经皮射频消融与射波刀治疗初发孤立性肝细胞癌的比较：一项初步研究。
Comparison of percutaneous radiofrequency ablation and CyberKnife(®) for initial solitary hepatocellular carcinoma: A pilot study.
作者信息
Shiozawa Kazue, Watanabe Manabu, Ikehara Takashi, Matsukiyo Yasushi, Kogame Michio, Kishimoto Yui, Okubo Yusuke, Makino Hiroyuki, Tsukamoto Nobuhiro, Igarashi Yoshinori, Sumino Yasukiyo
机构信息
Kazue Shiozawa, Manabu Watanabe, Takashi Ikehara, Yasushi Matsukiyo, Michio Kogame, Yoshinori Igarashi, Yasukiyo Sumino, Division of Gastroenterology and Hepatology, Department of Internal Medicine, Toho University Medical Center, Omori Hospital 6-11-1, Omorinishi, Ota-ku, Tokyo 143-8541, Japan.
出版信息
World J Gastroenterol. 2015 Dec 28;21(48):13490-9. doi: 10.3748/wjg.v21.i48.13490.
AIM
To compare therapeutic outcomes and adverse events in initial solitary hepatocellular carcinoma (HCC) treated with radiofrequency ablation (RFA) and CyberKnife(®).
METHODS
Seventy three consecutive patients with initial solitary HCC treated with RFA (38 patients; RFA group) and CyberKnife(®) (35 patients; CK group) were enrolled in this study. Background factors were compared between the two groups. Local and intrahepatic distant recurrence control, and cumulative survival rates were compared between the two groups. These were determined using the Kaplan-Meier method, and the significance of differences was analyzed by log-rank test. The presence of more grade 3 on CTCAE ver. 4.0 early and late adverse events was investigated.
RESULTS
In background factors, age was significantly higher (P = 0.005) and the tumor diameter was significantly larger (P = 0.001) in the CK group. The 1-year local recurrence control rates were 97.4% and 97.1% in the RFA and CK groups, respectively (P = 0.71); the 1-year intrahepatic distant recurrence control rates were 85.6% and 86.1%, respectively (P = 0.91); and the 1-year cumulative survival rates were 100% and 95.2%, respectively (P = 0.075), showing no significant difference in any rate between the two groups. There were no late adverse event in the RFA group, but 11.4% in the CK group had late adverse events. In the CK group, the Child-Pugh score at 12 mo after treatment was significantly higher than that in the RFA group (P = 0.003) and significantly higher than the score before treatment (P = 0.034).
CONCLUSION
The occurrence of adverse events is a concern, but CyberKnife(®) treatment is likely to become an important option for local treatment of early HCC.
目的
比较射频消融（RFA）和射波刀治疗初发孤立性肝细胞癌（HCC）的治疗效果和不良事件。
方法
本研究纳入73例连续的初发孤立性HCC患者，其中38例接受RFA治疗（RFA组），35例接受射波刀治疗（CK组）。比较两组的背景因素。比较两组的局部和肝内远处复发控制情况以及累积生存率。采用Kaplan-Meier法确定上述指标，并通过对数秩检验分析差异的显著性。调查CTCAE ver. 4.0早期和晚期不良事件中3级及以上不良事件的发生情况。
结果
在背景因素方面，CK组年龄显著更高（P = 0.005），肿瘤直径显著更大（P = 0.001）。RFA组和CK组的1年局部复发控制率分别为97.4%和97.1%（P = 0.71）；1年肝内远处复发控制率分别为85.6%和86.1%（P = 0.91）；1年累积生存率分别为100%和95.2%（P = 0.075），两组各率之间均无显著差异。RFA组无晚期不良事件，而CK组有11.4%发生晚期不良事件。CK组治疗后12个月的Child-Pugh评分显著高于RFA组（P = 0.003），且显著高于治疗前评分（P = 0.034）。
结论
不良事件的发生是一个需要关注的问题，但射波刀治疗可能会成为早期HCC局部治疗的一个重要选择。
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