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Hyperfractionated Three-dimensional Conformal Radiotherapy for Small Hepatocellular Carcinoma：A Pilot Study
小型肝癌之多分次三度空間順形放射治療：前導研究
摘要
本研究之目的為評估多分次三度空間順形放射治療對小型肝癌的治療成效。 此回溯性研究乃針對從1999年10月至2000年12月，39位實行多分次三度空間順形放射治療之小型肝癌（腫瘤小於5公分）病患。病患平均年齡為59.79±10.45歲(從35至80歲)，平均追蹤日數為511.67±104.81天(從307至812天)。多分次三度空間順形放射治療利用6至10百萬伏特光子射線，以每次1.5戈雷，每天2次，每週5天，總劑量45至75戈雷之方式施行。平均治療體積為137.22±76.40毫升（從26.93至334.06毫升）。 180天、360天和720天之累積存活率分別為100.0%、97.44%和62.64%。整體中位存活時間為495天。急性放射副作用，包括：10位病患白血球降低（25.6%）、9位病患肝功能檢查上升（23.1%）、3位病患為發燒（7.7%）和13位病患有腸胃反應。三位病患（2位放射線引起之腸炎、1位上消化道出血）發生晚期副作用。 我們的經驗指出對即使已接受其他方式治療，其肝功能仍屬正常之小型肝癌病患，多分次三度空間順形放射治療是安全有效之治療模式。初步資料顯示當併用其他療法時，研究三度空間順形放射治療於治療效果上所扮演的潛在角色是極具價值且有成功的希望。
並列摘要
The purpose of this study is to evaluate the therapeutic results of small hepatocellular carcinoma (HCC) treated with hyperfractionated three-dimensional conformal radiotherapy (3-D conformal RT). This retrospective study was to review 39 small HCC (tumor ≤ 5cm in size) patients who had been treated with hyperfractionated 3-D conformal RT from October 1999 to December 2000. The mean age was 59.79 ± 10.45years old (range 35-80 years old). Patients had the mean follow-up period of 511.67 ± 104.81 days (range 307-812 days). Hyperfractionated 3-D conformal RT was delivered using 6 or 10MV photons at 1.5Gy per fraction, twice a day on 5days of the week for a total dose of 45-75Gy. The mean treatment volume was 137.22 ± 76.40ml (ranged 26.93-334.06 ml). The cumulative survival rates were 100.0% for 180days, 97.44% for 360 days and 62.64% for 720days, respectively. The overall median survival time was 495days. Acute radiation toxicity included 10 patients (25.6%) leukopenia, 9 patients (23.1 %) had elevation in liver function tests, 3 patients (7.7%) had fever and 13 patients (33.3%) complained GI toxicity. Late complications were occurred in 3 patients (2 RT enteritis, 1 UGI bleeding). Our experience concludes that hyperfractionated 3-D conformal RT may be a safe, effective treatment modality in small HCC patients with preserved liver function even if they have already been treated with other therapies. The preliminary data shows quite promising and is valuable to study the potential role of 3-D conformal RT in strengthening the therapeutic efficacy when combined with other therapy.
延伸閱讀
- Huang, Y. J., Leung, S. W., Wang, C. J., Sun, L. M., Yeh, S. A., Huang, E. Y., Chen, H. C., Fang, F. M., Hsiung, C. Y., & Hsu, H. C. (2001). 以三度空間順形放射治療門靜脈栓塞為肝癌合併門靜脈栓塞之初始治療方法：對於無法接受其他治療但完成放射治療病人之預後因子與結果. 放射治療與腫瘤學, 8(1), 1-14. https://doi.org/10.6316/TRO/200108(1)1
- Wang, P. M., Hsu, W. C., Chan, S. C., Chung, N. N., Ting, L. L., Ying, K. S., Chao, C. J., & Lin, G. D. (2003). 三度空間順形放射治療及thalidomide對晚期肝癌之初步成果. 放射治療與腫瘤學, 10(4), 209-218. https://doi.org/10.6316/TRO/200310(4)209
- Lin, J. C., Jen, Y. M., Huang, W. Y., Chen, C. M., Chao, H. L., Lin, C. S., Su, Y. F., Lin, K. T., 范兆岳, Nien, W. Y., & Lin, M. J. (2012). 針對無法切除或復發的肝癌病患比較立體定位放射治療及三度空間順形放射治療. 放射治療與腫瘤學, 19(2), 105-117. https://doi.org/10.6316/TRO/201219(2)105
- Liu, C. R., Lin, C. L., Liao, L. Y., Tu, H. Y., Hung, C. F., Wang, C. S., & Leu, J. D. (2003). 以三度空間順形放射治療的方式治療廣泛性肝癌合併肝門靜脈腫瘤栓塞. 放射治療與腫瘤學, 10(2), 69-78. https://doi.org/10.6316/TRO/200310(2)69
- Hsu, W. C., Wang, P. M., Ying, K. S., Chao, C. J., Huang, J. C., & Lin, G. D. (2002). 三度空間順形放射治療對肝癌合併肝門靜脈栓塞之初步成果. 中華放射線醫學雜誌, 27(2), 59-66. https://www.airitilibrary.com/Article/Detail?DocID=10188940-200204-27-2-59-66-a