Takeda Atsuya, Sanuki Naoko, Eriguchi Takahisa, Kobayashi Takashi, Iwabutchi Shogo, Matsunaga Kotaro, Mizuno Tomikazu, Yashiro Kae, Nisimura Shuichi, Kunieda Etsuo
Radiation Oncology Center, Ofuna Chuo Hospital, Kamakura, Kanagawa, Japan; Hepatology and Gastroenterology Center, Ofuna Chuo Hospital, Kamakura, Kanagawa, Japan.
J Gastroenterol Hepatol. 2014 Feb;29(2):372-9. doi: 10.1111/jgh.12350.
Stereotactic ablative body radiotherapy (SABR) is a relatively new treatment for hepatocellular carcinoma (HCC). The outcomes of SABR for previously untreated solitary HCC unfit for ablation and surgical resection were evaluated.
Untreated solitary HCC patients treated with SABR were retrospectively studied. Between 2005 and 2012, 221 HCC patients underwent SABR. Among them, patients with untreated solitary HCC, treated with only SABR or SABR preceded by transarterial chemoembolization, were eligible. Based on baseline liver function and liver volume receiving ≥ 20 Gy, 35-40 Gy in five fractions was prescribed to the planning target volume surface.
Sixty-three patients were eligible, with a median follow-up duration of 31.1 (range 12.0-88.1) months. No patients were lost to follow-up. Twenty patients were treated with only SABR. In 43 patients treated with SABR preceded by transarterial chemoembolization, accumulation of lipiodol in the tumor remained complete in five, a partial defect in 38 on pre-SABR computed tomography. The 1-, 2-, and 3-year local control rates were 100%, 95%, and 92%, respectively; the intrahepatic recurrence-free rates were 76%, 55%, and 36%, respectively; and the overall survival rates were 100%, 87%, and 73%, respectively. Grade 3 laboratory toxicities in the acute, subacute, and chronic phases were observed in 10, 9, and 13 patients, respectively, and ascites occurred in one patient.
Local control and overall survival after SABR for untreated solitary HCC were excellent despite the candidates being unfit for resection and ablation. SABR is safe and might be an alternative to resection and ablation.
立体定向体部消融放疗（SABR）是一种相对较新的肝细胞癌（HCC）治疗方法。本研究评估了SABR治疗先前未接受治疗、不适合消融和手术切除的孤立性HCC的疗效。
对接受SABR治疗的未经治疗的孤立性HCC患者进行回顾性研究。2005年至2012年期间，221例HCC患者接受了SABR治疗。其中，仅接受SABR治疗或在SABR之前接受经动脉化疗栓塞的未经治疗的孤立性HCC患者符合条件。根据基线肝功能和接受≥20 Gy、分五次给予35 - 40 Gy的肝脏体积，将计划靶体积表面的处方剂量设定为35 - 40 Gy，分五次给予。
63例患者符合条件，中位随访时间为31.1（范围12.0 - 88.1）个月。无患者失访。20例患者仅接受SABR治疗。在43例在SABR之前接受经动脉化疗栓塞的患者中，5例患者肿瘤内碘油沉积保持完整，38例在SABR前计算机断层扫描显示部分缺损。1年、2年和3年局部控制率分别为100%、95%和92%；肝内无复发生存率分别为76%、55%和36%；总生存率分别为100%、87%和73%。急性、亚急性和慢性期3级实验室毒性分别在10例、9例和13例患者中观察到，1例患者出现腹水。
尽管这些患者不适合切除和消融，但SABR治疗未经治疗的孤立性HCC后的局部控制和总生存率良好。SABR是安全的，可能是切除和消融的替代方法。
