Yuan Zhi-Yong, Meng Mao-Bin, Liu Chun-Lei, Wang Huan-Huan, Jiang Chao, Song Yong-Chun, Zhuang Hong-Qing, Yang Dong, Wang Jing-Sheng, Wei Wang, Li Feng-Tong, Zhao Lu-Jun, Wang Ping
Department of Radiation Oncology, CyberKnife Center, Key Laboratory of Cancer Prevention and Therapy, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center of Cancer, Tianjin, People's Republic of China.
Onco Targets Ther. 2014 Jun 12;7:915-23. doi: 10.2147/OTT.S58409. eCollection 2014.
The aim of this study was to evaluate the efficacy and toxicity of stereotactic body radiation therapy (SBRT) in the treatment of patients with liver metastases. Between August 2006 and July 2011, patients with 1-4 liver metastases were enrolled and treated with SBRT using the CyberKnife(®) system at Tianjin Medical University Cancer Institute and Hospital. The metastases were from different primary tumors, with a maximum tumor diameter of less than 6 cm. The primary endpoint was local control. Secondary endpoints were overall survival, progression-free survival, distant progression-free survival, and adverse events. Fifty-seven patients with 80 lesions were treated with SBRT. The 1-year and 2-year local control rates were 94.4% and 89.7%, respectively. The difference in local control between patients who received adjuvant treatment before SBRT and those who did not reached statistical significance (P=0.049). The median overall survival for the entire cohort was 37.5 months. According to the primary tumor sites, the median overall survival was not reached. The 2-year overall survival rate was 72.2% in the favorable group (primary tumors originating from the colon, breast, or stomach, as well as sarcomas); however, in the unfavorable group (primary tumors originating from the pancreas, lung, ovary, gallbladder, uterus, hepatocellular carcinoma, as well as olfactory neuroblastoma), the median overall survival and 2-year overall survival rates were 37.5 months and 55.9%, respectively (P=0.0001). Grade 1-2 fatigue, nausea, and vomiting were the most common adverse events, and no grade 3 and higher adverse events were observed. With excellent local control in the absence of severe toxicity, SBRT provides an alternative for patients with 1-4 liver metastases who cannot undergo surgery or other treatments.
本研究旨在评估立体定向体部放射治疗（SBRT）对肝转移患者的疗效和毒性。2006年8月至2011年7月，天津医科大学肿瘤医院收治了1 - 4个肝转移灶的患者，并使用射波刀（CyberKnife®）系统进行SBRT治疗。转移灶来自不同的原发肿瘤，最大肿瘤直径小于6 cm。主要终点是局部控制。次要终点是总生存期、无进展生存期、远处无进展生存期和不良事件。57例患者的80个病灶接受了SBRT治疗。1年和2年局部控制率分别为94.4%和89.7%。SBRT前接受辅助治疗和未接受辅助治疗的患者在局部控制方面的差异具有统计学意义（P = 0.049）。整个队列的中位总生存期为37.5个月。根据原发肿瘤部位，中位总生存期未达到。在有利组（原发肿瘤起源于结肠、乳腺、胃以及肉瘤）中，2年总生存率为72.2%；然而，在不利组（原发肿瘤起源于胰腺、肺、卵巢、胆囊、子宫、肝细胞癌以及嗅神经母细胞瘤）中，中位总生存期和2年总生存率分别为37.5个月和55.9%（P = 0.0001）。1 - 2级疲劳、恶心和呕吐是最常见的不良事件，未观察到3级及以上不良事件。SBRT在无严重毒性的情况下具有出色的局部控制效果，为无法接受手术或其他治疗的1 - 4个肝转移患者提供了一种替代方案。
