Department of Clinical Oncology, Tuen Mun Hospital, Hong Kong, China.
Department of Clinical Oncology, University of Hong Kong, Hong Kong, China.
Strahlenther Onkol. 2019 Mar;195(3):254-264. doi: 10.1007/s00066-018-1391-2. Epub 2018 Nov 9.
We retrospectively evaluated the efficacy and safety of stereotactic body radiotherapy (SBRT) combined with trans-arterial chemoembolization (TACE) as initial therapy in Barcelona Clinic Liver Cancer (BCLC) system stage B-C hepatocellular carcinoma (HCC).
Seventy-two patients received a single dose of TACE followed by SBRT 4 weeks later. All patients had tumor sizes ≥5 cm, at least 700 ml of disease-free liver, Child-Pugh (CP) score ≤ B7 and tumor nodules ≤5. SBRT dose, ranging from 6 × 5-8 Gy or 5-10 × 4 Gy, was individualized according to normal tissue constraints. No subsequent scheduled treatment was delivered unless disease progression was observed. Local control (LC), overall survival (OS), progression-free survival (PFS), response rate (RR), and toxicity were evaluated.
The patients' characteristics were: median age 60 years (range 28-87 years); CP score A/B (n = 68/4); BCLC stage B/C (n = 51/21); solitary/multifocal (n = 37/35); portal vein invasion (n = 18). The median tumor size and GTV were 11.2 cm (range 5.0-23.6 cm) and 751 cm (range 41-4009 cm), respectively. The median equivalent dose in 2 Gy per fraction (EQD2, α/β = 10) was 37.3 Gy2 (range, 28-72 Gy2). The median follow-up time was 16.8 months (range, 3-96 months). The objective RR was 68% and the 1‑year LC rate was 93.6% (95% CI, 87.6-100%). The median OS was 19.8 months (95% CI, 11.6-30.6 months). SBRT-related grade 3 or higher adverse gastrointestinal events and treatment-related death occurred in three (2.8%) and one patient (1.4%) respectively. No patient developed classical radiation-induced liver injury.
Our experience suggests that combined TACE and SBRT can be a safe and effective initial therapy for BCLC stage B-C HCC with appropriate patient selection. Further prospective trials are warranted.
我们回顾性评估了立体定向体部放疗（SBRT）联合经动脉化疗栓塞（TACE）作为巴塞罗那临床肝癌（BCLC）系统 B 期和 C 期肝癌初始治疗的疗效和安全性。
72 例患者接受单次 TACE 治疗，4 周后接受 SBRT。所有患者肿瘤大小均≥5cm，无病肝体积至少 700ml，Child-Pugh（CP）评分≤B7，肿瘤结节数≤5。根据正常组织限制，SBRT 剂量个体化，范围为 6×5-8Gy 或 5-10×4Gy。除非观察到疾病进展，否则不进行后续计划治疗。评估局部控制（LC）、总生存期（OS）、无进展生存期（PFS）、反应率（RR）和毒性。
患者特征为：中位年龄 60 岁（范围 28-87 岁）；CP 评分 A/B（n=68/4）；BCLC 分期 B/C（n=51/21）；单发/多发（n=37/35）；门静脉侵犯（n=18）。中位肿瘤大小和 GTV 分别为 11.2cm（范围 5.0-23.6cm）和 751cm（范围 41-4009cm）。2Gy 等效剂量（EQD2，α/β=10）中位数为 37.3Gy2（范围 28-72Gy2）。中位随访时间为 16.8 个月（范围 3-96 个月）。客观 RR 为 68%，1 年 LC 率为 93.6%（95%CI，87.6-100%）。中位 OS 为 19.8 个月（95%CI，11.6-30.6 个月）。SBRT 相关 3 级或更高胃肠道不良事件和治疗相关死亡分别发生在 3 例（2.8%）和 1 例（1.4%）患者中。无患者发生典型放射性肝损伤。
我们的经验表明，对于适当的患者选择，联合 TACE 和 SBRT 可为 BCLC 期 B-C 肝癌提供一种安全有效的初始治疗方法。需要进一步的前瞻性试验。
