Efficacy And Safety Of Transarterial Arterial Chemoembolization Combined With Intensity-modulated Radiotherapy For Primary Hepatic Carcinoma

Objective:To investigate the clinical efficacy of hepatic arterial chemoembolization combined with intensity-modulated radiotherapy for primary hepatic carcinoma.Methods:The clinical data of 90 patients with primary hepatic carcinoma from January 2011 to February 2015 in our hospital(therapeutic methods were divided into two groups:50 patients in TACE group and 40 patients in TACE combined with IMRT group)was retrospectively analyzed.To compare the short-term curative effect,AFP level,KPS score,adverse reactions and renal function changes after treatment in the two groups of patients.Survival rate was calculated by the Kaplan-Meier method and compared statistically using the Log rank test.In order to identify the independent factors for survival,variables(such as Age,sex,HBsAg,Child-Pugh classification,tumor size,AFP,TNM stage,lipiodol deposition type and grouping)that associated with survival in univariate analysis were subsequently included in the multivariate analysis using Cox proportional hazard model.Results:In terms of short-term efficacy,the objective response rate ORR(CR+PR)in TACE group was 50.0%,and the ORR(CR+PR)of TACE combined IMRT group was 75.0%.There was a statistically significant difference in ORR between the two groups(P<0.05).In terms of AFP level,there was no statistically significant difference in AFP values between the two groups before treatment(P>0.05).In the TACE group and TACE combined IMRT group,the AFP value decreased by more than 50%after treatment was 10 cases and 17 cases respectively.The AFP value in the group was statistically different(P<0.05).There was a statistically significant difference between the AFP values before and after treatment in both groups(P<0.05).KPS:In the 1 month after treatment,the KPS scores of patients with TACE alone and TACE combined with IMRT group were higher than those before treatment.There was a statistically significant difference(P<0.05).The difference in KPS scores between the two groups after treatment was statistically significant(P<0.05).Adverse reactions:There were adverse reactions such as digestive tract reaction,fever,transaminase elevation and bone marrow suppression in both groups.There was no significant difference in the incidence of adverse reactions between the two groups(P>0.05).There was no occurrence of radiation liver disease in the TACE and IMRT groups.Changes in renal function:There was no significant difference in blood urea nitrogen(BUN)and serum creatinine(CR)between TACE group before and after treatment(P>0.05).There was no significant difference in blood urea nitrogen(BUN)and serum creatinine(CR)between TACE and IMRT groups before and after treatment(P>0.05).In the survival analysis,the median survival time of TACE group and TACE combined IMRT group was 16.0(10.5-21.5)months and 24.0(17.2-30.8)months,respectively(P<0.05).The 1-,2-,and 3-year survival rates of TACE group and TACE combined IMRT group were 56.0%,30.0%,14.0%and 82.5%,52.5%,and 32.5%,respectively(P<0.05).Univariate analysis showed that factors related to prognosis were grouped(P<0.05),but age,gender,HBsAg,Child-Pugh classification,tumor size,serum AFP,TNM staging,lipiodol deposition type and prognosis were not significantly related(P>0.05).Multivariate regression analysis showed that grouping was significantly associated with prognosis(P<0.05)and was an independent factor that affected the prognosis of patients.Conclusion:The short-term efficacy of TACE combined with IMRT group in patients with primary hepatic carcinoma was higher than that in TACE alone,and the survival time was significantly prolonged.The incidence of adverse reactions was slightly higher than that of TACE alone,but most patients were able to tolerate.TACE combined with IMRT treatment can be used as a new treatment for patients with unresectable liver cancer.