Preliminary Results of Three-Dimensional Conformal Radiotherapy and Thalidomide for Advanced Hepatocellular Carcinoma

三度空間順形放射治療及thalidomide對晚期肝癌之初步成果

王博民(Po-Ming Wang) ； 許維中(Wei-Chung Hsu) ； 詹淑卿(Sue-Ching Chan) ； 鍾娜娜(Na-Na Chung) ； 丁禮莉(Lai-Lei Ting) ； 英恭史(Kung-Shih Ying) ； 趙哲仁(Che-Jen Chao) ； 林高德(Gau-De Lin)

《放射治療與腫瘤學》 10卷4期 (2003/12) Pp. 209-218

https://doi.org/10.6316/TRO/200310(4)209

摘要

背景：本文目的欲以評估三度空間順形放射治療及thalidomide對晚期肝癌之反應與治療成效。
材料與方法：從1999年10月至2002年9月，33位晚期肝癌病患施行三度空間順形放射治療及thalidomide治療。病患平均年齡為61.36歲（36至80歲）。三度空間順形放射治療利用6或 10百萬伏特光子射線，以每週5天，每天2次，每次1.5 Gy之方式施行，總劑量為45至75 Gy。平均治療體積369.59毫升（32.54至2094.82毫升）。Thalidomide的治療劑量：每天200 毫克，25人；300毫克，5人； 400毫克，3人。
結果：有64%病患（21/33；1完全反應，20部分反應）對放射治療範圍內有反應，有12.1%病患（4/33；4部分反應）對非放射治療病灶有反應。如果將治療療效以不同腫瘤型態區分，復發性腫瘤、巨大腫瘤、肝癌合併轉移病灶及多發性病灶對三度空間順形放射治療範圍內的反應分別為80.0%（8/10；1完全反應，7部分反應）、71.4%（5/7；5部分反應）、61.5%（8/13；8部分反應）和0%（0/3；2病情穩定、1病情進展）（p = 0.234）。復發性腫瘤、巨大腫瘤、肝癌合併轉移病灶及多發性病灶對非放射治療病灶的反應分別為10.0%（1/10；1部分反應）、14.3%（1/7；1部分反應）、15.4%（2/13；2部分反應）和0%（0/3；所有均為病情進展）（p = 0.778）。平均及中位存活日數分別為327及242天。治療後副作用，包括：便秘（26/33，78.8%）、困倦及嗜睡（15/33，45.5%）、皮疹（11/33，33.3%）、下肢水腫（20/33，60.6%）、周邊神經病變（2/33，6.1%）、眩暈（1/33，3.0%）起立性低血壓（1/33，3.0%）、白血球降低（5/33，15.2%）、暫時性肝功能障礙（9/33，27.3%）和上腹痛（8/33，24.2%）。
結論：我們的經驗指出對腫瘤無法切除之肝癌病患，三度空間順形放射治療合併thalidomide治療是安全有效之治療模式。初步資料顯示研究三度空間順形放射治療合併thalidomide治療在不同期別之肝癌的治療策略所扮演的角色是極具價值且有成功的希望。

關鍵字

順形放射治療 ； 肝癌

並列摘要

Purpose : The purpose of this study was to evaluate the response and therapeutic results of advanced hepatocellular carcinoma (HCC) treated with three-dimensional conformal radiotherapy (3D-CRT) and thalidomide.
Materials and Methods : From October 1999 to September 2002, thirty-three advanced HCC patients who had been treated with 3D-CRT and thalidomide were reviewed. The mean age was 61.36 years old (range: 36-80 years old). Three-dimensional CRT was delivered at 1.5 Gy per fraction using 6 or 10 MV photons, twice a day and 5 days a week for a total dose of 45- 75 Gy. The mean treatment volume was 369.59 ml (range: 32.54-2094.82 ml). The dosage of thalidomide was 200 mg/day in 25 patients, 300 mg/day in 5 patients, and 400 mg/day in 3 patients.
Results : Sixty-four percent [21/33; 1 complete response (CR), 20 partial response (PR)] of patients responded in 淯T field?and 12.1% (4/33; 4 PR) of patients responded in 烋on-irradiated lesion? When therapeutic outcome was determined by the different tumor patterns, the responses of 淯T field?for the recurrent tumor, huge mass, HCC with metastatic lesions and multiple lesions were 80.0% (8/10; 1 CR, 7 PR), 71.4% (5/7; 5 PR), 61.5% (8/13; 8 PR), and 0% (0/3; 2 SD and 1 PD), respectively (p = 0.234). Furthermore, the responses of 烋on-irradiated lesion?for the recurrent tumor, huge mass, HCC with metastatic lesions and multiple lesions were 10.0% (1/10; 1 PR), 14.3% (1/7; 1 PR), 15.4% (2/13; 2 PR), and 0% (0/3; all 3 PD), respectively (p = 0.778). The mean and median survival times were 327 and 242 days, respectively. The adverse effects of 3D-CRT and thalidomide include constipation (26/33, 78.8%), drowsiness and sedation (15/33, 45.5%), skin rash (11/33, 33.3%), lower extremity edema (20/33, 60.6%), peripheral neuropathy (2/33, 6.1%), dizziness (1/33, 3.0%), orthostatic hypotension (1/33, 3.0%), leukopenia (5/33, 15.2%), transient elevation in liver function tests (9/33, 27.3%), and epigastralgia (8/33, 24.2%).
Conclusions : Our experience concluded that 3D-CRT combined with thalidomide might be a safe and effective treatment modality for unresectable HCC patients. The preliminary data showed quite promising result. It is valuable to study the potential role of 3D-CRT combined with thalidomide in the treatment strategy for HCC at various stages.

並列關鍵字

Conformal radiotherapy ； Hepatocellular carcinoma ； Thalidomide