Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University Health System, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 120-752, Republic of Korea.
J Cancer Res Clin Oncol. 2014 Sep;140(9):1595-605. doi: 10.1007/s00432-014-1697-0. Epub 2014 May 9.
To investigate whether image-guided intensity-modulated radiation therapy (IG-IMRT) improves survival in hepatocellular carcinoma (HCC) relative to 3-dimensional conformal radiotherapy (3D-CRT).
Between 2006 and 2011, 187 HCC patients treated with definitive RT were reviewed. Median age was 53(range 51-83). All patients were stage III or IV-A. Concurrent chemoradiation was received by 178 patients (95.2 %). Overall actuarial survival (OS), progression-free survival (PFS), and infield-failure-free survival (IFFS) analyses were performed by Kaplan-Meier method. A Cox proportional hazards model was used for univariate and multivariate analysis. Pearson's chi-square test or Fisher's exact test was used to compare patient characteristics and treatment-related toxicity between the groups.
Sixty-five patients were treated with IG-IMRT and 122 patients with 3D-CRT. No significant differences were seen between the groups for all patient characteristics. IG-IMRT delivered higher doses than 3D-CRT (median biological effective dose 62.5 vs 53.1 Gy, P < 0.001). IG-IMRT showed significantly higher 3-year OS (33.4 vs 13.5 %, P < 0.001), PFS (11.1 vs 6.0 %, P = 0.004), and IFFS (46.8 vs 28.2 %, P = 0.007) than 3D-CRT. On univariate and multivariate analysis, RT modality was significant prognostic factor for OS (HR 2.18; 95 % CI 1.45-3.25; P < 0.001), PFS (HR 1.64; 95 % CI 1.17-2.29; P = 0.004). There was no significant difference between the two modalities for radiation-induced liver disease (P = 0.716).
Our findings suggest that IG-IMRT could be an effective treatment that provides survival benefit without increasing severe toxicity in locally advanced HCC.
研究图像引导调强放疗（IG-IMRT）是否优于三维适形放疗（3D-CRT），从而提高肝癌（HCC）患者的生存率。
回顾性分析了 2006 年至 2011 年间 187 例接受根治性放疗的 HCC 患者。中位年龄为 53 岁（范围 51-83 岁）。所有患者均为 III 期或 IV-A 期。178 例（95.2%）患者接受同期放化疗。采用 Kaplan-Meier 法进行总生存率（OS）、无进展生存率（PFS）和场内失败无进展生存率（IFFS）分析。采用 Cox 比例风险模型进行单因素和多因素分析。采用 Pearson's chi-square 检验或 Fisher's exact 检验比较两组患者的特征和与治疗相关的毒性。
65 例患者接受 IG-IMRT 治疗，122 例患者接受 3D-CRT 治疗。两组患者的所有特征均无显著差异。IG-IMRT 组的生物有效剂量（median biological effective dose，BED）明显高于 3D-CRT 组（中位 BED 为 62.5 Gy 与 53.1 Gy，P<0.001）。IG-IMRT 组的 3 年 OS（33.4%与 13.5%，P<0.001）、PFS（11.1%与 6.0%，P=0.004）和 IFFS（46.8%与 28.2%，P=0.007）明显高于 3D-CRT 组。单因素和多因素分析显示，放疗方式是 OS（HR 2.18；95%CI 1.45-3.25；P<0.001）和 PFS（HR 1.64；95%CI 1.17-2.29；P=0.004）的显著预后因素。两种治疗方式对放射性肝损伤（radiation-induced liver disease，RILD）的影响无显著差异（P=0.716）。
我们的研究结果表明，IG-IMRT 可能是一种有效的治疗方法，在不增加严重毒性的情况下为局部晚期 HCC 患者提供生存获益。
