Departmentof Radiation Oncology, University Medical Center Freiburg, Robert-Koch-Str. 3, 79106, Freiburg im Breisgau, Germany.
University Medical Center Freiburg, Freiburg, Germany.
Strahlenther Onkol. 2019 Mar;195(3):246-253. doi: 10.1007/s00066-018-1385-0. Epub 2018 Oct 23.
To evaluate the feasibility and toxicity profile of repeated stereotactic body radiotherapy (SBRT) for recurrent primary or secondary liver tumors.
Consecutive patients with primary (hepatocellular carcinoma [HCC] or cholangiocarcinoma [CCC]) or secondary liver cancer (LM), with intrahepatic recurrence or progression after SBRT, underwent re-SBRT in 3 to 12 fractions with a median time of 15 (range 2-66) months between treatments.
In all, 24 patients which were previously treated with SBRT (30 lesions) were retreated with SBRT for "in- and out-of-field" recurrences (2nd SBRT: n = 28, 3rd SBRT: n = 2). The median follow-up after re-irradiation was 14 months. The median prescribed dose for the first SBRT was 46.5 (range 33-66 Gy, EQD2 = 70.5) Gy and 48 (range 27-66 Gy, EQD2 = 71) Gy for the re-SBRT. The median mean liver dose (D) was 6 Gy (range 1-25, EQD2 = 7 Gy) for the first SBRT and 10 Gy (range 1-63 Gy, EQD2 = 9 Gy) for the re-SBRT. Of the 30 re-irradiated lesions 6 were re-irradiated in-field resulting in a median EQD2 of 359 (range 120-500) Gy for both treatments, with an α/β = 2 to account for liver parenchyma. Treatment was well tolerated. Two patients with stent placement before SBRT developed cholangitis 4 and 14 months after re-SBRT. There were no elevations of the serum liver parameters after re-SBRT. One patient developed a grade 3 gastrointestinal bleeding. There was no radiation induced liver disease (RILD) observed.
Repeated liver SBRT is feasible, without excessive liver toxicity, when there is no considerable overlapping with pre-irradiated portions of the stomach or bowel and enough time for the liver to regenerate.
评估复发原发性或继发性肝癌多次立体定向体放射治疗（SBRT）的可行性和毒性概况。
连续入组的原发性（肝细胞癌 [HCC] 或胆管细胞癌 [CCC]）或继发性肝癌（LM）患者，在 SBRT 后出现肝内复发或进展，在 3 至 12 次分割中进行再 SBRT，两次治疗之间的中位时间为 15 个月（范围 2-66 个月）。
总共 24 名患者先前接受过 SBRT（30 个病灶），因“靶内和靶外”复发而接受 SBRT 再治疗（第 2 次 SBRT：n = 28，第 3 次 SBRT：n = 2）。再放疗后中位随访时间为 14 个月。首次 SBRT 的中位处方剂量为 46.5（范围 33-66 Gy，EQD2 = 70.5）Gy，再 SBRT 的中位处方剂量为 48（范围 27-66 Gy，EQD2 = 71）Gy。首次 SBRT 的中位平均肝脏剂量（D）为 6 Gy（范围 1-25，EQD2 = 7 Gy），再 SBRT 的中位平均肝脏剂量为 10 Gy（范围 1-63 Gy，EQD2 = 9 Gy）。30 个再照射病灶中有 6 个在靶内再照射，两次治疗的中位 EQD2 为 359（范围 120-500）Gy，考虑到肝实质的 α/β = 2。治疗耐受性良好。两名在 SBRT 前放置支架的患者在再 SBRT 后 4 个月和 14 个月时出现胆管炎。再 SBRT 后血清肝脏参数无升高。1 例发生 3 级胃肠道出血。未观察到放射性肝损伤（RILD）。
当没有与胃或肠的预先照射部分有明显重叠，并且肝脏有足够的时间再生时，多次肝脏 SBRT 是可行的，且不会引起肝毒性。
