姑息放疗在治疗晚期肝脏恶性肿瘤中的疗效及生活质量评估-现代医学

姑息放疗在治疗晚期肝脏恶性肿瘤中的疗效及生活质量评估

单位：1. 南京中医药大学附属南京医院/南京市第二医院肿瘤科, 江苏南京 210003;
2. 南京中医药大学附属南京医院/南京市第二医院放疗科, 江苏南京 210003

分类号：R735.7

出版年·卷·期（页码）：2021·49·第六期（623-629）

摘要：

目的：评估姑息放疗（三维适形/适形调强放疗）治疗晚期肝脏恶性肿瘤（包括原发性肝癌、转移性肝癌）的疗效、不良反应以及生活质量变化。方法：选择2015年6月至2018年12月采用三维适形/适形调强放疗治疗的南京中医药大学附属南京医院126例晚期肝脏恶性肿瘤患者，前瞻性研究放疗近期疗效及不良反应，并于放疗前、放疗结束、放疗后3个月、放疗后6个月，运用EORTC QLQ-C30量表动态评估患者生活质量，并计算半年、1年生存率。结果：放疗后3个月，完全缓解4例（3.2%），部分缓解57例（45.2%），疾病稳定29例（23.0%），疾病进展36例（28.6%），客观缓解率为48.4%，疾病控制率为71.4%；6个月、1年生存率分别为66.7%、17.5%，中位生存时间为6.8个月，不良反应以疲乏、食欲下降、肝功能异常、腹水为主；与放疗前相比，在放疗结束时，整体健康状况评分有所降低（P=0.007），放疗后3个月、6个月，QLQ-C30整体健康状态评分，相对于基线分别改善32.5%、37.5%，恶化22.5%、27.5%，保持稳定45%、35%。多因素Logistic回归分析显示近期疗效、ECOG评分、肝内病灶数目以及放疗生物等效剂量对肝脏恶性肿瘤放疗后生活质量影响具有统计学意义。结论：姑息放疗有利于降低晚期肝脏恶性肿瘤负荷，放疗不良反应可接受，与放疗前相比，放疗后3个月患者生活质量显著提高。

Objective: To evaluate the efficacy, adverse reactions and changes in quality of life in patients with advanced hepatic malignant tumors, including primary hepatocellular carcinoma and metastatic liver tumor after three-dimensional conformal/conformal intensity modulated radiotherapy. Methods: From June 2015 to December 2018, 126 patients with advanced liver tumors were treated with three-dimensional conformal/conformal intensity modulated radiotherapy in NanJing Second Hospital. The short-term efficacy, adverse reactions and changes in quality of life after radiotherapy were prospectively studied. The EORTC QLQ-C30 scale was used to dynamically evaluate quality of life of patients before and immediately after radiotherapy, 3and 6 months after radiotherapy, and the survival rates were calculated athalf a year and one year. Results: 3 months after radiotherapy, complete response 4 case (3.2%), partial response 57 cases (49.2%), stable disease 29 cases (23.0%), progressive disease 36 cases (28.6%), objective remission rate 48.4%, disease control rate 71.4%. The 6-months and 1-year survival rates were 66.7% and 17.5% respectively, median survival time was 6.8 months, the main adverse reactions were fatigue, loss of appetite, abnormal liver function and ascites. Compared with before radiotherapy, the global health status score decreased at the end of radiotherapy(P=0.007). Compared with baseline, the Global health status score of QLQ-C30 improved by 32.5%, 37.5%, deteriorated by 22.5%, 27.5% and remained stable by 45% and 35% in 3 and 6 months after radiotherapy. Multivariate Logistic regression analysis showed that the short-term efficacy, ECOG score, the number of intrahepatic lesions and the bioequivalent dose of radiotherapy had statistical significance on quality of life of patients after radiotherapy. Conclusion: Palliative radiotherapy is helpful to rapidly reduce the burden of advanced liver malignant tumors with low adverse reactions. The quality of life of patients increased significantly in 3 months after radiotherapy.

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