| Objective:Collecting the clinical data of primary liver cancer patients treated with stereotactic body radiotherapy(SBRT),and analyzing the treatment plan and the treatment effect to provide reference for clinical treatment of primary liver cancer.Methods:(1)Study object: the clinical data of 743 patients with primary liver cancer was collected,who were treated by gamma knife in a grade A tertiary hospital during February 2009 to June 2016.(2)Study methods: the conditions of primary liver cancer patients and therapy plan were statistically analyzed to evaluate thier outcome situation,occurring of adverse reactions,changes of assay index before and after the treatment,the recent and forward curative effect.(3)Statistical analysis: the relationshipswere analyzed by Chi-square test or rank testamong improvement rate,the incidence of adverse reactions,the efficient and age,the score of KPS,clinical stage and therapeutic doses.Assay index changes before and after the treatment were analyzed using t test or rank test.The influence factors of primary liver cancer patients' survival time were analyzed by Kaplan Meier method and Cox regression model.Results:(1)General conditions of patients with primary liver cancer: 630 cases are males,accounting for 84.8%.113 cases are females,accounting for 15.2%.The youngestpatient was 19 years old and the eldest one was 92 years old,the average age was54.3±11.5 years old.80 cases had KPS score less than 80,accounting for 10.2%.667 cases had KPS score of 80 or more,accounting for 89.8%.A total of 426 cases with clear clinical staging,including 18 cases of ? period,accounting for 4.2%;17 cases of ? period,accounting for 4.0%,284 cases of ? phase,accounting for 66.7%;107 cases of ? phase,accounting for 25.1%.(2)The outcome of patients with primary liver cancer: among 743 patients with primary liver cancer,706 cases were improved,31 cases had no significant changes,3 cases got worse and 3 cases died when they left the hospital.The recovery rate was 95.0%.The three dead were died of upper gastrointestinal bleeding,hepatic encephalopathy and multiple organ failure.Differences of the clinical symptoms improved among groups of KPS,distant metastasis,cumulative dose and biological effective dose(BED)were statistically significant(P<0.05).The improvement rates of cases in the groups of KPS?80,without distant metastases,the cumulative dose?3000c Gy and BED?4000c Gy were 95.7%,97.4%,97.2% and 97.6%,which were higher than the groups of KPS<80,withdistant metastases,the cumulative dose<3000c Gy and BED<4000c Gy(81.6%,90.7%,90.6% and 93.3%).(3)The adverse reactions of patients with primary liver cancer: 243 cases had adverse reactions after the first hospital admission,accounted for 32.7%.The symptoms were relieved after treatment.The difference of adverse reaction rates between different cumulative dose groups was statistically significant(P=0.04).The adverse reaction rate in the group of cumulative dose?3000c Gy was 30.3%,which was lower than the group of cumulative dose<3000c Gy.(4)Laboratory examination: albumin,red blood cells and platelets index were decreasedafter gamma knife treatment,while glutamic-pyruvic transaminase,total bilirubin,direct bilirubin and neutrophils ratio were higher than before(P<0.05).(5)Short-term effects: among 99 patients,the number of partial response(PR),stable disease(SD),and disease progression(PD)in 1 to 3 months were 63 cases,33 cases and 3 cases,respectively.The effective rate during 1 to 3 months was 63.6%.The difference of effective rate during 1 to 3 months between different cumulative dose was statistically significant(P=0.04).The effective rate in the group of cumulative dose?3000c Gy during 1 to 3 months was 67.8%,which was higher than the rate of 33.3% in the group of cumulative dose<3000c Gy.Among 30 patients,the number of complete remission(CR),partial response(PR),stable disease(SD),and disease progression(PD)in 4 to 6 months were 1cases,18 cases,9 cases and 2 cases,respectively.The effective rate during 4 to 6 months was 63.3%.The difference of effective rate between the patients who accepted or not accepted other treatments before hospital admission was statistically significant(P=0.02).The effective rate during 4 to 6 months of patients who accepted other treatments before hospital admission was 90.9%,which was higher than the rate of 47.4% for the ones who not accepted.(6)Long-term effects: 160 cases had long-term follow-up data.The range of survival time was 1 to 62 months,and the median survival time was 6 months.The survival rates of six months,1 year,2 years,3 years for patients were 49.6%,25.7%,10.7% and 3.8%,respectively.Cumulative dose and whether accepted other treatment after discharging from hospital would statistically significantly have statistically significant impact on patients' survival time(P<0.05).The patients whose cumulative dose were 3000 c Gy or more had a longer survive time than the patients whose cumulative dose less than 3000 c Gy(P=0.004).The patients who accepted other treatment after discharging from hospital survive longer than those who not accepted(P=0.001).Conclusions:(1)Among the primary liver cancer patients who treated by gamma knife,the number of male patients was lager than female patients and most of them were middle-old aged patients.What's more,a large number of the patients had been in the middle-late stage when they were treated.(2)The improvement rate of patients with primary liver cancer was 95.3%.Among them,the improvement rates of patients who had higher KPS,no distant metastasis,and exposure to high radiation dose within a certain dose range were higher.(3)The incidence of adverse reactions was low for patients who exposure to high cumulative dose within a certain dose range.(4)Gamma knife therapy will have an impact on liver function and blood routine,which could lead to the increase of glutamic-pyruvic transaminase,total bilirubin,direct bilirubin and neutrophils ratio and the decrease of Albumin,red blood cells and platelets index.(5)The recent curative effect was better for those who were not treated prior to hospital admission and accepted higher cumulative dose irradiation within a certain dose range.(6)The median survival time for primary liver cancer patients was relatively short.The patientswho accepted higher cumulative dose irradiation within a certain dose range and accepted other treatments after charging fromhospital had a longer survival time than those who were not. |
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