| 赵雨婷,王洪智,董德左,朱向高,高嵩,朱旭,王维虎.放疗联合动脉化疗栓塞及酪氨酸激酶抑制剂治疗肝癌合并瘤栓的长期结果[J].中华放射医学与防护杂志,2022,42(8):577-583 |
| 放疗联合动脉化疗栓塞及酪氨酸激酶抑制剂治疗肝癌合并瘤栓的长期结果 |
| Long-term follow-up results of radiotherapy combined with transcatheter arterial chemoembolization and tyrosine kinase inhibitor in patients with hepatocellular carcinoma showing macrovascular invasion |
| 投稿时间：2022-04-30 |
| DOI：10.3760/cma.j.cn112271-20220430-00184 |
| 中文关键词: 肝细胞性肝癌 静脉瘤栓 调强放疗 动脉化疗栓塞 酪氨酸激酶抑制剂 |
| 英文关键词:Hepatocellular carcinoma Macrovascular invasion Intensity-modulated radiotherapy Transcatheter arterial chemoembolization Tyrosine kinase inhibitor |
| 基金项目:国家自然科学基金（82073333） |
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| 中文摘要: |
| 目的 探讨调强放疗联合动脉化疗栓塞及酪氨酸激酶抑制剂（tyrosine kinase inhibitor，TKI）治疗肝细胞性肝癌合并静脉瘤栓患者的长期随访结果。方法 回顾性分析2015年10月至2018年10月北京大学肿瘤医院收治的63例肝细胞性肝癌合并静脉瘤栓且无远处转移患者，其中28例接受调强放疗联合动脉化疗栓塞及索拉非尼（A组），35例接受调强放疗联合动脉化疗栓塞（B组）。采用倾向评分配比法，分析联合与不联合索拉非尼组的治疗疗效。结果 中位随访时间62个月。A组和B组的中位生存时间分别为19.0和15.2个月（χ2=3.15，P=0.076），A组的中位无进展生存时间为10.7个月，高于B组的8.6个月（χ2=3.99，P=0.046）。经过倾向评分配比平衡组间差异后，A组的中位生存时间为30.6个月，明显高于B组的15.2个月（χ2=5.34，P=0.023）；A组的中位无进展生存时间12.5个月，仍然高于B组的8.3个月（χ2=4.79，P=0.026）。全组10例（15.9%）患者治疗中出现3级血液学毒性，7例（11.1%）患者出现3级肝功能异常。A组较B组的皮肤反应、手足综合征和腹泻发生率高，但均为1~2级不良反应。全组无4级不良反应，无放射诱发肝病及治疗相关死亡发生。结论 长期随访结果显示，肝细胞性肝癌合并静脉瘤栓患者在调强放疗加动脉化疗栓塞的基础上联合TKI提高了疗效。 |
| 英文摘要: |
| Objective To assess the long-term follow-up results of intensity-modulated radiotherapy (IMRT) combined with transcatheter arterial chemoembolization (TACE) and tyrosine kinase inhibitor (TKI) in patients with hepatocellular carcinoma (HCC) showing macrovascular invasion (MVI).Methods A retrospective analysis was conducted for 63 patients with HCC showing MVI without distant metastasis treated in Peking University Cancer Hospital from October 2015 to October 2018. Among them 28 patients were treated with IMRT combined with TACE and sorafenib (Group A) and 35 patients were treated with IMRT combined with TACE (Group B). Propensity score matching (PSM) was applied to assess the progression-free survival (PFS) and the overall survival (OS) of both groups.Results The median follow-up time was 62 months. Before PSM, the median OS of group A and B were 19.0 months and 15.2 months (χ2=3.15, P=0.076), respectively, and the median PFS of groups A (10.7 months) was longer than that of group B (8.6 months;χ2=3.99, P=0.046). After PSM, the median OS of group A (30.6 months) was significantly longer than that of group B (15.2 months;χ2=5.34, P=0.023), and the PFS of groups A (12.5 months) was still longer than that of group B (8.3 months; χ2=4.79, P=0.026). In the whole group, 10 patients (15.9%) suffered from grade-3 hematologic toxicity, and seven patients (11.1%) experienced grade-3 hepatic toxicity. The incidence of skin reactions, hand-foot syndrome, and diarrhea in group A was higher than that in group B, but all these adverse events were grade 1-2. Moreover, no grade-4 adverse events, radiation-induced liver disease, and treatment-related mortality occurred in both groups.Conclusions As demonstrated by the long-term follow-up result, IMRT combined with TACE and TKI could improve both the PFS and the OS of patients with HCC showing MVI after PSM. |
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