三维适形放射治疗原发性肝癌患者发生放射性肝损伤相关因素分析*

doi:10.3969/j.issn.1672-5069.2017.01.023

实用肝脏病杂志 ›› 2017, Vol. 20 ›› Issue (1): 89-92.doi: 10.3969/j.issn.1672-5069.2017.01.023

三维适形放射治疗原发性肝癌患者发生放射性肝损伤相关因素分析^*

吕东来, 陆林, 卢虎生, 胡宗涛, 秦峰

230031合肥市解放军第105医院肿瘤中心（吕东来,陆林,卢虎生,胡宗涛）; 第81医院（秦峰）

收稿日期:2016-09-02 出版日期:2017-01-20 发布日期:2017-02-10
通讯作者: 秦峰,E-mail:18909698003@163.com
作者简介:吕东来,男,36岁,医学博士,主治医师。主要从事胶质瘤和消化道肿瘤的基础和临床研究。E-mail:lvxunhuan@163.com
基金资助:
原南京军区卫生科技基金重点资助项目（编号：12MA031）

Risk factors for predicting radiation-induced liver disease after three-dimensional conformal radiotherapy for patients with hepatocellular carcinoma

Lyu Donglai, Lu Lin, Lu Husheng, et al.

Clinical Oncology Centre,105th Hospital,Hefei 230031,Anhui Province,China

Received:2016-09-02 Online:2017-01-20 Published:2017-02-10

摘要/Abstract

摘要： 目的研究三维适形放射治疗原发性肝癌患者发生放射性肝损伤（RILD)的相关危险因素。方法对2009年3月至2015年12月期间收治的三维适形放射治疗的原发性肝癌患者的临床资料进行归纳整理,以假设检验筛选相关危险因素,并进行多因素非条件Logistic回归分析。结果本组纳入研究的原发性肝癌患者39例,在完成放射治疗后发生RILD 14例（35.9%);各类别单因素的假设检验提示肝癌患者的年龄和肝功能CTP评分与放疗后RILD的发生相关（P<0.05）;进一步的非条件多因素Logistic回归分析显示,年龄≥60岁（OR:15.72,P=0.020）和肝功能CTP评分≥6（OR:24.95,P=0.005）是三维适形放射治疗原发性肝癌后发生RILD的2个独立危险因素。结论通过对三维适形放射治疗原发性肝癌患者发生RILD的研究,初步识别了肝癌患者接受放疗后发生RILD的相关危险因素,为日后制定治疗计划时减少RILD的发生,或建立适当的干预措施提供了科学依据。

关键词: 肝癌, 三维适形放疗, 放射性肝损伤, 回归分析

Abstract: Objective This study was aimed to investigate the possible clinical factors contributing to the development of radiation-induced liver disease（RILD） in patients with hepatocellular carcinoma receiving three-dimensional conformal radiotherapy. Methods Between March 2009 and December 2015,we included 39 patients with hepatocellular carcinoma who received three-dimensional conformal radiotherapy. Clinical data,including gender,age,other treatments,liver function test Results,and three-dimensional conformal radiotherapy parameters were retrieved for analysis. Multivariate non-conditional Logistic regression analysis was used to identify the predictors of RILD. Results Out of 39 patients with hepatocellular carcinoma,fourteen（35.9%） developed RILD after three-dimensional conformal radiotherapy;The unconditional multivariate Logistic analysis showed that the pretreatment Child-Turcotte-Pugh score ≥6 [odds ratio （OR）:24.95,P=0.005] and age ≥60 years （OR:15.72,P= 0.020） were independent risk factors for the development of RILD. Conclusion The occurrence of RILD must be taken into consideration when the three-dimensional conformal radiotherapy is applied to the patients with hepatocellular carcinoma,and the primary identification of the risk factors for RILD is important.

Key words: Hepatocellular carcinoma, Three-dimensional conformal radiotherapy, Radiation-induced liver disease, Logistic analysis

吕东来, 陆林, 卢虎生, 胡宗涛, 秦峰. 三维适形放射治疗原发性肝癌患者发生放射性肝损伤相关因素分析^*[J]. 实用肝脏病杂志, 2017, 20(1): 89-92.

