Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Republic of Korea.
Department of Radiation Oncology, National Taiwan University Hospital, Taipei City, Taiwan.
Int J Radiat Oncol Biol Phys. 2021 Feb 1;109(2):464-473. doi: 10.1016/j.ijrobp.2020.09.038. Epub 2020 Nov 20.
Despite the worldwide implementation of stereotactic body radiation therapy (SBRT) for hepatocellular carcinoma (HCC), there is a lack of consensus guideline on prescription dose. Herein, this multinational study aimed to investigate the effects of the prescribed radiation dose on oncologic outcomes of SBRT for HCC.
The multi-institutional retrospective cohort included 510 patients treated with SBRT between 2010 and 2016. All relevant clinical factors and factors related to SBRT were analyzed to evaluate freedom from local progression (FFLP) and overall survival (OS). Based on a biologically effective dose (BED) cutoff value of 100 Gy, 198 tumors were selected from each group in propensity score matching (PSM).
Baseline characteristics in the BED <100 Gy group were unfavorable (Child-Pugh class B, 19%; advanced stage, 72%; median tumor size was 4 cm) compared with the BED ≥100 Gy group. With a median follow-up of 22 (interquartile range, 9.8-37.6) months, the 2-year FFLP and OS rates were 77% and 73%, respectively. Patients treated with a BED ≥100 Gy showed better rates of 2-year FFLP and OS than patients treated with a BED <100 Gy (FFLP, 89% vs 69%; OS, 80% vs 67%; P < .001). In the multivariable analysis before and after PSM, BED ≥100 Gy was identified as the main prognostic factor for both FFLP and OS (P < .01). Additionally, a dose-response relationship was observed between FFLP and BED (odds ratio, 0.92 per 5 Gy, P = .048).
A BED ≥100 Gy was significantly associated with outcomes, and a dose-response relationship was observed between local tumor progression and BED. Given that SBRT is being increasingly used in HCC, detailed consensus guidelines regarding SBRT dose prescription should be established.
尽管全世界都在实施立体定向体部放射治疗（SBRT）治疗肝细胞癌（HCC），但对于处方剂量仍缺乏共识指南。本研究旨在调查 HCC 的 SBRT 中规定剂量对肿瘤学结果的影响。
多机构回顾性队列纳入了 2010 年至 2016 年期间接受 SBRT 治疗的 510 例患者。分析所有相关临床因素和与 SBRT 相关的因素，以评估无局部进展（FFLP）和总生存率（OS）。基于生物有效剂量（BED）截断值 100Gy，在倾向评分匹配（PSM）中从每组中选择 198 个肿瘤。
BED<100Gy 组的基线特征较差（Child-Pugh 分级 B，19%；晚期，72%；中位肿瘤大小为 4cm）与 BED≥100Gy 组相比。中位随访 22（四分位距，9.8-37.6）个月后，2 年 FFLP 和 OS 率分别为 77%和 73%。BED≥100Gy 组的患者 2 年 FFLP 和 OS 率优于 BED<100Gy 组（FFLP，89% vs 69%；OS，80% vs 67%；P<0.001）。在 PSM 前后的多变量分析中，BED≥100Gy 被确定为 FFLP 和 OS 的主要预后因素（P<0.01）。此外，还观察到 FFLP 与 BED 之间存在剂量反应关系（优势比，每 5Gy 为 0.92，P=0.048）。
BED≥100Gy 与结果显著相关，并且局部肿瘤进展与 BED 之间存在剂量反应关系。鉴于 SBRT 在 HCC 中的应用越来越广泛，应制定关于 SBRT 剂量处方的详细共识指南。
