Radiation Oncology Center, Ofuna Chuo Hospital, Kamakura, Japan.
Department of Radiation Oncology, Saiseikai Yokohamashi Tobu Hospital, Yokohama, Japan.
Acta Oncol. 2020 Aug;59(8):888-894. doi: 10.1080/0284186X.2020.1741679. Epub 2020 Mar 27.
To clarify local control by salvage stereotactic body radiotherapy (SBRT) for recurrent/residual hepatocellular carcinoma (HCC) compared with initial definitive SBRT for local treatment-naïve HCC. We retrospectively investigated HCC patients that received SBRT between July 2005 and December 2017. We classified HCC tumors as the initial definitive SBRT group (Arm-1; initial definitive SBRT, Arm-2; initial definitive planned SBRT following transarterial chemoembolization (TACE)) and salvage SBRT group (Arm-3; salvage SBRT for recurrent/residual tumors after TACE, Arm-4; salvage SBRT for recurrent/residual tumors after radiofrequency ablation (RFA), Arm-5; salvage SBRT for recurrent/residual other than Arm-3 or Arm-4). Local control was evaluated by mRECIST. We reviewed 389 HCC tumors of 323 patients treated by 35-40 Gy/5 fr. The median follow-up time for local recurrence of tumors was 34.8 months (range, 6.5-99.2). The cumulative local recurrence rates at 3 years of Arm-1-5 were 1.4% (95% CI, 0.3-4.4%), 5.0% (95% CI, 1.6-11.5%), 12.4% (95% CI, 5.7-21.9%), 14.8% (95% CI, 3.3-34.3%) and 7.3% (95% CI, 1.9-18.0%), respectively. The cumulative local recurrence rates at 3 years of initial definitive treatment and salvage treatment groups were 2.8% (95% CI, 1.1-5.6%) and 11.1% (95% CI, 6.3-17.3%), respectively (=.004). On multivariate analysis, salvage treatment and the tumor diameter were significant risk factors of local recurrence ( = .02, < .001 respectively). Estimated overall survival at 3 years for all patients in initial definitive treatment and salvage treatment groups were 71.5% (95% CI, 63.4-78.1%) and 66.1% (95% CI, 56.4-74.2%), respectively ( = .20). No treatment-related death caused by SBRT was observed. This analysis showed local control of salvage SBRT for recurrent/residual HCC was significantly worse than that of initial definitive SBRT for local treatment-naïve HCC. However, local control of salvage SBRT was relatively good, and salvage SBRT is one of the favorable treatment options for recurrent/residual HCC.
为了明确挽救性立体定向体放射治疗（SBRT）治疗复发性/残留肝细胞癌（HCC）的局部控制情况，与局部治疗初治的 HCC 初始确定性 SBRT 相比。我们回顾性研究了 2005 年 7 月至 2017 年 12 月期间接受 SBRT 的 HCC 患者。我们将 HCC 肿瘤分为初始确定性 SBRT 组（Arm-1；初始确定性 SBRT、Arm-2；初始确定性计划 SBRT 后经动脉化疗栓塞术（TACE））和挽救性 SBRT 组（Arm-3；TACE 后复发性/残留肿瘤的挽救性 SBRT、Arm-4；射频消融（RFA）后复发性/残留肿瘤的挽救性 SBRT、Arm-5；除 Arm-3 或 Arm-4 之外的其他复发性/残留肿瘤的挽救性 SBRT）。局部控制通过 mRECIST 评估。我们回顾了 323 名患者的 389 个 HCC 肿瘤，接受了 35-40Gy/5fr 的治疗。肿瘤局部复发的中位随访时间为 34.8 个月（范围 6.5-99.2）。Arm-1-5 组的 3 年累积局部复发率分别为 1.4%（95%CI，0.3-4.4%）、5.0%（95%CI，1.6-11.5%）、12.4%（95%CI，5.7-21.9%）、14.8%（95%CI，3.3-34.3%）和 7.3%（95%CI，1.9-18.0%）。初始确定性治疗和挽救性治疗组的 3 年累积局部复发率分别为 2.8%（95%CI，1.1-5.6%）和 11.1%（95%CI，6.3-17.3%）（=0.004）。多变量分析显示，挽救性治疗和肿瘤直径是局部复发的显著危险因素（=0.02，<0.001）。所有患者在初始确定性治疗和挽救性治疗组的 3 年总生存率分别为 71.5%（95%CI，63.4-78.1%）和 66.1%（95%CI，56.4-74.2%）（=0.20）。未观察到因 SBRT 引起的治疗相关死亡。本分析显示，复发性/残留 HCC 挽救性 SBRT 的局部控制明显差于局部治疗初治的 HCC 初始确定性 SBRT。然而，挽救性 SBRT 的局部控制相对较好，挽救性 SBRT 是复发性/残留 HCC 的一种有利治疗选择。
