首页|三维适形放疗治疗原发性肝癌患者疗效及发生放射性肝损伤影响因素分析

三维适形放疗治疗原发性肝癌患者疗效及发生放射性肝损伤影响因素分析

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目的 分析采用三维适形放疗(3DCRT)治疗原发性肝癌(PLC)患者的疗效和放射性肝损伤(RILI)发生的影响因素。方法 2019 年4 月~2022 年4 月我院诊治的PLC患者85 例,均接受3DCRT治疗。按照实体瘤疗效评价标准考核疗效,根据报道的标准诊断RILI。应用Logistic回归模型分析影响PLC患者接受3D-CRT治疗疗效和RILI发生的因素。结果 经3D-CRT治疗,本组获得客观缓解 50 例(58。8%);客观缓解组TNM Ⅳ期和Child-Pugh B级占比分别为36。0%和14。0%,均显著低于非客观缓解组的60。0%和48。6%(P<0。05),而单次剂量为3~4Gy和总剂量为50~60 Gy占比分别为52。0%和68。0%,均显著高于非客观缓解组的28。6%和45。7%(P<0。05);本组发生RILI者15 例(17。7%);RILI组TNM Ⅳ期和Child-Pugh B级、单次剂量为 3~4Gy和总剂量 50~60 Gy占比分别为 80。0%、93。0%、73。3%和86。7%,均显著高于无RILI组(分别为38。6%、14。3%、35。7%和52。9%,P<0。05);多因素Logistic回归分析发现,TNM分期、Child-Pugh分级、单次剂量和总剂量均为影响 3DCRT 治疗的疗效和发生 RILI 的因素(OR=5。078、4。988、4。600、4。850、4。963、5。043、5。150、4。740,P<0。05)。结论 PLC患者接受3DCRT治疗的疗效和RILI的发生受TNM分期、Child-Pugh分级、单次剂量和总剂量的影响,临床在制定放疗计划时,要充分考虑以上敏感因素,以保证提高疗效并显著降低RILI的发生。
Short-term efficacy of three-dimensional conformal radiotherapy in patients with primary liver cancer
Objective The aim of this study was to investigate the short-term efficacy of three-dimensional conformal radiotherapy(3DCRT)in patients with primary liver cancer(PLC)and to analyze the influencing factors for radiation-induced liver injury(RILI)occurrence.Methods 85 patients with PLC were encountered in our hospital between April 2019 and April 2022,and all received 3DCRT therapy.The short-term efficacy was evaluated by RECIST,and the RILI was diagnosed based on liver function tests.The multivariate Logistic regression analysis was applied to reveal the factors impacting the efficacy and the occurrence of RILI.Results After the 3D-CRT treatment,the objective remission rate(ORR)was 58.8%in our series;the percentages of TNM stage Ⅳ and Child-Pugh class B in 50 patients with objective remission were 36.0%and 14.0%,both significantly lower than 60.0%and 48.6%(P<0.05),while the percentages of single dose of 3-4 Gy and total dose of 50-60 Gy were 52.0%and 68.0%,both significantly higher than 28.6%and 45.7%(P<0.05)in those without objective remission;the prevalence of RILI was 17.7%during the 3D-CRT therapy;the percentages of TNM stageⅣ,Child-Pugh class B,single dose of 3-4 Gy and total dose of 50-60 Gy in15 patients with RILI were80.0%,93.0%,73.3%and 86.7%,all significantly higher than 38.6%,14.3%,35.7%and 52.9%(P<0.05)in 70 patients without RILI;the multivariate Logistic regression analysis showed that the TNM stage,Child-Pugh classification,single dose and total dose were all the independent risk factors impacting the efficacy and the occurrence of RILI(OR = 5.078,4.988,4.600,4.850,4.963,5.043,5.150,4.740,respectively,P<0.05).Conclusion The efficacy of 3DCRT treatment in patients with PLC and the occurrence of RILI are influenced by TNM staging,Child-Pugh class,single dose and total dose,so the clinicians should fully consider the above sensitive factors when making the radiotherapy plans to ensure the improved efficacy and less incidence of RILI.

HepatomaThree-dimensional conformal radiotherapyRadiation-induced liver injuryTherapyImpacting factors

包天舒、杜野牧、姚善文、冯鹤云

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223300 江苏省淮安市南京医科大学附属淮安第一医院介入放射科

223300 江苏省淮安市南京医科大学附属淮安第一医院肝胆胰外科

223300 江苏省淮安市南京医科大学附属淮安第一医院影像中心

原发性肝癌 三维适形放疗 放射性肝损伤 治疗 影响因素

江苏省自然科学基金面上项目

BK20191492

2024

实用肝脏病杂志
中华医学会安徽分会

实用肝脏病杂志

CSTPCD
影响因子:1.362
ISSN:1672-5069
年,卷(期):2024.27(1)
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