Schoenberg Markus, Khandoga Andrey, Stintzing Sebastian, Trumm Christoph, Schiergens Tobias Simon, Angele Martin, Op den Winkel Mark, Werner Jens, Muacevic Alexander, Rentsch Markus
Department of General, Visceral and Transplantation Surgery, Hospital of the University of Munich.
Surgery, Ludwig Maximilian University of Munich.
Cureus. 2016 Apr 28;8(4):e591. doi: 10.7759/cureus.591.
CyberKnife radiosurgery (CK) is an effective tool for the treatment of malignancies. Its greatest potential is in high-dose radiosurgery delivered to targets in organs that move with respiration, e.g., liver tumors. For hepatocellular carcinoma (HCC), however, surgical treatment (resection, transplantation) is most likely to produce long-term survival; for non-resectable tumors, therapies other than radiosurgery are typically recommended. This study evaluated the long-lasting anti-tumor effects of CK combined with surgery in patients with HCC. MATERIALS AND METHODS : Eighteen patients (three women, 15 men) were included in this prospective observational study. They received 21 single-fraction CK treatments (26 Gy). Patient characteristics, treatment effects, tumor response (according to the Response Evaluation Criteria In Solid Tumors (RECIST) grading) and survival were measured for a median period of 29 months.
Local tumor control was achieved in 15 patients, with complete and partial remission observed in 10 and five patients, respectively. One patient was treated for two separate lesions in one session, and one received three treatments each separated by two-year intervals; both patients are tumor-free. Two patients showed minimal response, and in one patient local tumor viability could not be excluded by MRI. Nine patients had HCC recurrence, all distant to the treated site. Nine patients died during follow-up, including two with clear relation to tumor progress. Tumor-free survival was 79.4% after one year and 29.8% after three years, and the corresponding overall survival was 84.8% and 66%. CONCLUSION : This study shows the high effectiveness of single-session frameless CyberKnife radiosurgery for treatment of hepatocellular carcinoma and reconfirms previous results of fractioned radiotherapy of HCC. It also demonstrates the potential of radiosurgery to be combined with surgical concepts.
射波刀放射外科手术（CK）是治疗恶性肿瘤的有效工具。其最大潜力在于对随呼吸运动的器官中的靶点进行高剂量放射外科治疗，例如肝肿瘤。然而，对于肝细胞癌（HCC），手术治疗（切除、移植）最有可能实现长期生存；对于不可切除的肿瘤，通常推荐放射外科手术以外的其他治疗方法。本研究评估了CK联合手术对HCC患者的长期抗肿瘤效果。
本前瞻性观察性研究纳入了18例患者（3名女性，15名男性）。他们接受了21次单次分割的CK治疗（26 Gy）。对患者特征、治疗效果、肿瘤反应（根据实体瘤疗效评价标准（RECIST）分级）和生存情况进行了为期29个月的中位时间测量。
15例患者实现了局部肿瘤控制，分别有10例和5例患者观察到完全缓解和部分缓解。1例患者在一次治疗中针对两个不同病灶进行了治疗，1例患者接受了三次治疗，每次治疗间隔两年；这两名患者均无肿瘤。2例患者反应轻微，1例患者的MRI检查不能排除局部肿瘤存活。9例患者出现HCC复发，均为远离治疗部位的远处复发。9例患者在随访期间死亡，其中2例与肿瘤进展有明确关系。一年后的无瘤生存率为79.4%，三年后的无瘤生存率为29.8%，相应的总生存率分别为84.8%和66%。
本研究表明单次无框架射波刀放射外科手术治疗肝细胞癌具有很高的有效性，并再次证实了先前肝细胞癌分次放疗的结果。它还展示了放射外科手术与手术理念相结合的潜力。
