Department of Clinical Oncology, Pamela Youde Nethersole Eastern Hospital, Hong Kong SAR, People's Republic of China.
Radiother Oncol. 2012 Jan;102(1):56-61. doi: 10.1016/j.radonc.2011.05.022. Epub 2011 Jun 2.
To implement a reliable, practical and reproducible treatment procedure, based on in-room kV-image guidance and respiratory control, for liver cancer patients treated with high dose conformal radiotherapy using a commercially available treatment system.
CT stimulation was conducted under voluntary breath hold or gating using the Varian Real-time Position Management™ (RPM) System. Treatments were delivered daily under kV image guidance to verify the diaphragmatic or lipiodol-defined tumor position.
Thirty-three patients with liver confined hepatocellular carcinoma were treated between May 2006 and Dec 2009. After a median follow-up period of 16.5 months (range: 3.5-40.7), all but 2 patients demonstrated radiological tumor regression. Eight patients (24%) achieved complete remission. The median tumor shrinkage was 42% (27-100%). Subsequent in-field tumor progression was observed in only three patients (10%). For the 23 patients with abnormal alpha fetoprotein level, 22 of them showed biochemical response with a median AFP level drop of 78%. The treatment was well tolerated: Grade 3 toxicities occurred in 5 patients (1 leucopenia, 1 elevated liver enzyme and 3 elevated bilirubin level) but there was no grade 4 toxicity or treatment related death. The 1 year overall survival rate is 71.7% and median survival time is 17.2 months (3.5-40.7 months).
Excellent treatment results with minimal toxicities could be achieved in a clinical environment with a commercially available highly sophisticated radiotherapy system.
在配备有商业上可利用的治疗系统的临床环境中，实施一种基于室内千伏级影像引导和呼吸控制的可靠、实用和可重复的肝癌患者大剂量适形放疗治疗方案。
使用瓦里安实时位置管理系统（Varian Real-time Position Management，RPM），在自愿屏气或门控下进行 CT 激发。在千伏级图像引导下，每天进行治疗，以验证膈肌或碘化油定义的肿瘤位置。
2006 年 5 月至 2009 年 12 月，对 33 例局限于肝脏的肝细胞癌患者进行了治疗。中位随访时间为 16.5 个月（范围：3.5-40.7 个月），所有患者除 2 例外均显示影像学肿瘤消退。8 例（24%）患者达到完全缓解。肿瘤缩小的中位数为 42%（27-100%）。仅 3 例（10%）患者随后出现了场内肿瘤进展。在 23 例甲胎蛋白水平异常的患者中，22 例患者的生化反应显示甲胎蛋白水平下降，中位数为 78%。该治疗方案耐受性良好：5 例患者出现 3 级毒性（1 例白细胞减少，1 例肝酶升高，3 例胆红素升高），但无 4 级毒性或治疗相关死亡。1 年总生存率为 71.7%，中位生存时间为 17.2 个月（3.5-40.7 个月）。
在配备有商业上可利用的高度复杂放疗系统的临床环境中，可实现出色的治疗效果和最小的毒性。
