Tsurugai Yuichiro, Takeda Atsuya, Eriguchi Takahisa, Sanuki Naosko, Aoki Yousuke
Radiation Oncology Center, Ofuna Chuo Hospital, Kamakura, Kanagawa, Japan.
Hepatol Res. 2021 Mar;51(3):294-302. doi: 10.1111/hepr.13590. Epub 2021 Mar 2.
Decisions regarding therapeutic plans for inoperable patients with hepatocellular carcinoma (HCC) adjacent to the gastrointestinal (GI) tract are challenging because radiofrequency ablation has the potential risk of thermal injury. Moreover, the response rate of transcatheter arterial chemoembolization is relatively low and stereotactic body radiotherapy (SBRT) is believed to be too toxic. We have applied hypofractionated radiotherapy (HFRT) for such lesions. This study investigated the outcomes and toxicities of this treatment.
Among consecutive HCC patients treated with radiotherapy with curative intent at our institution between 2015 and 2019, we retrospectively extracted those outside of the indication for SBRT due to exceeding the constraint of the GI tract and who were treated using HFRT with a prescription dose of 42 Gy in 14 fractions and prophylactic proton pump inhibitor administration for 6 months. The oncological outcomes and toxicities were investigated.
A total of 66 patients with 73 lesions were eligible. The median follow-up period was 24.0 months. The local recurrence, intrahepatic recurrence, liver-related death, and overall survival rates at 2 years were 11.3%, 50.6%, 15.9%, and 60.4%, respectively. Six (9.1%) patients experienced Child-Pugh score deterioration ≥2 within 6 months following treatment. Two and one patient developed grades 2 and 3 gastroduodenal bleeding, respectively.
HFRT can achieve good local control in patients with HCC adjacent to the GI tract, with low GI toxicity incidence. Our study demonstrated that HFRT can be a potentially curative treatment option for lesions.
对于与胃肠道（GI）相邻的无法手术的肝细胞癌（HCC）患者，制定治疗方案具有挑战性，因为射频消融存在热损伤的潜在风险。此外，经动脉化疗栓塞的缓解率相对较低，而立体定向体部放疗（SBRT）被认为毒性过大。我们已将低分割放疗（HFRT）应用于此类病变。本研究调查了这种治疗方法的疗效和毒性。
在2015年至2019年期间，在我们机构接受根治性放疗的连续HCC患者中，我们回顾性提取了因超出胃肠道限制而不符合SBRT适应症且接受HFRT治疗的患者，处方剂量为42 Gy分14次给予，并给予6个月的预防性质子泵抑制剂。调查了肿瘤学疗效和毒性。
共有66例患者的73个病灶符合条件。中位随访期为24.0个月。2年时的局部复发、肝内复发、肝脏相关死亡和总生存率分别为11.3%、50.6%、15.9%和60.4%。6例（9.1%）患者在治疗后6个月内Child-Pugh评分恶化≥2分。分别有2例和1例患者发生2级和3级胃十二指肠出血。
HFRT可以在与胃肠道相邻的HCC患者中实现良好的局部控制，胃肠道毒性发生率低。我们的研究表明，HFRT对于此类病灶可能是一种潜在的根治性治疗选择。