Lyu Donglai, Lu Lin, Lu Husheng, et al.. Risk factors for predicting radiation-induced liver disease after three-dimensional conformal radiotherapy for patients with hepatocellular carcinoma[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2017, 20(1): 89-92.

参考文献

[1] Feng M,Ben-Josef E. Radiation therapy for hepatocellular carcinoma. Semin Radiat Oncol,2011,21:271-277.
[2] Benson R,Madan R,Kilambi R,et al. Radiation induced liver disease:A clinical update. J Egyp N Ca Inst,2016,28: 7-11.
[3] 申文江,王绿叶.放射治疗损伤. 北京：中国医药科技出版社,2001：131.
[4] 高东伟,于甬华. 细胞因子与放射性肝损. 实用肝脏病杂志,2006,9:249-251.
[5] 原发性肝癌规范化诊治的专家共识. 实用肝脏病杂志,2009,12：321-327.
[6] Marks LB,Yorke ED,Jackson A,et al. Use of normal tissue complication probability models in the clinic. Int J Radiat Oncol Biol Phys,2010,76:10-19.
[7] Guha C,Kavanagh BD. Hepatic radiation toxicity: avoidance and amelioration. Semin Radiat Oncol,2011,21:256-263.
[8] Cheng JC,Wu JK,Huang CM,et al. Radiation-induced liver disease after radiotherapy for hepatocellular carcinoma: clinical manifestation and dosimetric description. Int J Radiat Oncol Biol Phys,2002,53:156-162.
[9] Liang SX,Zhu XD,Lu HJ,et al. Hypofractionated three dimensional conformal radiation therapy for primary liver carcinoma. Cancer,2005,103:2181-2188.
[10] Stenmark MH,Cao Y,Wang H,et al. Estimating functional liver reserve following hepatic irradiation:adaptive normal tissue response models. Radiother Oncol,2014,111:418-423.
[11] Ingold JA,Reed GB,Kaplan HS,et al.Radiation hepatitis. Am J Roentgenol,1965,93:200-208.
[12] Wickremesekera J K,Chen W,Cannan R J,et al. Serum proinflammatory cytokine response in patients with advanced liver tumors following selective internal radiation therapy with 90 Yttrium microspheres. Int J Radiat Oncol Biol Phys,2001,49:1015-1021.
[13] Gencel O,Naziroglu M,Celik O,et al. Selenium and vitamin E modulates radiation induced liver toxicity in pregnant and nonpregnant rat:effects of colemanite and hematite shielding. Biol Trace Elem Res,2010,135:253-263.
[14] Feng M,Smith DE,Normolle DP,et al. A phase I clinical and pharmacology study using amifostine as a radioprotector in dose-escalated whole liver radiation therapy. Int J Radiat Oncol Biol Phys,2012,83:1441-1447.
[15] Kim TH,Kim DY,Park JW,et al. Dose-volumetric parameters predicting radiation-induced hepatic toxicity in unresectable hepatocellular carcinoma patients treated with three-dimensional conformal radiotherapy. Int J Radiat Oncol Biol Phys,2007,67（1）:225-231.
[16] Liang SX,Huang XB,Zhu XD,et al. Dosimetric predictor identification for radiation-induced liver disease after hypofractionated conformal radiotherapy for primary liver carcinoma patients with Child-Pugh grade A cirrhosis. Radiat Oncol,2011,98:265-269.
[17] Jung J,Yoon SM,Kim SY,et al. Radiation-induced liver disease after stereotactic body radiotherapy for small hepatocellular carcinoma:clinical and dose-volumetric parameters. Radiat Oncol,2013,8:249.
[18] Huang Y,Chen SW,Fan CC,et al. Clinical parameters for predicting radiation-induced liver disease after intrahepatic reirradiation for hepatocellular carcinoma. Radiat Oncol,2016,11:89.
[19] 张宁宁,程晓静,刘建勇,等. 非手术治疗原发性肝癌研究进展. 实用肝脏病杂志,2016,19:249-252.

