Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea.
Department of Radiation Oncology, Gachon University Gil Medical Center, Incheon, South Korea.
Radiother Oncol. 2019 Apr;133:1-8. doi: 10.1016/j.radonc.2018.12.025. Epub 2019 Jan 11.
To evaluate the effects of dose escalation by intensity-modulated radiotherapy (IMRT) in liver-directed concurrent chemoradiotherapy for locally advanced Barcelona Clinic Liver Cancer stage C hepatocellular carcinoma (BCLC-C HCC).
During 2005-2016, 637 patients with BCLC-C HCC received RT with concurrent hepatic arterial 5-fluorouracil. Patients were divided into two groups according to the biologically effective doses for a tumor (α/β = 10 Gy): <72 Gy (536 patients) and ≥72 Gy (101 patients). In each group, 128/536 (24%) and 94/101 patients (93%) used IMRT, respectively.
The median follow-up for patients alive at the time of analysis was 36 months (range, 6-159 months). For ≥72 Gy and <72 Gy groups, the median overall survival (OS) was 21 and 13 months, respectively (P = .002). The 1-year local failure-free survival (LFFS) were significantly higher in high-dose group (95% vs. 79%; P < .001). After propensity score matching, high-dose group still had significantly better 1-year OS (62% vs. 51%; P = .03) and 1-year LFFS (95% vs. 78%; P = .008). In the multivariate model, RT dose was an independent predictor of LFFS and OS. The surgical conversion rate was significantly higher in high-dose group (20% vs. 12%, P = .03), with substantially increased median OS among patients who underwent surgery (104 months vs. 11 months; P < .001). There were no significant differences in gastrointestinal bleeding or radiation-induced liver disease.
In liver-directed concurrent chemoradiotherapy, radiation dose escalation by IMRT increased LFFS and OS for locally advanced BCLC-C HCC. It also increased the conversion rate to curative resection, which was attributable to increased OS.
评估强度调制放疗（IMRT）剂量递增在局部晚期巴塞罗那临床肝癌分期 C 期肝细胞癌（BCLC-C HCC）肝定向同步放化疗中的作用。
2005 年至 2016 年，637 例 BCLC-C HCC 患者接受了 RT 联合肝动脉 5-氟尿嘧啶治疗。根据肿瘤的生物有效剂量（α/β=10 Gy）将患者分为两组：<72 Gy（536 例）和≥72 Gy（101 例）。在每组中，分别有 128/536（24%）和 94/101（93%）例患者使用了 IMRT。
在分析时存活患者的中位随访时间为 36 个月（范围 6-159 个月）。对于≥72 Gy 和<72 Gy 组，中位总生存期（OS）分别为 21 和 13 个月（P=0.002）。高剂量组的 1 年局部无失败生存率（LFFS）显著较高（95%比 79%；P<0.001）。在倾向评分匹配后，高剂量组仍具有显著更好的 1 年 OS（62%比 51%；P=0.03）和 1 年 LFFS（95%比 78%；P=0.008）。在多变量模型中，RT 剂量是 LFFS 和 OS 的独立预测因素。高剂量组手术转化率显著较高（20%比 12%；P=0.03），手术患者的中位 OS 明显延长（104 个月比 11 个月；P<0.001）。胃肠道出血或放射性肝损伤无显著差异。
在肝定向同步放化疗中，通过 IMRT 增加放疗剂量可提高局部晚期 BCLC-C HCC 的 LFFS 和 OS。它还增加了根治性切除的转化率，这归因于 OS 的提高。
