摘要目的 比较单纯介入肝动脉化疗栓塞(TACE)、单纯适形放射治疗(3DCRT)、TACE+3DCRT对原发性肝癌(PHC)的疗效.方法 67例PHC患者随机分为3个组,A组25例(TACE1～5次,平均3.2次),B组20例(3DCRT45～60 Gy,平均50 Gy),C组22例(TACE+3DCRT,先行TACE1～4次,平均3次,休息4～8周后3DCRT;TACE和3DCRT方法与A,B组相同).介入化疗先将氟脲嘧啶1000～1250 mg和羟基树碱20～30 mg后将顺铂60～80 mg和丝裂霉素14～20 mg(或阿霉素50～60 mg)与超液化碘油10～30 mg充分混合成乳剂缓慢注入,再用1～2 mm明胶海绵颗粒栓塞肝动脉.适形放疗采用6MV-X直线加速器治疗.结果 1、2、3年生存率A组分别为61.3%、34.0%、19.8%;B组分别为53.1%、31.3%、18.8%;C组分别为74.8%、57.0%、40.4%.C组＞A组和B组(Logrank检验,PABC、PAC、PBC＜0.05,PAB＞0.05)发症主要为发热,C组＞A组＞B组(x2检验,P＜0.01);白细胞下降,C组＞A组＞B组(t检验和方差分析,P＜0.01);肝功能不全,C组＞B组＞A组(x2检验,P＜0.01).结论 PHC疗效TACE+3DCRT优于单纯TACE和3DCRT,TACE与3DCRT相近.并发症主要是发热、白细胞下降(TACE+3DCRT＞TACE＞3DCRT)和肝功能不全(TACE+3DCRT＞3DCRT＞TACE).

abstractsObjective To compare the therapeutic effects of transcatheter hepatic chemoembolization (TACE) alone、 three dimensional conformal radiotherapy (3 DCRT) alone,and TACE + 3 DCRT.Methods 67 patients with primary hepatic cacer were randomized divided into three groups:A-25patients were treated with 1-5 times of TACE alone;B-20 patients,radiotherapy with 3DCRT 45-60 Gy average 50 Gy;Group c-22 patients,TACE plus radiotherapy,at the first time were received 1-4 times of TACE by radiotherapy,then with 3DCRT after a rest of 4-8 week.for TACE,1000-1250 mg 5-fluorouracil and 20-30 mg hydroxyeamptothecine were perfused into the hepatic arteries,then 60-80 mg cisplatin and 14-20 mg mitomycin(or 50-60 mg epirubicin)and iodized oil 10-30 ml were given to embolized the hepatic arteries which was then followed by 1-2 mm gelform spieces.For 3DCRT,radiation was given by 6MV X-ray.Results The overall survivals at 1-,2-and 3-years were 61.3% ,34.0% and 19.0%for A-group TACE alone,53.1% ,31.3% and 18.8% for B-group 3DCRT;74.8%,57.0% and 40.4% for C-group TACE + 3DCRT.The differences in the survivals are statistically significant(P ＜0.05).the main complication was fever.Conclusion Treatment result of TACE + 3DCRT is better than TACE alone or3DCRTalone.