorexia,6cases of low-grade fever,5cases of gastrointestinal toxicity,2cases of aggravated liver pain;5cases of a transient increase in aminotransferase;3cases of white blood cells reduced and a cases of radiation hepatitis in group A;11cases of fever, nausea and abdominal pain,12patients had a transient increase in aminotransferase,9cases of white blood cells and platelets decreased. All the patients can endure treatment after symptomatic treatment.Conclusion:3D-CRT combined with TACE is a feasible, non-surgical treatment for HCC patients with PVTT. In the clinical, we should use comprehensive and individualized treatment, optimal ordering, explore new technology and method to improve long-term efficacy.