Treatment Of Primary Hepatic Carcinoma Using Transcatheter Hepatic Arterial Chemoembolization In Combination With Body Gamma Knife

Objective To evaluate therapeutic efficacy of transcatheter arteral chemoembolization (TACE) combined with radiotherapy-body gamma knife in the treatment of hepatocellular carcinoma (HCC).Methods:Retrospectively analysis147patients of primary hepatic carcinoma in our hospital during2009～2011years. Of147patients recruited,52reat with TACE combined with Gamma kinfe and55with Gamma alone and40with TACE alone. alpha fetoprotein(AFP),hepatic function(ALT,AST),kiney function(Bun,Cr), survival time were observed.Results:Of the147patients recruited,52patients with TACE combined with Gamma kinfe and55patients with Gamma alone40with TACE alone, there was no statistically significant differences in sex, HBSAg(+) and liver function grades Child-pugh (A/B) between the two groups.(P>0.05)TACE group:Firstly, injected dexamethasone10mg for the purpose of prevent allergic reaction. Secondly,the patients in the treated group were received0.9%normal saline100ml infusion with the docetaxel60mg/m2.Thirdly, injecting mixture with the iodized oil5～20ml and5-fluorouracil250mg until blood slow or iodized oil deposit thickness.Combined therapy group:there were treated with TACE for1-3times after given radiotherapy-body gamma knife2-3weeks.Concerning short-term curative effect:the combined therapy group,9patient attained complete remission (CR) and10partial remission(PR) and33progressive disease(PD),the effective rate being37%. In TACE group,5patient attained complete remission(CR) and7partial remission(PR) and28progressive disease(PD),the effective rate being30%.In gamma knife group,8patient attained complete remission(CR) and10partial remission(PR) and27progressive disease(PD),the effective rate being32%.There was significant difference between combinde group and TACE group,gamma knife group and TACE group.(P<0.05)The survial time of combined therapy group,TACE group,gamma group was12.3±3.5months,11.4±2.5months,5.5±2.1months respectively,give asignificant difference between combined group and TACE group,gamma group and TACE group.(P<0.05)One month after treatment the patients in the three groups had arise in KPS compared with the pre-operatio.(P<0.05) In the same time,there was significant statistic difference in KPS the three groups.(P <0.05)In the three groups, the patients in AST,ALT all increase compared with the pre-operation,(P<0.05)there was no significant difference in AST,ALT and TBIL in the three groups.(P>0.05)In the three gyoups, there was no obviously change on serum creatinine(Cr) and blood urea nitrogen(BUN) compared with the pre-operatio.(P>0.05) In the TACE group, there was significant statistic on serum creatinine(Cr) compared with the pre-operation.(P<0.05)In the combined therapy group after interventional,3(5.7%) patients had nausea and1(2.5%) patients had fever.In the TACE group,9(22.3%) patients had nausea and12(29.4%) patients had fever,but for the most part in2to4days disappear. There was significant statistic difference on nausea and fever betwween the two groups.(P<0.05)The combined therapy group and the gamma kinife group radiation response rate to17.7%and23.3%. Respectively, for the performance of the white blood cells reduce,lack of energy,nausea,vomiting,symptomatic treatment by the improved after acute radiation side effects.According to RTOG standard all belong to the Ⅰ alevel Ⅱ, did not see the Ⅲ side effects. All of the patients can continue to treat to plans to end.Two groups of all did not appear pepticuccer,hemorrhage,perforated,radioactive enteritis etc radiation.Conclusions:1. TACE+Gamma kinife combination treatment of primary liver cance treatment has obvioas curative effect and it's advantage to TACE the inhibition of liver cells and kill the voce.2. TACE+Gamma kinife combination treatments treatment of primary liver cancer is TACE group and Gamma kinife can better to improve the patient group of living quality of recent,which to certain extent extend a patient's survival. Is a safe,effective and complionds do not increase the effective teeatment methods and further researd and promotion.3. TACE+Gamma kinife combination treatments treatment of primary liver cancer is TACE group and Gamma kinife to the gastrointestinal tyact and kidney damage of more small and patients had high safety t lerance.