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目的探讨三维适形放疗(3DCRT)联合香菇多糖治疗HBV阳性的原发性肝癌的临床效果和放射性肝损伤的程度。方法 48例不能手术HBV阳性的原发性肝癌患者随机分为两组,经强化CT扫描,精确勾画靶区和危险器官,以90%等剂量曲线包绕PTV,并依此为处方剂量线,分别设4～6个不规则照射野,常规分割照射,5次/周,2 Gy/次,总处方剂量60～64 Gy/30～32次。治疗组放疗过程中配合应用香菇多糖注射液2 mg加入250 ml葡萄糖液静脉滴注,每周2次,连用6～8周;对照组单纯应用放疗。结果治疗组、对照组近期瘤体缩小率分别为87.5%(21/24)和54.2%(13/24);甲胎蛋白(AFP)下降分别为83.3%(20/24)和45.8%(11/24),两组比较差异有统计学意义(P<0.05);治疗后6个月生存率95.8%(23/24),对照组是54.2%(13/24);急性放射性肝损伤的发生率分别为16.7%(4/24),25%(6/24)。结论三维适形放射治疗(3DCRT)联合香菇多糖治疗HBV阳性的原发性肝癌的近期疗效优于单纯3DCRT,急性放射性肝损伤的发生率也低于单纯3DCRT。
Objective To investigate the clinical effects of three-dimensional conformal radiotherapy (3DCRT) combined with lentinan in the treatment of HBV-positive primary liver cancer and the extent of radiation-induced liver injury. Methods Forty-eight patients with unresectable HBV-positive primary liver cancer were randomly divided into two groups. The target area and dangerous organs were accurately sketched by enhanced CT scan, and the dose-line curve was wrapped by 90% isodose curve. They were randomly divided into 4 ~ 6 irregular irradiation fields, and were divided into 2 groups by radiation, 5 Gy / week and 2 Gy / time. The total prescription dose was 60-64 Gy / 30-32 times. Radiotherapy in the treatment group with the application of levogrel injection 2mg 250ml glucose solution intravenously, twice a week, once every 6 to 8 weeks; the control group simply the application of radiotherapy. Results The reduction rates of the tumor in the treatment group and the control group were 87.5% (21/24) and 54.2% (13/24), respectively. The reduction of AFP was 83.3% (20/24) and 45.8% / 24). The difference between the two groups was statistically significant (P <0.05). The survival rate at 6 months after treatment was 95.8% (23/24) in the control group and 54.2% (13/24) in the control group. The incidence of acute radiation-induced liver injury Rates were 16.7% (4/24) and 25% (6/24), respectively. Conclusion Three-dimensional conformal radiotherapy (3DCRT) combined with lentinan in the treatment of HBV-positive primary liver cancer is better than simple 3DCRT in the short term. The incidence of acute radiation-induced liver injury is also lower than that of simple 3DCRT.