Lo Cheng-Hsiang, Huang Wen-Yen, Lin Kuen-Tze, Lin Miao-Jung, Lin Te-Pao, Jen Yee-Min
Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
J Gastroenterol Hepatol. 2014 Nov;29(11):1919-25. doi: 10.1111/jgh.12659.
This study aimed to evaluate the outcomes and toxicities of repeated stereotactic ablative radiotherapy (SABR) in hepatocellular carcinoma (HCC).
Fourteen HCC patients with local recurrence (18 lesions) after liver SABR received repeated radiotherapy with SABR using CyberKnife. No patients experienced radiation-induced liver disease after the first SABR course. The median first SABR dose was 41 Gy (range, 34-60 Gy); the median second SABR dose, 40 Gy (range, 25-50 Gy); and the median interval, 12.9 months. Local recurrence was divided into in-field recurrence and out-field recurrence.
Objective responses were observed in 11 tumors (61.1%), including five tumors (27.8%) with complete responses. Intrahepatic out-field failure was the main cause of treatment failure (7 of 14 patients). In-field failure had developed in 1 of 18 tumors (5.6%), resulting in a 2-year in-field failure-free rate of 88.2%. The median time to progression was 14.0 months, with 1- and 2-year progression-free survival rates of 68.6% and 42.9%, respectively. One- and two-year overall survival rates were 76% and 59.1%, respectively. Of the 14 patients, one developed radiation-induced liver disease and three showed progression of the Child-Turcotte-Pugh class after the second SABR course. Other toxicities were generally mild and tolerable.
Repeated SABR in selected HCC patients is feasible with acceptable toxicity.
本研究旨在评估重复立体定向消融放疗（SABR）治疗肝细胞癌（HCC）的疗效和毒性。
14例肝细胞癌患者在肝脏SABR治疗后出现局部复发（共18个病灶），接受了射波刀重复SABR放疗。首次SABR疗程后，无患者发生放射性肝病。首次SABR的中位剂量为41 Gy（范围34 - 60 Gy）；第二次SABR的中位剂量为40 Gy（范围25 - 50 Gy）；中位间隔时间为12.9个月。局部复发分为野内复发和野外复发。
11个肿瘤（61.1%）观察到客观反应，其中5个肿瘤（27.8%）完全缓解。肝内野外失败是治疗失败的主要原因（14例患者中有7例）。18个肿瘤中有1个（5.6%）发生野内失败，导致2年野内无失败率为88.2%。中位进展时间为14.0个月，1年和2年无进展生存率分别为68.6%和42.9%。1年和2年总生存率分别为76%和59.1%。14例患者中，1例在第二次SABR疗程后发生放射性肝病，3例Child-Turcotte-Pugh分级进展。其他毒性一般较轻且可耐受。
对选定的HCC患者进行重复SABR是可行的，毒性可接受。
