立体定向体部放射治疗肝细胞癌后肝毒性的前瞻性队列研究。

A prospective cohort study of hepatic toxicity after stereotactic body radiation therapy for hepatocellular carcinoma.

机构信息

Department of Radiation Oncology, Affiliated Tumor Hospital of Guangxi Medical University, Nanning, China; Department of Radiation Oncology, Rui Kang Hospital, Guangxi Traditional Chinese Medical University, Nanning, China.

Department of Radiation Oncology, University Hospital Freiburg, Germany.

出版信息

Radiother Oncol. 2018 Oct;129(1):136-142. doi: 10.1016/j.radonc.2018.02.031. Epub 2018 Mar 13.

DOI:10.1016/j.radonc.2018.02.031

PMID:29548558

Abstract

PURPOSE

To build and validate multivariate normal tissue complication probability (NTCP) models for radiation-induced hepatic toxicity (RIHT) after stereotactic body radiation therapy (SBRT).

METHODS

Eighty-five patients with hepatocellular carcinoma (HCC) in a phase II clinical trial were enroled. A progression of at least 1 or 2 points in the Child-Pugh (CP) score post-SBRT was classified as RIHT (≥1 or ≥2). NTCP models for RIHT (≥1 or ≥2) were developed using logistic regression. Nomograms for each model were formulated. The cut-off point of each independent dosimetric risk factor was obtained using receiver-operating characteristic (ROC) analysis. We used an independent cohort (101 patients) for model validation.

RESULTS

Twenty (23.5%) and 12 (14.2%) patients experienced RIHT (≥1) and RIHT (≥2), respectively. V, VS, and pretreatment CP (pre-CP) were the optimal predictors for RIHT (≥1 and ≥2) modelling. V ≤33.1% and VS ≥416.2 mL for RIHT (≥1), and V ≤21.5% and VS ≥621.8 mL for RIHT (≥2), were the cut-off points. Four NTCP models and their nomograms were generated. These models and nomograms showed good prediction performance (area under the curve (AUC), 0.83-0.89). Our NTCP model (RIHT ≥2) based on V plus pre-CP performed well (AUC = 0.78) in a validation cohort.

CONCLUSION

V, VS, and pre-CP are crucial predictors for RIHT (≥1 and ≥2). Our NTCP models and nomograms were conducive to obtain individual constraints for patients with HCC.

REGISTRATION NUMBER

ChiCTR-IIC-16008233.

摘要

目的

建立并验证立体定向体部放射治疗（SBRT）后放射性肝毒性（RIHT）的多变量正常组织并发症概率（NTCP）模型。

方法

本研究纳入了一项 II 期临床试验中的 85 例肝细胞癌（HCC）患者。SBRT 后 Child-Pugh（CP）评分至少增加 1 或 2 分被归类为 RIHT（≥1 或≥2）。使用逻辑回归建立 RIHT（≥1 或≥2）的 NTCP 模型。为每个模型制定了列线图。使用受试者工作特征（ROC）分析获得每个独立剂量学风险因素的截断值。我们使用独立队列（101 例患者）进行模型验证。

结果

20 例（23.5%）和 12 例（14.2%）患者分别发生 RIHT（≥1）和 RIHT（≥2）。V、VS 和治疗前 CP（pre-CP）是 RIHT（≥1 和≥2）建模的最佳预测因子。对于 RIHT（≥1），V≤33.1%和 VS≥416.2mL 是截断值；对于 RIHT（≥2），V≤21.5%和 VS≥621.8mL 是截断值。生成了 4 个 NTCP 模型及其列线图。这些模型和列线图具有良好的预测性能（曲线下面积（AUC），0.83-0.89）。在验证队列中，我们的基于 V 和 pre-CP 的 NTCP 模型（RIHT≥2）表现良好（AUC=0.78）。