Kubo Katsumaro, Kimura Tomoki, Aikata Hiroshi, Takahashi Shigeo, Takeuchi Yuki, Takahashi Ippei, Nishibuchi Ikuno, Murakami Yuji, Chayama Kazuaki, Nagata Yasushi
Department of Radiation Oncology, Hiroshima Prefectural Hospital, Hiroshima, Japan.
Department of Radiation Oncology, Hiroshima University Hospital, Hiroshima, Japan.
Hepatol Res. 2018 Aug;48(9):701-707. doi: 10.1111/hepr.13063. Epub 2018 Mar 23.
To evaluate the long-term outcome of stereotactic body radiotherapy in patients with small hepatocellular carcinoma who were ineligible for resection or ablation therapies.
A total of 65 patients with 74 hepatocellular carcinomas (median tumor size 16 mm) were enrolled in the present study. They were treated with the prescribed dose of 48 Gy in four fractions at the isocenter. We extended the observation period and analyzed long-term outcomes, including overall survival, progression-free survival, local control, and various prognostic factors, in these patients.
The median follow-up period was 41 months for all patients and 62 months for surviving patients. The 3- and 5-year overall survival rates were 56.3% (95% confidence interval, 44.1-68.5%) and 41.4% (95% confidence interval, 28.7-54.1%), respectively. The 3- and 5-year progression-free survival rates were 25.4% (95% confidence interval, 14.0-36.8%) and 10.6% (95% confidence interval, 1.5-19.8%), respectively. The 3- and 5-year local control rates were both 100% (95% confidence interval 100%). Liver toxicities exceeding grade 3 were observed in 15 patients (23.1%). The proportion of patients who had grade ≥3 toxicities did not increase. Adverse effects (grade ≤2) presented as significant prognostic factors of overall survival, while TNM stage (T1N0M0) was a significant prognostic factor of progression-free survival after multivariate analysis.
Stereotactic body radiotherapy was effective for patients with small hepatocellular carcinomas who were ineligible for resection or ablation therapies. The incidence of grade ≥3 adverse effects did not increase, even after longer follow-up times.
评估立体定向体部放射治疗对无法进行手术切除或消融治疗的小肝细胞癌患者的长期疗效。
本研究共纳入65例患者的74个肝细胞癌（肿瘤中位大小为16毫米）。这些患者在等中心接受了48 Gy分4次的处方剂量治疗。我们延长了观察期，并分析了这些患者的长期疗效，包括总生存期、无进展生存期、局部控制率以及各种预后因素。
所有患者的中位随访期为41个月，存活患者为62个月。3年和5年总生存率分别为56.3%（95%置信区间，44.1 - 68.5%）和41.4%（95%置信区间，28.7 - 54.1%）。3年和5年无进展生存率分别为25.4%（95%置信区间，14.0 - 36.8%）和10.6%（95%置信区间，1.5 - 19.8%）。3年和5年局部控制率均为100%（95%置信区间100%）。15例患者（23.1%）出现了超过3级的肝脏毒性。≥3级毒性患者的比例未增加。不良反应（≤2级）是总生存期的显著预后因素，而TNM分期（T1N0M0）是多因素分析后无进展生存期的显著预后因素。
立体定向体部放射治疗对无法进行手术切除或消融治疗的小肝细胞癌患者有效。即使经过更长的随访时间，≥3级不良反应的发生率也未增加。
