Treatment Of Primary Liver Cancer With Stereotactic Conformal Radiotherapy And After-loading High-dose-rate Brachytherapy

Primary liver cancer (PLC) is one of the most familiar malignancies in China. Most of them arise from the basis of post-hepatitis cirrhosis, hardly to be found in early stage. At present, hepatectomy is still the treatment of choice. Because most clinical PLC patients are in middle or late phases, the resection rate is only about 10 percent. The postoperative recurrence and metastasis rate are both higher, which restrict the treatment effect of PLC . Therefore, the key point of improving prognosis of PLC is to look for method which can prevent postoperative recurrence of PLC and provide effective non-surgical treatment for unresectable PLC. The important reason of recurrence is the remnant micrometastasis surrounding tumor tissue.Recently, with development of stereotactic conformal radiotherapy and after-loading high-dose-rate brachytherapy, the radiation therapy has become one of the important treatment for PLC. Irradiation can destroy tumor cells effectively when its dose reaches higher enough. Simultaneously the damage to normal liver tissue should be avoided. In this study, we discuss the therapeutical effect of stereotactic conformal radiotherapy on PLC and its value in preoperative application; thetreatment of micrometastasis surrounding tumor tissue with after-loading high-dose-rate brachytherapy through intraoperative placement of tubes which can prevent postoperative recurrence of PLC; the prospective study on treatment of unresectable late stage PLC with combination of transcatheter arterial chemoembolization and stereotactic conformal radiotherapy in order to improve the comprehensive therapeutical effect. The main work is described as follows:1. Application of stereotactic conformal radiotherapy in the treatment of PLCObjective: To discuss the therapeutical effect of stereotactic conformal radiotherapy on PLC and its value in preoperative application. Methods: From May 1998 to October 2001, 25 PLC patients received hepatectomy two weeks after preoperative short-time high dose stereotactic conformal radiotherapy, contrasted with 25 patients only received hepatectomy in the corresponding period. Postoperative pathology, liver function, blood routine, AFP, intraoperative bleeding volume, postoperative recurrence rate and survival rate were analysed. Results: Stereotactic conformal radiotherapy can destroy tumor cells effectively, result in formation of fiber organization zone and obliteration of small blood vessel and lymphatic vessel surrounding tumor tissue. It also reduce tumor volume(P<0.01), decrease intraoperative bleeding volume(P<0.05), increase postoperative AFP trans-negative rate in thenear future(P<0.01), decrease postoperative one year recurrence rate(P<0.01) and increase postoperative two year survival rate(P<0.01) significantly. Simultaneously, there is no severe side-effect. Conclusions: Stereotactic conformal radiotherapy is an effective approach for treatment of PLC. Preoperative short-time high dose radiotherapy can increase the resection rate, improve prognosis and enhance the opportunity of second period resection.2. Prevention of postoperative recurrence with after-loading high-dose-rate brachytherapy through intraoperative placement of tubesObjective: To discuss the treatment of micrometastasis surrounding tumor tissue with after-loading high-dose-rate brachytherapy through placement of tubes during operation and its value in preventing postoperative recurrence of PLC. Methods: From July 1998 to October 2000, 20 PLC patients received high-dose-rate 192lr after-loading brachytherapy one week after operation with intraoperative placement of tubes, contrasted with 20 patients only received hepatectomy in the corresponding period. Liver function, blood routine, AFP, one year and two year postoperative recurrence rate and survival rate were analysed. Results: After-loading high-dose-rate brachytherapy for incisal edge in the early period after operation can increase postoperative AFP trans-negative rate in the near future(P<0.05), decrease one year and twoyear post...