Que Jenny, Lin Chia-Hui, Lin Li-Ching, Ho Chung-Han
Department of Radiation Oncology, Chi Mei Medical Center.
Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science.
Medicine (Baltimore). 2020 Aug 7;99(32):e21561. doi: 10.1097/MD.0000000000021561.
In this study, we evaluated the feasibility and efficacy of stereotactic body radiation therapy (SBRT) in the treatment of Barcelona Clinic Liver Cancer (BCLC) stage C hepatocellular carcinoma (HCC).This retrospective study evaluated 139 patients with BCLC stage C HCC who underwent CyberKnife SBRT between January 2009 and September 2017. All patients had BCLC-C, Child-Turcotte-Pugh score A-B. In-field control, overall survival (OS), progression free survival (PFS), and prognostic factors were evaluated.An objective response rate was achieved in 81.5% patients (complete response, 36.2%, partial response, 45.3%). The median survival was 15.44 months, and the 1-, 3-, 5-year OS rates were 56%, 28%, and 20%, respectively. The median PFS was 6 months, the PFS rate at 1-, 3-, and 5-year were 35%, 14%, and 10%, respectively. In-field control of 1 to 2 years was achieved in 85.1% of patients. The major pattern of failure was out-field intrahepatic failure which comprised 42.9% of patients. Multivariate analysis revealed that the Child-Turcotte-Pugh score, macrovascular invasion, advance stage (III-IV), and tumor response rate were independent predictors of OS.The result of our study shows that SBRT is a safe and effective therapeutic option for BCLC stage C HCC lesions that are unsuitable for standard loco-regional therapies, Moreover, SBRT has acceptable local control rates and low-treatment toxicity.
在本研究中，我们评估了立体定向体部放射治疗（SBRT）在治疗巴塞罗那临床肝癌（BCLC）C期肝细胞癌（HCC）中的可行性和疗效。这项回顾性研究评估了2009年1月至2017年9月期间接受射波刀SBRT治疗的139例BCLC C期HCC患者。所有患者均为BCLC-C，Child-Turcotte-Pugh评分A - B级。评估了靶区内控制、总生存期（OS）、无进展生存期（PFS）和预后因素。81.5%的患者获得了客观缓解率（完全缓解率为36.2%，部分缓解率为45.3%）。中位生存期为15.44个月，1年、3年、5年总生存率分别为56%、28%和20%。中位无进展生存期为6个月，1年、3年和5年无进展生存率分别为35%、14%和10%。85.1%的患者实现了1至2年的靶区内控制。主要的失败模式是肝外肝内失败，占患者的42.9%。多因素分析显示，Child-Turcotte-Pugh评分、大血管侵犯、晚期（III - IV期）和肿瘤缓解率是总生存期的独立预测因素。我们的研究结果表明，SBRT是治疗不适合标准局部区域治疗的BCLC C期HCC病变的一种安全有效的治疗选择。此外，SBRT具有可接受的局部控制率和低治疗毒性。
