Lee Peter, Ma Yunsheng, Zacharias Isabel, Bozorgzadeh Adel, Wilson Sean, Foley Kim, Rava Paul, Masciocchi Mark, Ding Linda, Bledsoe Jacob, Fitzgerald Thomas J, Sioshansi Shirin
University of Massachusetts Medical School, Worcester, Massachusetts.
UMass Memorial Medical Center, Worcester, Massachusetts.
Adv Radiat Oncol. 2020 Apr 9;5(5):889-896. doi: 10.1016/j.adro.2020.01.009. eCollection 2020 Sep-Oct.
Our purpose was to report outcomes in patients with Child-Pugh B or C (CP B/C) hepatocellular carcinoma (HCC) treated with stereotactic body radiation therapy (SBRT).
Patients with HCC suitable for SBRT were prospectively enrolled in the study from 2012 to 2018. Outcomes in patients with CP B/C were analyzed. Cox proportional hazard models were used to compare survival outcomes between baseline CP score and post-SBRT CP score.
Twenty-three patients with CP B/C with a total of 29 HCC tumors were treated with SBRT. Eighty-seven percent of patients were CP B8-C10. Median tumor size was 3.1 cm (range, 1-10 cm). Median dose delivered was 40 Gy in a median of 5 fractions. Eighteen of 23 patients (78.3%) had been previously treated with transarterial chemoembolization. Median follow-up was 14.5 months. Rates of 6- and 12-month local control were 100% and 92.3%, respectively. Six- and 12-month survival rates were 73.9% and 56.5%, respectively. Median survival was 14.5 months overall and 9.2, 22.5, 14.5, and 14.4 months for patients with CP B7, B8, B9, and C10, respectively. No patients exhibited symptoms of classic radiation-induced liver disease. However, 10 patients had CP score progression, with 4 patients (17%) having a ≥2-point increase in CP score by 6 months (or time of censor). There were 7 liver-related deaths, and based on independent review by a hepatologist, 1 of these deaths may have been attributable to SBRT-related liver injury. Fifteen of 23 patients were listed for liver transplant (LT) at the time of SBRT and 9 went on to receive LT with a pathologic complete response rate of 63.6%. Median survival, excluding patients who received LT, was 7.3 months.
SBRT is a reasonable treatment option for carefully selected patients with CP B7-C10. In our small cohort, there was no detectable difference between local control or overall survival and baseline CP score.
我们的目的是报告接受立体定向体部放射治疗（SBRT）的Child-Pugh B或C级（CP B/C）肝细胞癌（HCC）患者的治疗结果。
2012年至2018年，前瞻性纳入适合SBRT的HCC患者。分析CP B/C患者的治疗结果。采用Cox比例风险模型比较基线CP评分与SBRT后CP评分之间的生存结果。
23例CP B/C患者共29个HCC肿瘤接受了SBRT治疗。87%的患者为CP B8-C10。肿瘤中位大小为3.1 cm（范围1-10 cm）。中位给予剂量为40 Gy，分5次给予。23例患者中有18例（78.3%）曾接受过经动脉化疗栓塞治疗。中位随访时间为14.5个月。6个月和12个月的局部控制率分别为100%和92.3%。6个月和12个月的生存率分别为73.9%和56.5%。总体中位生存期为14.5个月，CP B7、B8、B9和C10级患者的中位生存期分别为9.2、22.5、14.5和14.4个月。没有患者出现典型的放射性肝病症状。然而，10例患者出现CP评分进展，4例（17%）患者在6个月（或 censored时间）时CP评分升高≥2分。有7例肝脏相关死亡，经肝病专家独立评估，其中1例死亡可能归因于SBRT相关的肝损伤。23例患者中有15例在SBRT时被列入肝移植（LT）名单，9例接受了LT，病理完全缓解率为63.6%。排除接受LT的患者，中位生存期为7.3个月。
对于精心挑选的CP B7-C10级患者，SBRT是一种合理的治疗选择。在我们的小队列中，局部控制或总生存期与基线CP评分之间没有可检测到的差异。
