Department of Radiation Oncology, Soonchunhyang University College of Medicine, Bucheon, Korea.
Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Cancer Res Treat. 2019 Oct;51(4):1589-1599. doi: 10.4143/crt.2018.687. Epub 2019 Apr 10.
There is limited data on radiotherapy (RT) for hepatocellular carcinoma (HCC) in patients with Child-Pugh classification B (CP-B). This study aimed to evaluate the treatment outcomes of fractionated conformal RT in HCC patients with CP-B.
We retrospectively reviewed the data of HCC patients with CP-B treated with RT between 2009 and 2014 at 13 institutions in Korea. HCC was diagnosed by the Korea guideline of 2009, and modern RT techniques were applied. Fraction size was ≤ 5 Gy and the biologically effective dose (BED) ≥ 40 Gy10 (α/β = 10 Gy). A total of 184 patients were included in this study.
Initial CP score was seven in 62.0% of patients, eight in 31.0%, and nine in 7.0%. Portal vein tumor thrombosis was present in 66.3% of patients. The BED ranged from 40.4 to 89.6 Gy10 (median, 56.0 Gy10). After RT completion, 48.4% of patients underwent additional treatment. The median overall survival (OS) was 9.4 months. The local progression-free survival and OS rates at 1 year were 58.9% and 39.8%, respectively. In the multivariate analysis, non-classic radiation-induced liver disease (RILD) (p < 0.001) and additional treatment (p < 0.001) were the most significant prognostic factors of OS. Among 132 evaluable patients without progressive disease, 19.7% experienced non-classic RILD. Normal liver volume was the most predictive dosimetric parameter of non-classic RILD.
Fractionated conformal RT showed favorable OS with a moderate risk non-classic RILD. The individual radiotherapy for CP-B could be cautiously applied weighing the survival benefits and the RILD risks.
对于 Child-Pugh 分类为 B（CP-B）的肝细胞癌（HCC）患者，放射治疗（RT）的数据有限。本研究旨在评估 CP-B 型 HCC 患者接受分割适形 RT 的治疗结果。
我们回顾性分析了 2009 年至 2014 年韩国 13 家机构接受 RT 治疗的 CP-B 型 HCC 患者的数据。HCC 按照 2009 年韩国指南诊断，采用现代 RT 技术。分割剂量≤5Gy，生物有效剂量（BED）≥40Gy10（α/β=10Gy）。本研究共纳入 184 例患者。
初诊时 CP 评分 7 分占 62.0%，8 分占 31.0%，9 分占 7.0%。66.3%的患者存在门静脉癌栓。BED 范围为 40.4 至 89.6Gy10（中位数 56.0Gy10）。RT 完成后，48.4%的患者接受了额外治疗。中位总生存期（OS）为 9.4 个月。1 年局部无进展生存率和 OS 率分别为 58.9%和 39.8%。多因素分析显示，非经典放射性肝损伤（RILD）（p<0.001）和额外治疗（p<0.001）是 OS 的最重要预后因素。在 132 例无进展疾病的可评估患者中，19.7%发生非经典 RILD。正常肝体积是预测非经典 RILD 的最具预测性的剂量学参数。
分割适形 RT 显示出良好的 OS 结果，同时具有中度非经典 RILD 风险。对于 CP-B 患者，可以谨慎地应用个体化放疗，权衡生存获益和 RILD 风险。
