目的：探讨双靶区序贯调强放疗联合介入治疗巨块型肝癌的疗效。方法：选择2008 年1 月—2015 年1 月符合研究要求的巨块型肝癌共81 例，随机分为观察组和对照组，观察组40 例选用2 次介入+ 双靶区序贯调强放疗（30~40 Gy/15~20 F）、对照组41 例行2 次介入+超分割交替调强放疗（30~40 Gy/15~20 F），比较两组患者的疗效和不良反应。结果：术后两组AFP 水平均较术前明显降低；观察组与对照组总有效率为86.8% 与79.5%；观察组与对照组中位生存期分别为10.3、9.7 个月，6 个月与1、2、3 年生存率分别为63.2% 和59.0%，50.0%和48.7%、21.1% 和17.9%、5.3% 和2.6%，以上指标两组间差异均无统计学意义（均P>0.05）。观察组1~2 度骨髓抑制发生率低于对照组（P<0.05），但其他不良反应发生率两组间差异均无统计学意义（均P>0.05）。结论：双靶区序贯调强放疗与超分割交替调强放疗联合介入治疗巨块型肝癌均有较好的临床疗效，且不良反应能耐受，两种方法均为巨块型肝癌的有效的治疗方式。
Sequential dual-target intensity-modulated radiotherapy combined with interventional therapy for giant liver cancer
Objective: To determine the efficacy of sequential dual-target intensity-modulated radiation therapy combined with interventional therapy for giant liver cancer. Methods: Eighty-one eligible patients with giant liver cancer from January 2008 to January 2015 were enrolled. They were randomly divided into observational group and control group, and patients observational group (40 cases) underwent two-session interventional therapy followed by sequential dual-target intensity-modulated radiation therapy (30-40 Gy/15-20 F), and those in control group (41 cases) had a two-session interventional therapy followed by alternating hyperfractionated intensity-modulated radiation therapy (30-40 Gy/15-20 F). The efficacy and adverse reactions between the two groups were compared. Results: The AFP levels in both group were significantly decreased compared with their preoperative levels, and in observational group and control group, the overall response rate was 86.8% and 79.5%; the median survival time was 10.3 and 9.7 months, and the overall 6-month, and 1-, 2- and 3-year survival rate was 63.2% and 59.0%, 50.0% and 48.7%, 21.1% and 17.9%, 5.3% and 2.6%, respectively. The differences in all the above parameters between the two groups showed no statistical significance (all P>0.05). The incidence of grade 1/2 bone marrow suppression in observational group was lower than that in the control group (P<0.05) and the difference was statistically significant (P<0.05), but no significant difference was noted in incidence of other adverse reactions between the two groups (P>0.05). Conclusion: Either sequential dual-target intensity-modulated radiation therapy or alternating hyperfractionated intensity-modulated radiation therapy combined with interventional therapy can offer better clinical efficacy for giant liver cancer, with tolerable adverse reactions, so both methods are effective treatment modalities for giant liver cancer.