或下腔静脉癌栓临床观察-论文.pdf

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1、·1130·杨远游，等伽马刀治疗3l例原发性肝癌门脉和／或下腔静脉癌栓临床观察伽马刀治疗31例原发性肝癌门脉和／或下腔静脉癌栓临床观察杨远游，程海明，穆晓峰，宁健Gamma—-knifetreatmenton31patientswithprimarylivercancerwithpoMaland／orin-feriorvenacavafumorfhrombusYangYuanyou，ChengHaiming，MuXiaofeng，NingJianCancerRadiotherapyCenter，ArmedPoliceGeneralHospital，Beijing100039，Chin

2、a．【Abstract】0bjective：ToanalyzetheeffectivenessandprognosticfactorofGamma—knifetreatmentonprimarylivercancerportalveinand／orinferiorvenacavatumorthrombus．Methods：2006to2012inourhospital31casesofprimarylivercancerportalveinthrombosisand／orinferiorvenacavatumorthrombuspatientsweretreatedbysuperGa

3、mma—knifetoperformstereotacticradiotherapy．Prescriptiondoseto40％一60％isodoseline．A44Gytotalmedi—andose(rang：32—52Gy)wereprescribedtothe40％一60％isodoselineandin8—13fractionof3．5—5Gyeachforclinicaltargetvolume．Theclinicaltargetvolumeincludedtumorthrombuswithorwithouttheprimarylesionofliv—er．Attheen

4、doftreatment，bloodcount，bloodchemistry，tumormarkersandimaging(CTorMRI)weretestedevery1—3monthslater．Follow—uptimewas4—50monthswiththemedianfollow—uptimeof12months．follow—upre—viewtotheendofJune2013．Results：Oversurvivalperiodwas4—50monthswithamediansurvivalof12months，1一yearsurvivalratewas58．1％，2

5、一yearsurvivalrate9．7％．Tumorthrombusresponserates(CR+PR)83．9％，CR15cases(48．4％)，PR11cases(35．5％)，SD4cases(12．9％)，PD1case(3．2％)．Kanplan—meierUnivariatea—nalysisshowedthatthedifferenceofsurvivalintumorthrombussite(P=0．039)andprescriptiondose(P=0．009)weresignificative(groupofIVCwasbetterthangroupofP

6、V_rr，groupof>44Gywasbetterthangroupof≤44Gy)．COXmultivariateanalysisshowedthatprescriptiondosewassignificativeprognosticfactor(P=0．015)．Conclusion：Gamma—knifetreatmentonprimarylivercancerwithportaland／orinferiorvenacavatumorthrombusissafeandef-fectivewithmildtoxicityandfewercomplications，anditca

7、nprolongsurvival，Gamma—knifeisoneoftheoptionalwaysofprimarylivercancerwithportaL／inferiorvenacavatumorthrombustreatment．Prescriptiondoseissignificativeprognosticfactor．【Keywords】primarylivercancer；portalvein／inferiorvenacavatumort