Scorsetti Marta, Comito Tiziana, Cozzi Luca, Clerici Elena, Tozzi Angelo, Franzese Ciro, Navarria Pierina, Fogliata Antonella, Tomatis Stefano, D'Agostino Giuseppo, Iftode Cristina, Mancosu Pietro, Ceriani Roberto, Torzilli Guido
Radiotherapy and Radiosurgery, Oncology, Liver Surgery, Hepatology Departments, Humanitas Clinical and Research Center, Rozzano, MI, Italy.
J Cancer Res Clin Oncol. 2015 Jul;141(7):1301-9. doi: 10.1007/s00432-015-1929-y. Epub 2015 Feb 3.
To evaluate the feasibility and efficacy of stereotactic body radiation therapy (SBRT) in the treatment of hepatocellular carcinoma (HCC) unsuitable for standard loco-regional therapies.
Patients with 1-3 inoperable HCC lesions with diameter ≤6 cm were treated by SBRT. According to lesions size and liver function, two prescription regimens were adopted: 48-75 Gy in three fractions or 36-60 Gy in six fractions. SBRT was delivered using the volumetric modulated arc therapy technique with flattening filter-free photon beams. The primary end points of this study were in-field local control (LC) and toxicity. Secondary end points were overall survival (OS) and progression-free survival (PFS).
Forty-three patients with 63 HCC lesions were irradiated. All patients had Child-Turcotte-Pugh class A or B disease. Thirty lesions (48%) were treated with 48-75 Gy in three consecutive fractions, and 33 (52%) received 36-60 Gy in six fractions. Median follow-up was 8 months (range 3-43 months). Actuarial LC at 6, 12 and 24 months was 94.2 ± 3.3, 85.8 ± 5.5 and 64.4 ± 11.5%, respectively. A biological equivalent dose (BED) >100 Gy and GTV size were significant prognostic factors for LC in univariate analysis (p < 0.001 and p < 0.02). Median OS was 18.0 ± 5.8 months. Actuarial OS at 6, 12 and 24 months was 91.1 ± 4.9, 77.9 ± 8.2 and 45.3 ± 14.0%, respectively. Univariate analysis showed that OS is correlated with LC (p < 0.04), BED >100 (p < 0.05) and cumulative gross tumor volume GTV <5 cm (p < 0.04). Median PFS was 8 months, with a 1-year PFS rate of 41%. A significant (≥ grade 3) toxicity was observed in seven patients (16%) 2-6 months after the completion of the treatment. No classic radiation-induced liver disease was observed.
Stereotactic body radiation therapy is a safe and effective therapeutic option for HCC lesions unsuitable to standard loco-regional therapies, with acceptable local control rates and low treatment-related toxicity. The significant correlation between LC and higher doses and between LC and OS supports the clinical value of SBRT in these patients.
评估立体定向体部放射治疗（SBRT）用于治疗不适于标准局部区域治疗的肝细胞癌（HCC）的可行性和疗效。
对1 - 3个直径≤6 cm的不可手术切除的HCC病灶患者采用SBRT治疗。根据病灶大小和肝功能，采用两种处方方案：分三次给予48 - 75 Gy或分六次给予36 - 60 Gy。使用容积调强弧形治疗技术及无均整器光子束进行SBRT治疗。本研究的主要终点是靶区内局部控制（LC）和毒性。次要终点是总生存期（OS）和无进展生存期（PFS）。
43例患者共63个HCC病灶接受了放疗。所有患者的Child - Turcotte - Pugh分级为A或B级。30个病灶（48%）分三次连续给予48 - 75 Gy，33个病灶（52%）分六次给予36 - 60 Gy。中位随访时间为8个月（范围3 - 43个月）。6个月、12个月和24个月的精算局部控制率分别为94.2±3.3%、85.8±5.5%和64.4±11.5%。在单因素分析中，生物等效剂量（BED）>100 Gy和大体肿瘤体积（GTV）大小是局部控制的显著预后因素（p < 0.001和p < 0.02）。中位总生存期为18.0±5.8个月。6个月、12个月和24个月的精算总生存率分别为91.1±4.9%、77.9±8.2%和45.3±14.0%。单因素分析显示，总生存期与局部控制（p < 0.04）、BED>100（p < 0.05）和累积大体肿瘤体积GTV <5 cm（p < 0.04）相关。中位无进展生存期为8个月，1年无进展生存率为41%。7例患者（16%）在治疗结束后2 - 6个月出现显著（≥3级）毒性反应。未观察到典型的放射性肝病。
立体定向体部放射治疗是不适于标准局部区域治疗的HCC病灶的一种安全有效的治疗选择，局部控制率可接受且治疗相关毒性低。局部控制与较高剂量以及局部控制与总生存期之间的显著相关性支持了SBRT在这些患者中的临床价值。
