Dewas S, Mirabel X, Kramar A, Jarraya H, Lacornerie T, Dewas-Vautravers C, Fumagalli I, Lartigau É
Département universitaire de radiothérapie, CLCC Oscar-Lambret, 3, rue Frédéric-Combemale, BP 307, 59020 Lille cedex, France.
Cancer Radiother. 2012 Feb;16(1):58-69. doi: 10.1016/j.canrad.2011.06.005. Epub 2011 Dec 30.
The CyberKnife(®) system is a recent radiation therapy technique that allows treatment of liver lesions with real-time tracking. Because of its high precision, the dose administered to the tumor can be increased. We report Oscar-Lambret Cancer Centre experience in the treatment of primary and secondary liver lesions.
It is a retrospective study analyzing all the patients who have been treated for their liver lesions since July 2007. A hundred and twenty patients have been treated: 42 for hepatocellular carcinoma, 72 for liver metastases and six for cholangiocarcinoma. Gold seeds need to be implanted before the treatment and are used as markers to follow the movement of the lesion due to respiration. On average, the treatment is administered in three to four sessions over 12 days. A total dose of 40 to 45 Gy at the 80% isodose is delivered. Local control and overall survival analysis with Log-rank is performed for each type of lesion.
Treatment tolerance is good. The most common toxicities are of digestive type, pain and asthenia. Six gastro-duodenal ulcers and two radiation-induced liver disease (RILD) were observed. At a median follow-up of 15 months, the local control rate is respectively of 80.4% and 72.5% at 1 and 2 years. Overall survival is 84.6 and 58.3% at 1 and 2 years. The local control is significantly better for the hepatocellular carcinoma and overall survival is significantly better for liver metastases (P<0.05). The local control rate and overall survival at 1 year for cholangiocarcinoma is 100%.
CyberKnife(®) is a promising technique, well tolerated, with tumoral local control rates comparable to other techniques. Its advantage is that it is very minimally invasive delivered as an outpatient procedure in a frail population of patient (disease, age).
射波刀系统是一种最新的放射治疗技术，可对肝脏病变进行实时追踪治疗。因其高精度，可提高给予肿瘤的剂量。我们报告了奥斯卡 - 兰布雷癌症中心治疗原发性和继发性肝脏病变的经验。
这是一项回顾性研究，分析了自2007年7月以来所有接受肝脏病变治疗的患者。共治疗了120例患者：42例肝细胞癌患者，72例肝转移瘤患者，6例胆管癌患者。治疗前需植入金标，用作标记以追踪因呼吸导致的病变移动。平均而言，治疗在12天内分三至四个疗程进行。在80%等剂量线上给予40至45 Gy的总剂量。对每种病变类型进行局部控制和总生存分析，并采用对数秩检验。
治疗耐受性良好。最常见的毒性反应为消化类型、疼痛和乏力。观察到6例胃十二指肠溃疡和2例放射性肝病（RILD）。中位随访15个月时，1年和2年的局部控制率分别为80.4%和72.5%。1年和2年的总生存率分别为84.6%和58.3%。肝细胞癌的局部控制明显更好，肝转移瘤的总生存明显更好（P<0.05）。胆管癌1年的局部控制率和总生存率均为100%。
射波刀是一种有前景的技术，耐受性良好，肿瘤局部控制率与其他技术相当。其优势在于它是一种微创技术，可在体弱患者群体（疾病、年龄）中作为门诊手术进行。
