Department of Radiation Oncology, Yonsei Cancer Center, Severance Hospital, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea.
J Radiat Res. 2013 Nov 1;54(6):1069-77. doi: 10.1093/jrr/rrt034. Epub 2013 Apr 30.
Before the sorafenib era, advanced but liver-confined hepatocellular carcinoma (HCC) was treated by liver-directed therapy. Hepatic arterial concurrent chemoradiotherapy (CCRT) has been performed in our group, giving substantial local control but frequent failure. The aim of this study was to analyze patterns of failure and find out predictive clinical factors in HCC treated with a liver-directed therapy, CCRT. A retrospective analysis was done for 138 HCC patients treated with CCRT between May 2001 and November 2009. Protocol-based CCRT was performed with local radiotherapy (RT) and concurrent 5-fluorouracil (5-FU) hepatic arterial infusion chemotherapy (HAIC), followed by monthly HAIC (5-FU and cisplatin). Patterns of failure were categorized into three groups: infield, intrahepatic-outfield and extrahepatic failure. Treatment failure occurred in 34.0% of patients at 3 months after RT. Infield, intrahepatic-outfield and extrahepatic failure were observed in 12 (8.6%), 26 (18.7%) and 27 (19.6%) patients, respectively. Median progression-free survival for infield, outfield and extrahepatic failure was 22.4, 18 and 21.5 months, respectively. For infield failure, a history of pre-CCRT treatment was a significant factor (P = 0.020). Pre-CCRT levels of alpha-fetoprotein and prothrombin induced by vitamin K absence or antagonist-II were significant factors for extrahepatic failure (P = 0.029). Treatment failures after CCRT were frequent in HCC patients, and were more commonly intrahepatic-outfield and extrahepatic failures than infield failure. A history of pre-CCRT treatment and levels of pre-CCRT tumor markers were identified as risk factors that could predict treatment failure. More intensified treatment is required for patients presenting risk factors.
在索拉非尼时代之前，局限于肝脏的晚期肝细胞癌（HCC）采用肝脏定向疗法治疗。我们组曾进行过肝动脉同期放化疗（CCRT），虽然局部控制效果显著，但治疗失败率较高。本研究旨在分析 HCC 采用肝脏定向治疗（CCRT）后的失败模式，并找出预测临床因素。对 2001 年 5 月至 2009 年 11 月期间采用 CCRT 治疗的 138 例 HCC 患者进行回顾性分析。采用局部放疗（RT）联合 5-氟尿嘧啶（5-FU）肝动脉灌注化疗（HAIC）同期进行方案型 CCRT，随后每月进行 HAIC（5-FU 和顺铂）。将失败模式分为三组：瘤内、肝内-瘤外和肝外失败。放疗后 3 个月，有 34.0%的患者发生治疗失败。分别有 12 例（8.6%）、26 例（18.7%）和 27 例（19.6%）患者出现瘤内、肝内-瘤外和肝外失败。瘤内、肝外和肝外失败的中位无进展生存期分别为 22.4、18 和 21.5 个月。对于瘤内失败，CCRT 前治疗史是一个显著因素（P=0.020）。CCRT 前甲胎蛋白和维生素 K 拮抗剂诱导的凝血酶原水平是肝外失败的显著因素（P=0.029）。CCRT 后 HCC 患者的治疗失败较为常见，且肝内-瘤外和肝外失败较瘤内失败更为常见。CCRT 前治疗史和肿瘤标志物水平是预测治疗失败的风险因素。对于存在这些风险因素的患者，需要更强化的治疗。
