Su Ting-Shi, Liang Ping, Lu Huan-Zhen, Liang Jian, Gao Ying-Chuan, Zhou Ying, Huang Yong, Tang Min-Yang, Liang Jian-Ning
Department of Radiation Oncology, Rui Kang Hospital, Guangxi Traditional Chinese Medical University, Nanning, Guangxi Zhuang Autonomous Region, China.
Cyberknife Center, Rui Kang Hospital, Guangxi Traditional Chinese Medical University, Nanning, Guangxi Zhuang Autonomous Region, China.
J Surg Oncol. 2016 Feb;113(2):181-7. doi: 10.1002/jso.24128. Epub 2015 Dec 14.
To evaluate the efficacy of stereotactic body radiation therapy (SBRT) in small hepatocellular carcinoma (HCC) patients.
From March 2009 to April 2015, we treated 132 small HCC patients with SBRT. Eligibility criteria included longest tumor diameter ≤5.0 cm; Child-Turcotte-Pugh (CTP) Class A or B; unfeasible, difficult or refusal to undergo other surgery or percutaneous ablative therapies; and tumor recurrence after other local treatment. The dose of 42-46 Gy in 3-5 fractions and 28-30 Gy in 1 fraction was prescribed.
Of the treated patients, 114 were classified as CTP A and 18 as CTP B. Median tumor size was range 1.1-5.0 cm. The local control rate at 1 years was 90.9%. OS at 1, 3, and 5 years was 94.1%, 73.5%, and 64.3%, respectively. PFS at 1, 3, and 5 years was 82.7%, 58.3%, and 36.4%, respectively. Hepatic toxicity grade ≥3 was observed in 11 patients. Multivariate analysis revealed that CTP B was associated with worse OS (P < 0.001) and multiple nodules were associated with worse PFS (P = 0.001).
SBRT is a promising alternative treatment for patients with primary or recurrent small HCC who are unsuitable for surgical resection or local ablative therapy.
评估立体定向体部放射治疗（SBRT）对小肝癌（HCC）患者的疗效。
2009年3月至2015年4月，我们对132例小肝癌患者进行了SBRT治疗。入选标准包括肿瘤最长直径≤5.0厘米；Child-Turcotte-Pugh（CTP）分级为A或B级；不可行、困难或拒绝接受其他手术或经皮消融治疗；以及其他局部治疗后肿瘤复发。处方剂量为分3 - 5次给予42 - 46 Gy，或单次给予28 - 30 Gy。
在接受治疗的患者中，114例CTP分级为A，18例为CTP分级为B。肿瘤大小中位数范围为1.1 - 5.0厘米。1年局部控制率为90.9%。1年、3年和5年总生存率分别为94.1%、73.5%和64.3%。1年、3年和5年无进展生存率分别为82.7%、58.3%和36.4%。11例患者观察到≥3级肝毒性。多因素分析显示，CTP分级为B与较差的总生存率相关（P < 0.001），多个结节与较差的无进展生存率相关（P = 0.001）。
对于不适合手术切除或局部消融治疗的原发性或复发性小肝癌患者，SBRT是一种有前景的替代治疗方法。
