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射波刀治疗复发性肝癌患者的效果及预后分析
Effect of CyberKnife radiosurgery on survival rate of patients with recurrent liver cancer after surgery
文章发布日期:2017年11月07日  来源:  作者:李 欢,孙 静,张 弢,等  点击次数:1797次  下载次数:357次

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【摘要】:目的分析射波刀立体定向放射治疗切除术后、消融术后复发性肝癌的效果和影响生存率的相关因素。方法对2011年1月-2014年1月于中国人民解放军三○二医院行射波刀治疗的34例术后复发性肝癌患者进行回顾性分析,计算患者放疗后的生存率和生存时间,分析影响其生存的相关因素。肿瘤靶区(GTV)为1.475~1082.075 cm3,中位值162.99 cm3,分割剂量7~20 Gy/次(中位值9 Gy),照射次数2~8次(中位值5次),肿瘤剂量24~60 Gy(中位值45 Gy),每日照射1次。主要观察指标为近期疗效、毒副作用、远期疗效。Log-rank检验分析生存相关影响因素,计数资料组间比较采用χ2检验和Fisher精确检验。结果放疗后患者1、2、3年总体生存率分别为91.2%、70.6%和44.1%,中位生存期34个月。1、2、3年的无进展生存率分别为55.9%、38.2%、29.4%。术后≤1年(早期)及>1年(晚期)复发组经放疗后1、2、3年总体生存率分别为89%、73.7%、57.9%和93%、73.3%、33.3%,组间比较差异无统计学意义(χ2=0.354,P=0.368)。单因素分析结果显示,性别、年龄、术后复发时间、复发灶直径、数目、肝功能分级、AFP水平、有无合并化疗等因素与放疗后患者生存期无明显相关性(P值均>0.05)。结论射波刀治疗复发性肝癌是安全有效的,肝癌局部控制率好,患者总生存率较高,且治疗几乎无创伤性,副作用小,患者易耐受,为原发性肝癌肝内复发提供了新的治疗方向。
【Abstract】:ObjectiveTo investigate the clinical effect of CyberKnife radiosurgery, a type of stereotactic body radiotherapy, in the treatment of recurrent liver cancer after resection or ablation, as well as the effect of clinical factors on survival rate. MethodsA retrospective analysis was performed for the clinical data of 34 patients with recurrent liver cancer after surgery who were treated with CyberKnife radiosurgery. The patients′ survival rate and survival time after radiotherapy were calculated, and the influencing factors for survival were analyzed. The gross tumor volume of tumor target was 1.475-1082.075 cm3 (median 162.99 cm3). The fraction dose was 7-20 Gy (median 9 Gy), the number of times of irradiation was 2-8 times (median 5 times), and the tumor dose was 24-60 Gy (median 45 Gy) once a day. The major indices for observation were short-term outcome, toxic and side effects, and long-term outcome. The log-rank test was used to analyze the surviral-related factors. The chi-square test and fisher test were used for comparison of categorical data between groups. Results The 1-, 2-, and 3-year overall survival rates after radiotherapy were 91.2%, 70.6%, and 44.1%, respectively, and the median survival time was 34 months. The 1-, 2-, and 3-year progression-free survival rates were 55.9%, 38.2%, and 29.4%, respectively. There were no significant differences in 1-, 2-, and 3-year overall survival rates after radiotherapy between the ≤1-year (early) postoperative group and the >1-year (late) postoperative group (89%/737%/57.9% vs 93%/73.3%/33.3%, χ2=0354, P=0368). The univariate analyses showed that sex, age, time to postoperative recurrence, diameter and number of recurrent lesions, liver function classification, alpha-fetoprotein level, and chemotherapy were not significantly associated with patients' survival after radiotherapy. ConclusionCyberKnife radiosurgery is safe and effective in the treatment of recurrent liver cancer, with the advantages of good local control of liver cancer, a high overall survival rate, noninvasiveness, few side effects, and good tolerability, and thus provides a new direction for the treatment of intrahepatic recurrence of primary liver cancer.
【关键字】:肝肿瘤;复发;放射外科手术;存活率分析
【Key words】:liver neoplasms;recurrence;radiosurgery;survival analysis
【引证本文】:LI H, SUN J, ZHANG T, et al. Effect of CyberKnife radiosurgery on survival rate of patients with recurrent liver cancer after surgery[J]. J Clin Hepatol, 2017, 33(12): 2337-2341. (in Chinese)
李欢,孙静,张弢,等. 射波刀治疗复发性肝癌患者的效果及预后分析[J]. 临床肝胆病杂志, 2017, 33(12): 2337-2341.

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