关键词: 原发性肝癌, 肝动脉栓塞化疗, 三维适形放疗, 多因素分析, 放射性肝损伤

Abstract: Objective To analyze the efficacy of transcatheter arterial chemoembolization (TACE) combined with three-dimensional conformal radiation therapy (3D-CRT) in the treatment of patients with advanced hepatitis B primary liver cancer (PLC).Methods Between January 2019 and June 2024, 72 PLC patients with advanced hepatitis B were enrolled. According to the previous guidelines, the enrolled patients were treated with antiviral therapy, TACE and 3D-CRT. According to the evaluation standard of response to solid tumor treatment, the therapeutic effect was evaluated and divided into two groups: the effective group and the ineffective group. The clinical data of the two groups were compared and factors influencing the short-term clinical effect of TACE combined with 3D-CRT in the treatment of advanced PLC patients was analyzed, and the adverse reactions during the treatment were also analyzed.Results Three months after TACE combined with 3D-CRT treatment, the curative effect was evaluated, of which 51 cases were effective [complete remission (CR)+ partial remission (PR)] and 21 cases were ineffective [disease stability (SD)+disease progression (PD)]. Compared with the ineffective group, the cases of AFP<400μg/L, 50-60 Gy radiotherapy dose, BCLC stage B and Child-Pugh grade A in the effective group increased significantly (P<0.05), while the tumor diameter and gross tumor volume decreased significantly (P<0.05). Multivariate analysis showed that AFP level, gross tumor volume, radiation dose and Child-Pugh grade were independent factors influencing the short-term clinical efficacy of TACE combined with 3D-CRT in the treatment of advanced PLC patients (P<0.05). Adverse reactions during treatment included those during TACE and 3D-CRT. During TACE, the adverse reactions included fever in 9 cases (12.5%), epigastric pain in 7 cases (9.7%) and nausea and vomiting in 5 cases (6.9%). Adverse reactions during 3D-CRT included epigastric fullness in 11 cases (15.3%), agranulocytosis in 6 cases (8.3%), gastric burning discomfort in 4 cases (5.5%) and radiation-induced liver damage in 3 cases (4.2%).Conclusion TACE combined with 3D-CRT has a good curative effect on PLC in the treatment of advanced hepatitis B, but the curative effect is affected by many factors, including AFP level, gross gross tumor volume, radiation dose and Child-Pugh classification. In clinical practice, the treatment plan should be adjusted according to the individual differences of patients, so as to improve the curative effect and reduce the occurrence of adverse reactions.

Key words: Primary liver cancer, Transcatheter arterial chemoembolization, Three-dimensional conformal radiation therapy, Multivariate analysis, Radioactive liver damage