三维适形放射治疗原发性肝癌患者发生放射性肝损伤相关因素分析^*

Risk factors for predicting radiation-induced liver disease after three-dimensional conformal radiotherapy for patients with hepatocellular carcinoma

PDF (PC)

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 15

编辑推荐

Metrics

本文评价

[1]	邢昊, 韩骏, 杨田. 应用血清PIVKA-II诊断肝细胞癌研究进展^*[J]. 实用肝脏病杂志, 2019, 22(6): 934-937.
[2]	刘杏, 赵树立, 张殿隆. 七氟烷吸入时机对肝脏部分切除术患者肝脏缺血再灌注损伤的影响*[J]. 实用肝脏病杂志, 2019, 22(5): 728-731.
[3]	裴颖, 黄峰, 殷宏振, 郭化磊. 去甲斑蝥酸钠对肝癌异位移植瘤小鼠肠道微生态的影响初探*[J]. 实用肝脏病杂志, 2019, 22(4): 486-489.
[4]	张微, 史军梅, 王倩. 新生儿发生高胆红素血症危险因素分析[J]. 实用肝脏病杂志, 2019, 22(4): 534-536.
[5]	戴青云, 王润东, 荚卫东. 术前预后营养指数评估肝细胞癌患者肝切除术后早期肿瘤复发价值探讨^*[J]. 实用肝脏病杂志, 2019, 22(4): 561-564.
[6]	崔发强, 李涛, 王铮, 陈青. 原发性肝癌患者外周血KRAS基因水平及其对西妥昔单克隆抗体治疗疗效的影响[J]. 实用肝脏病杂志, 2019, 22(4): 565-568.
[7]	彭新健, 肖玉辉, 许斯鼎, 石荣跃, 王耀政, 王瑜琳. 放射性肝损伤患者肝脏磁共振扩散加权成像表现特征分析[J]. 实用肝脏病杂志, 2019, 22(3): 373-376.
[8]	赵晓光, 史玉洁. 应用还原型谷胱甘肽预防处理接受TACE治疗的中晚期原发性肝癌患者对肝功能的影响[J]. 实用肝脏病杂志, 2019, 22(3): 425-428.
[9]	李克田,沈明格,王凤荣,胡春荣,曹玉杰,芦鹏. 血糖水平对原发性肝癌患者¹⁸F-FDG摄取和PET/CT检查图像质量的影响研究^*[J]. 实用肝脏病杂志, 2019, 22(2): 256-259.
[10]	张帮健,魏寿存,杨小燕. 右美托咪啶联合丙泊酚麻醉对肝癌切除术患者围手术期血清细胞因子和术后苏醒质量的影响 ^*[J]. 实用肝脏病杂志, 2019, 22(2): 264-267.
[11]	李芳, 邹桂舟, 叶珺, 郜玉峰. 不同HBV感染转归人群外周血PD-1拷贝数分布研究^*[J]. 实用肝脏病杂志, 2019, 22(1): 37-40.
[12]	王军艳, 陈建婷, 张婷, 范丽, 杜姗, 蒋承志, 牟花妮. 乙型肝炎肝硬化患者院内获得性感染相关危险因素分析^*[J]. 实用肝脏病杂志, 2019, 22(1): 101-104.
[13]	王翠晓, 高静. 血清高尔基蛋白73、甲胎蛋白异质体3、甲胎蛋白和α-L-岩藻糖苷酶水平诊断原发性肝癌的效能分析^*[J]. 实用肝脏病杂志, 2019, 22(1): 113-116.
[14]	陈向, 汪宝林, 吴琛, 唐劲草, 张弛, 褚朝顺. 动脉灌注化疗栓塞联合放射粒子植入治疗原发性肝癌患者疗效及其对肝组织TRF1和TRF2表达的影响^*[J]. 实用肝脏病杂志, 2019, 22(1): 121-124.
[15]	闫书鸣, 王建国, 李泽信, 游焜, 王亮, 郭鹏威. 门冬氨酸鸟氨酸治疗肝癌切除术患者对肝脏缺血再灌注损伤的保护作用研究^*[J]. 实用肝脏病杂志, 2018, 21(6): 932-935.