目的：肝癌合併肝門靜脈腫瘤椎塞的預後很差，至今尚未得到有效且一致性的治療方法。本文探討利用三度空間順形治療的方式，治療肝門靜脈腫瘤栓塞。對無法切除的肝癌病人之存活及後續治療的影響，並分析其預後因子。材料與方法：自1998至2001年，共有31位廣泛性肝癌合併肝門靜脈腫瘤栓塞的病人至本科接受肝門靜脈之局部放射線治療。其中23位病人完成治療計畫並有完整的後續追蹤。這些病人給予的劑量平均為47.6±4.4Gy ，每次1.8-2.2Gy。治療結束後2至4週，以腹部超音波或電腦斷層來評估肝門靜脈腫瘤栓塞的反應，之後並定期追蹤。病人的存活時間自診斷出肝門靜脈腫瘤栓塞算起至統計結束。結果：有9位病人(39%)的肝門靜脈腫瘤栓塞消失或縮小，這9位病人全部接受後續的肝動脈栓塞或酒精注射治療，這群病人的存治時間也明顯超過另外14位病人。多變項分析顯示肝門靜脈腫瘤栓塞的反應及後續的治療是影響存活時間的變項，而影響肝門靜脈栓塞反應的變項則包括放射治療前的血紅素(Hb)、血清白蛋白(serum albumin)。肝門靜脈腫瘤栓塞消失或縮小的中位時間為17天(10-255天)。結論：以三度空間順形治療的方式治療肝門靜脈腫瘤栓塞，在特定情況下，可以提供病人接受後續治療的機會，進而延長存活時間。積極提高病人的血紅素並改善營養狀態，可提升治療效果。

Purpose: Hepatocellular carcinoma (HCC)with portal vein tumor thrombosis(PVTT)has poor prognosis. The aim of this study was to investigate the efficacy and prognostic factors of conformal radiotherapy for PVTT in unresectable HCC. The primary endpoint of this study is the overall survival of patients. The secondary endpoint is the overall response of tumors. Patients and Methods: form June 1998 to December 2001, 23 patients of advanced HCC with PVTT enrolled into the study. Mean treatment dose was 47.6 ±4.4 Gy, in a daily fraction of 1.8-2.2 Gy. Response was assessed by enhanced computer tomography (CT) scan and/or color Doppler abdominal ultrasonography 2-4 weeks following completion of the treatment and then in a 2-4 month interval. Survival was calculated from the diagnosis of PVTT using the Kaplan-Meier method. Results: An objective response was observed in 9 patients, giving a response rate of 39%. The survival rate of the responder patients was significant higher than non-responders(median survival 13 vs. 5 months, p=0.0027). All of the 9 responders received sub-sequent transcatheter arterial chemoembolization (TACE) or percutaneous ethanol injection (PEI). Multivariate analysis showed that the response of PVTT and the subsequent treatments were the prognostic factors of the survival, while the pre-treatment hemoglobin and serum albumin level were the factors that affected response. The intervals from the completion of radiotherapy to response ranged from 10 to 255 days(median 17 days). Conclusion: Local conformal irradiation to PVTT is sometimes feasible and effective. Better nutritional status reflected by the hemoglobin and serum albumin levels improves response rates and prolongs survival consequent to subsequent TACE or PEI.