Department of Radiation Oncology, University of Arizona College of Medicine, Tucson, Arizona.
Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin.
Cancer Med. 2019 Mar;8(3):928-938. doi: 10.1002/cam4.1948. Epub 2019 Jan 31.
Stereotactic body radiation therapy (SBRT) is an emerging option for unresectable hepatocellular carcinoma (HCC) without consensus regarding optimal dose schemas. This analysis identifies practice patterns and factors that influence dose selection and overall survival, with particular emphasis on dose and tumor size.
MATERIALS/METHODS: Query of the National Cancer Database (NCDB) identified patients with unresectable, nonmetastatic HCC who received SBRT from 2004 to 2013. Biological Effective Dose (BED) was calculated for each patient in order to uniformly analyze different fractionation regimens.
A total of 456 patients met the inclusion criteria. The median BED was 100 Gy (22.5-208.0), which corresponded to the most common dose fractionation (50 Gy in five fractions). Various factors influenced dose selection including tumor size (P < 0.001), tumor stage (P = 0.002), and facility case volume (<0.001). On multivariate analysis, low BED (<75 Gy, HR 2.537, P < 0.001; 75-100 Gy, HR 1.986, P = 0.007), increasing tumor size (HR 1.067, P = 0.032), elevated AFP (HR 1.585, P = 0.019), stage 3 (HR 1.962, P < 0.001), low-volume facilities (1-5 cases HR 1.687, P = 0.006), and a longer time interval from diagnosis to SBRT (>2 to ≤4 months, HR 1.456, P = 0.048; >4 months, HR 2.192, P < 0.001) were associated with worse survival.
SBRT use is increasing for HCC, and multiple regimens are clinically employed. Although high BED was associated with improved outcomes, multiple factors contributed to the dose selection with favorable patients receiving higher doses. Continued efforts to enhance radiation planning and delivery may help improve utilization, safety, and efficacy.
立体定向体部放射治疗（SBRT）是一种治疗不可切除肝癌（HCC）的新兴方法，但对于最佳剂量方案尚未达成共识。本分析旨在确定影响剂量选择和总生存期的实践模式和因素，尤其侧重于剂量和肿瘤大小。
材料/方法：通过查询国家癌症数据库（NCDB），确定了 2004 年至 2013 年间接受 SBRT 治疗的不可切除、非转移性 HCC 患者。为了统一分析不同分割方案，对每位患者进行了生物有效剂量（BED）计算。
共纳入 456 例患者。中位 BED 为 100Gy（22.5-208.0），对应最常见的剂量分割（50Gy/5 次）。各种因素影响剂量选择，包括肿瘤大小（P<0.001）、肿瘤分期（P=0.002）和治疗机构的病例量（<0.001）。多因素分析显示，低 BED（<75Gy，HR 2.537，P<0.001；75-100Gy，HR 1.986，P=0.007）、肿瘤增大（HR 1.067，P=0.032）、甲胎蛋白升高（HR 1.585，P=0.019）、分期 3 期（HR 1.962，P<0.001）、低病例量机构（1-5 例 HR 1.687，P=0.006）以及从诊断到 SBRT 的时间间隔较长（>2 至≤4 个月 HR 1.456，P=0.048；>4 个月 HR 2.192，P<0.001）与生存率降低相关。
SBRT 治疗 HCC 的应用日益增多，且有多种方案可供临床选择。尽管高 BED 与改善预后相关，但多个因素影响了剂量选择，有利患者接受较高剂量。持续努力提高放射计划和治疗效果可能有助于提高利用率、安全性和疗效。
