Analysis Of The Efficacy Of Large Fraction Intensity Modulated Radiotherapy In The Treatment Of Portal Vein Tumor Thrombus Of Primary Liver Cancer

Objective: The purpose of this study was to compare the efficacy and safety of large fractionated intensity modulated radiotherapy(IMRT)and conventional fractionated intensity modulated radiotherapy in the treatment of primary liver cancer(PLC)with portal vein tumor thrombus(PVTT),to explore the clinical value of large fractionated intensity modulated radiotherapy in the treatment of primary hepatocellular carcinoma with portal vein tumor thrombus,and to analyze the relevant factors affecting the prognosis of patients.Methods: Forty-five patients with primary liver cancer with portal vein tumor thrombus treated in the Department of Oncology,affiliated Hospital of Hebei Engineering University from June 2016 to December 2018 were collected.According to the random number table,the patients were divided into two groups: conventional fractionated radiotherapy group(23 cases)and large fractionated radiotherapy group(22cases).The patients in the conventional fractionated radiotherapy group received a single radiotherapy dose of 2 Gy,5 times a week,completed in 5~7 weeks and the total dose was 58Gy~62Gy.The patients in the large fractionated radiotherapy group received a single radiotherapy dose of 3 Gy,5 times a week,completed in 3~4 weeks and the total dose was 54Gy~57Gy.The gross tumor target(GTV)of the above two groups included cancer thrombus or tumor thrombus and the adjacent primary focus,all of which were in accordance with the 90% isodose curve to cover the planned target(PTV).According to the standard of RECIST.1.1 version of solid tumor,the short-term curative effect and objective remission rate(ORR)of patients in conventional fractionated radiotherapy group and large fractionated radiotherapy group were compared,and the 6-month,1-and 2-year survival rate,median survival time(MST)and adverse reactions of radiotherapy were statistically analyzed,and the therapeutic effects of the two groups were compared.At the same time,the relevant factors affecting the prognosis of these patients were analyzed according to the prognosis.Results: All the 45 patients in the group completed radiotherapy as planned.evaluated by imaging epigastric enhanced CT or MRI,complete remission was achieved in 2 cases(8.6%),partial remission in 6 cases(26.1%),stable in 10 cases(43.4%),and progress in 5 cases(21.7%).The objective remission rate was 34.7%.The 6-month,1-year and 2-year survival rates were 69.6%,30.4% and 8.7%,respectively.In the large fractionated radiotherapy group,complete remission was achieved in 3 cases(13.6%),partial remission in 7 cases(31.8%),stable in 6 cases(27.2%),and progress in 6cases(27.2%).The objective remission rate was 45.4%,and the 6-month,1-year and 2-year survival rates were 68.1%,31.8% and 4.5%,respectively.The most common adverse reactions in both groups were general fatigue,dizziness,anorexia,myelosuppression,nausea,vomiting,epigastric fullness,aggravation of liver distension and other symptoms,most of which were grade 1 to grade 2,and the incidence of grade3 adverse reactions was 2.8%.In the large fractionated radiotherapy group,there was 1case of mild radiation hepatitis,no grade 3 or more adverse reactions,no gastrointestinal bleeding,radiation liver failure and other serious complications.Univariate analysis showed that the main factors related to the 1-year survival rate of patients with conventional fractionation and large fractionation radiotherapy(P < 0.05):PVTT classification,Child-Pugh grade,target range.In univariate analysis,COX regression multivariate analysis showed that PVTT classification,Child-Pugh grade and target range were independent related factors affecting the prognosis of patients.Conclusions:1.The efficacy of large fractionated intensity modulated radiotherapy is similar to that of conventional fractionated intensity modulated radiotherapy in the treatment of primary liver cancer with portal vein tumor thrombus,and there is no significant difference in adverse reactions.2.Large fractionated intensity modulated radiotherapy is effective and safe,which can shorten the time of radiotherapy and provide an opportunity for follow-up treatment,which is worthy of clinical promotion.3.Multivariate analysis showed that portal vein tumor thrombus classification,Child-Pugh grade and target range were important factors affecting prognosis.