| Backgrounds and Objective:Hepatocellular carcinoma (HCC) is a common cancer in digestive system. It is the sixth most common cancer in the world (600,000 diagnoses per year) and is the third most common cause of cancer-related death .Resection is the most important treatments for HCC in the past few years. Five-year survival after resection ranges from 31% to 56%. Resection often is not possible because of poor liver function or macrovascular tumor invasion.Because﹤15% of patients with HCC are candidates for resection, many other therapies have been investigated. Radiation therapy (RT) has played a minor role in the management of patients with unresectable liver cancer, primarily because of the low tolerance of the whole liver to RT and challenges associated with delivering highly conformal, high-dose RT to liver tumors while sparing dose to the uninvolved liver. Modern technology allows greater confidence in ascertaining the HCC target volume to be irradiated.Three-dimensional conformal RT(3D-CRT) and Intensity Modulated RT(IMRT) is new technologic advancement that facilitates the delivery of highly conformal RT. With 3D-CRT or IMRT, radiation is conducted to obtain to the best target coverage and sparing of dose to the normal tissues. But the single effect of radiation therapy is not ideal in hepatocellular carcinoma, we should pay attention to the Combined Modality Therapy. This article aims to investigate the combined treatment technological feasibility, security and short term efficacy with radiotherapy and interstitial implantation of 5- FU slow release particles for hepatic carcinoma. At the same time to study the pharmacokinetics and side-effect of 5- FU slow release particles.Methods : From July 2004 to March 2007, 22 cases of hepatic carcinoma were treated with 5 - FU slow release particles combined with radiotherapy. First, we implanted 5 - FU slow release particles guiding by treatment planning system and 1000mg 5– FU were used for each patient. Then we monitored the blood drug leve of 5– FU after 1 day, 7 days, 14 days, 21 days and 28 days. Radiotherapy was given following the implanting after 3～5 days by 1.8～2Gy per fraction , 5 times per week; The total dose of radiotherapy was 48.6～63Gy.Results : Fully operating procedure was accomplished for all the patients. No operating complication occurred. The remission rate of the pain was 90.9% (20 /22). CT scan showed that the reduced size of tumor changed in different degree 3～6 months after the operation. As a result, there were 5 cses showing CR, 12 cases showing PR, 5 cases showing NC and no cases showing PD. The overall rate (CR+PR) was 77.3% (17/22).The overrall survival rate at 1, 2 and 3 years was 72.7%, 45.5 % and 27.3%, respectively. Following up 6～38 months, the median survival stage was 21 months.Conclusion: 5-Fu slow release particles can prolong the regional action time and improve the regional concentration of chemotherapeutic drugs. Do not appear the toxic and side-effect of 5- FU. Using radiotherapy with interstitial implantation of 5-Fu slow release particles had significant radiosensitizing effect and is safe, mininvasive and effective for treatment of hepatic carcinoma. |
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