原发性肝癌三维适形和调强放疗的基础和临床研究

报告三维适形（3-dimensional conformal radiation therapy, 3DCRT）和调强放疗（intensity-modulated radiation therapy, IMRT）治疗原发性肝癌（HCC）的基础和临床研究,建立了3DCRT和IMRT放疗HCC的技术，进行3个临床试验，获得了令人鼓舞的3年总生存率：28 ％～33 ％。治疗并发症主要是放射性肝病（RILD），此并发症的死亡率为76 ％，预防RILD最有效的方法是把对正常肝脏的放射剂量限制在安全的范围内。我国的HCC病人大都伴有肝硬化，伴发的肝硬化损害了肝脏对放射损伤的修复和肝脏再生的能力，他们的放射耐受剂量是（全肝平均剂量）：Child-Pugh A病人23 Gy，Child-Pugh B病人6 Gy，这个耐受量显著低于目前国际上通用的30 Gy。研究建立了用于预测我国HCC病人放疗中发生RILD发生概率的Lyman数学模式，其参数明显不同于国外的模式，并将一整套适合我国国情的HCC放疗技术成功地进行了临床实践，证实了放疗可以作为不能手术肝癌的一种治疗选择。

Three-dimensional conformal and intensity modulated radiation therapy for hepatocellular carcinoma:basic study and clinical trials

This report consists of two parts: basic study and clinical trial for 3-dimensional conformal radiation therapy (3DCRT) and intensity modulated radiation therapy (IMRT) in treating hepatocellular carcinoma (HCC). The technique of 3DCRT and IMRT has been established for HCC irradiation. And 3 clinical trials have been carried out, which yielded encouraging outcome with 3-year rvivals of 28 % to 33 % for locally advanced HCC. Radiation induced liver disease (RILD) was the predominant complication, resulting in a mortality of 76 %. It was critical to keep irradiation dose to normal liver in a tolerable level. For HCC patients associated with hepatic cirrhosis, tolerance was mean dose to normal liver of 23 Gy for Child-Pugh A and 6 Gy for Child-Pugh B, instead of 30 Gy generally used for liver without cirrhosis in the West. A Lyman mathematic model was established,which coule predicate the RILD occurrence probability for Chinese HCC patients.The model has apparently different parameters from those abroad.The established technique of HCC irradiation,which is fit to Chinese HCC,has been successfully applied in a series of clinical trials.It demonstrates that radiation therapy is one of the treatment choices for medically inoperable and technically unresectable HCC.