高剂量立体定向体放射治疗可提高不能手术的肝细胞癌患者的局部控制率和总生存率。
High-dose stereotactic body radiotherapy correlates increased local control and overall survival in patients with inoperable hepatocellular carcinoma.
机构信息
Department of Radiation Oncology, Korea Institute of Radiological & Medical Science, Seoul, Republic of Korea.
出版信息
Radiat Oncol. 2013 Oct 27;8:250. doi: 10.1186/1748-717X-8-250.
BACKGROUND
Recent studies using stereotactic body radiotherapy (SBRT) for hepatocellular carcinoma (HCC) have reported high tumor response and local control. However, the optimal SBRT dose remains unknown, and it is still not clear whether a dose response relationship for local control (LC) and overall survival (OS) exist or not. We performed this study to determine whether a dose response relationship for LC and OS is observed in SBRT for inoperable HCC.
METHODS
Between 2003 and 2011, 108 patients with HCC were treated with SBRT. All patients were unsuitable for surgery or local ablation and had incomplete response to transarterial chemoembolization. Eighty-two patients with a longest tumor diameter (LD) less than or equal to 7.0 cm who were treated with 3-fraction SBRT and were analyzed. This cohort comprised 74 Child-Turcotte-Pugh (CTP) class A patients and 8 CTP class B7 patients. The median LD was 3.0 cm (range, 1.0-7.0 cm), and the median dose was 51 Gy (range, 33-60 Gy).
RESULTS
LC and OS rates at 2 years after SBRT were 87% and 63%, respectively, with a median follow-up duration of 30 months for all patients. The 2-year LC/OS rates for patients treated with doses of > 54, 45-54, and < 45 Gy were 100/71, 78/64, and 64%/30%, respectively (p = .009/p < .001). Multivariate analysis revealed that the SBRT dose (p = .005) and Barcelona Clinic Liver Cancer stage (p = .015) were significant prognostic factors for OS. Correlation analysis revealed a positive linear relationship between the SBRT dose and LC (p = .006, R = .899)/OS (p = .002, R = .940) at 2 years. Based on the tumor-control probability model, a dose of 54.8 Gy provides 2-year LC with a 90% probability. Five patients experienced grade 3 or higher gastrointestinal toxicity, and 6 had deteriorating of CTP score by greater than or equal to 2 within 3 months of SBRT.
CONCLUSIONS
This study demonstrated a dose response relationship for LC and OS with SBRT for HCC. Higher LC rates resulting from an increased dose may translate into survival benefits for patients with HCC.
背景
最近使用立体定向体放射疗法（SBRT）治疗肝细胞癌（HCC）的研究报告了高肿瘤反应和局部控制率。然而，最佳 SBRT 剂量仍不清楚，也不清楚局部控制（LC）和总生存（OS）是否存在剂量反应关系。我们进行这项研究是为了确定 SBRT 治疗不可切除 HCC 是否存在 LC 和 OS 的剂量反应关系。
方法
2003 年至 2011 年，108 例 HCC 患者接受 SBRT 治疗。所有患者均不适合手术或局部消融，且经肝动脉化疗栓塞治疗后不完全缓解。对 82 例最长肿瘤直径（LD）≤7.0cm 且接受 3 分次 SBRT 治疗的患者进行分析。该队列包括 74 例 Child-Turcotte-Pugh（CTP）A级患者和 8 例 CTP 级 B7 患者。中位 LD 为 3.0cm（范围 1.0-7.0cm），中位剂量为 51Gy（范围 33-60Gy）。
结果
SBRT 治疗后 2 年 LC 和 OS 率分别为 87%和 63%，所有患者中位随访时间为 30 个月。接受剂量>54Gy、45-54Gy 和<45Gy 的患者 2 年 LC/OS 率分别为 100/71%、78/64%和 64%/30%（p=0.009/p<0.001）。多因素分析显示，SBRT 剂量（p=0.005）和巴塞罗那临床肝癌分期（p=0.015）是 OS 的显著预后因素。相关性分析显示，SBRT 剂量与 LC（p=0.006，R=0.899）/OS（p=0.002，R=0.940）在 2 年时呈正线性关系。基于肿瘤控制概率模型，54.8Gy 的剂量可提供 2 年 LC 的 90%概率。5 例患者出现 3 级或以上胃肠道毒性，6 例患者在 SBRT 后 3 个月内 CTP 评分恶化≥2 级。
结论
本研究表明 HCC 的 SBRT 存在 LC 和 OS 的剂量反应关系。较高的剂量可提高 LC 率，从而可能使 HCC 患者受益。
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