State Key Laboratory of Oncology in Southern China, Department of Radiation Oncology, Cancer Center, Sun Yat-sen University, Guangzhou, China.
PLoS One. 2013 May 30;8(5):e63864. doi: 10.1371/journal.pone.0063864. Print 2013.
To report the feasibility, efficacy, and toxicity of stereotactic body radiotherapy (SBRT) for the treatment of portal vein tumor thrombosis (PVTT) and/or inferior vena cava tumor thrombosis (IVCTT) in patients with advanced hepatocellular carcinoma (HCC).
Forty-one patients treated with SBRT using volumetric modulated arc therapy (VMAT) for HCC with PVTT/IVCTT between July 2010 and May 2012 were analyzed. Of these, 33 had PVTT and 8 had IVCTT. SBRT was designed to target the tumor thrombosis and deliver a median total dose of 36 Gy (range, 30-48 Gy) in six fractions during two weeks.
The median follow-up was 10.0 months. At the time of analysis, 15 (36.6%) achieved complete response, 16 (39.0%) achieved partial response, 7 (17.1%) patients were stable, and three (7.3%) patients showed progressive disease. No treatment-related Grade 4/5 toxicity was seen within three months after SBRT. One patient had Grade 3 elevation of bilirubin. The one-year overall survival rate was 50.3%, with a median survival of 13.0 months. The only independent predictive factor associated with better survival was response to radiotherapy.
VMAT-based SBRT is a safe and effective treatment option for PVTT/IVCTT in HCC. Prospective randomized controlled trials are warranted to validate the role of SBRT in these patients.
报道立体定向体部放疗（SBRT）治疗晚期肝细胞癌（HCC）合并门静脉癌栓（PVTT）和/或下腔静脉癌栓（IVCTT）的可行性、疗效和毒性。
分析了 2010 年 7 月至 2012 年 5 月期间采用容积旋转调强放疗（VMAT）治疗 HCC 合并 PVTT/IVCTT 的 41 例患者。其中 33 例有 PVTT，8 例有 IVCTT。SBRT 的设计目标是肿瘤血栓，并在两周内分 6 次给予中位总剂量 36Gy（范围 30-48Gy）。
中位随访时间为 10.0 个月。在分析时，15 例（36.6%）完全缓解，16 例（39.0%）部分缓解，7 例（17.1%）患者病情稳定，3 例（7.3%）患者病情进展。SBRT 后 3 个月内未见治疗相关 4/5 级毒性。1 例患者出现胆红素 3 级升高。一年总生存率为 50.3%，中位生存时间为 13.0 个月。唯一与生存相关的独立预测因素是对放疗的反应。
基于 VMAT 的 SBRT 是 HCC 合并 PVTT/IVCTT 的一种安全有效的治疗选择。需要前瞻性随机对照试验来验证 SBRT 在这些患者中的作用。
