Shen Jie, Yan Jing, Zhu Sihui, Kong Weiwei, Zou Zhengyun, Liu Juan, Li Shuangshuang, Liu Baorui
Comprehensive Cancer Centre of Nanjing Drum Tower Hospital, Clinical College of Nanjing Medical University, Nanjing, China.
Comprehensive Cancer Centre of Drum Tower Hospital, Medical School of Nanjing University, Clinical Cancer Institute of Nanjing University, Nanjing, China.
Front Oncol. 2021 May 31;11:559112. doi: 10.3389/fonc.2021.559112. eCollection 2021.
The effects of radiotherapy on hepatocellular carcinoma (HCC) still remain to be further proved. The dose of radiotherapy is generally 2Gy25f. In the current study, we prospectively investigated the clinical outcomes of advanced or recurrent HCC patients who received hypofractionated radiotherapy at a dose of 5Gy10f with tomotherapy. A study involving hypofractionated radiotherapy (5Gy10f) based on TOMO was conducted in HCC patients with Child-Pugh grade A or B who were unsuitable candidates for resection or radiofrequency ablation or with residual disease after transarterial chemoembolization (TACE). The prescription dose was 50 grays in 10 fractions. From Sep. 2016 and Dec. 2017, 65 patents were evaluated with a median follow-up of 24 months (range: 7-41 months). 10 patients were treatment-naïve (failure to undergo surgery or intervention due to the presence of a portal or portal branch tumor thrombus), 15 patients were treated for residual HCC after TACE as salvage therapy, and 40 cases were treated for recurrent HCC. The median overalls survival (OS) of these patients was 18 months. Among them, 27 patients classified as BCLC stage B had a median OS of 22 months. Moreover, 28 patients classified as BCLC stage C had a median OS of 14 months. None of the patients experienced recurrence in the area of radiotherapy. The local control rate of primary tumor at 3 months, 6 months, 1 year and 2 years was 100%. The 3-month survival rate was 100%, the 6-month survival rate was 100%, the 1-year survival rate was 75.4%, and the 2-year survival rate was 43%. In addition, 14 patients had the opportunity to continue the treatment of PD-1 antibody after the disease progression, and their prognosis was not surprisingly better compared with the patients who did not receive PD-1 antibody treatment (NR . 15 months, P=0.04). No serious side effect was found in all patients during and after radiotherapy. Hypofractionated radiotherapy (5Gy10f) based on TOMO achieved high local control rate and OS with tolerable toxicities for HCC patients. TOMO therapy could be used to effectively against HCC in treatment-naive, intrahepatic failure, residual disease, and recurrent settings.
放射治疗对肝细胞癌（HCC）的疗效仍有待进一步证实。放射治疗的剂量一般为2Gy×25次。在本研究中，我们前瞻性地调查了接受容积旋转调强放疗（tomotherapy）、剂量为5Gy×10次的晚期或复发性HCC患者的临床结局。一项针对Child-Pugh A级或B级、不适合手术切除或射频消融或经动脉化疗栓塞（TACE）后有残留病灶的HCC患者，开展了基于TOMO的大分割放疗（5Gy×10次）研究。处方剂量为50格雷，分10次。2016年9月至2017年12月，对65例患者进行了评估，中位随访时间为24个月（范围：7 - 41个月）。10例患者为初治患者（因存在门静脉或门静脉分支肿瘤血栓而未能接受手术或介入治疗），15例患者在TACE后对残留HCC进行挽救性治疗，40例患者为复发性HCC接受治疗。这些患者的中位总生存期（OS）为18个月。其中，27例被归类为BCLC B期的患者中位OS为22个月。此外，28例被归类为BCLC C期的患者中位OS为14个月。所有患者在放疗区域均未出现复发。原发肿瘤在3个月、6个月、1年和2年时的局部控制率均为100%。3个月生存率为100%，6个月生存率为100%，1年生存率为75.4%，2年生存率为43%。此外，14例患者在疾病进展后有机会继续接受PD - 1抗体治疗，与未接受PD - 1抗体治疗的患者相比，他们的预后并不意外地更好（无进展生存期. 15个月，P = 0.04）。所有患者在放疗期间及放疗后均未发现严重副作用。基于TOMO的大分割放疗（5Gy×10次）对HCC患者实现了较高的局部控制率和总生存期，且毒性可耐受。TOMO治疗可有效用于初治、肝内衰竭、残留病灶及复发情况下的HCC治疗。
