Joo Ji Hyeon, Park Jin-Hong, Kim Jin Cheon, Yu Chang Sik, Lim Seok-Byung, Park In Ja, Kim Tae Won, Hong Yong Sang, Kim Kyu-Pyo, Yoon Sang Min, Park Jongmoo, Kim Jong Hoon
Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Department of Colon and Rectal Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
Int J Radiat Oncol Biol Phys. 2017 Nov 15;99(4):876-883. doi: 10.1016/j.ijrobp.2017.07.030. Epub 2017 Jul 31.
To evaluate the effective dose and patterns of recurrence after stereotactic body radiation therapy (SBRT) for hepatic metastases that arise from colorectal cancer.
A cohort of 70 patients with 103 colorectal liver metastases were treated with SBRT at a single institution. The prescribed doses were 45 to 60 Gy in 3 to 4 fractions, but these were modified according to the tolerance of the adjacent normal tissue. To allow for dose comparisons, a biological equivalent dose was calculated.
The median follow-up period was 34.2 months (range, 5.3-121.8 months). The 2-year overall survival and progression-free survival rates were 75% and 35%, respectively. In subgroups, the 2-year local control rates for biological equivalent dose ≤80 Gy (group 1), 100 to 112 Gy (group 2), and ≥132 Gy (group 3) were 52%, 83%, and 89%, respectively. Cox proportional hazards model revealed a significant difference between groups (hazard ratio 0.44, P=.03 for group 2; hazard ratio 0.17, P=.17 for group 3; P=.01 for total). The major pattern of failure was a new liver metastasis out of the SBRT field. There was no grade ≥3 toxicity.
Stereotactic body radiation therapy of liver metastases derived from colorectal cancer offers a locally effective treatment without significant complications. Longer local control can be expected if higher doses are used. Further studies will be needed to compare the efficacies of SBRT with those of surgical resection or radiofrequency ablation.
评估立体定向体部放疗（SBRT）治疗结直肠癌肝转移的有效剂量及复发模式。
在单一机构对70例患者的103处结直肠癌肝转移灶进行了SBRT治疗。处方剂量为45至60 Gy，分3至4次给予，但根据相邻正常组织的耐受性进行了调整。为便于剂量比较，计算了生物等效剂量。
中位随访期为34.2个月（范围5.3 - 121.8个月）。2年总生存率和无进展生存率分别为75%和35%。在亚组中，生物等效剂量≤80 Gy（第1组）、100至112 Gy（第2组）和≥132 Gy（第3组）的2年局部控制率分别为52%、83%和89%。Cox比例风险模型显示组间存在显著差异（第2组风险比0.44，P = 0.03；第3组风险比0.17，P = 0.17；总体P = 0.01）。主要失败模式是SBRT照射野外出现新的肝转移。无3级及以上毒性反应。
立体定向体部放疗治疗结直肠癌肝转移疗效显著，且无明显并发症。使用更高剂量有望获得更长的局部控制时间。需要进一步研究比较SBRT与手术切除或射频消融的疗效。
