Department of Radiation Oncology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
Faculty of Medicine, University of Queensland, Brisbane, Queensland, Australia.
J Med Imaging Radiat Oncol. 2021 Dec;65(7):956-968. doi: 10.1111/1754-9485.13309. Epub 2021 Aug 15.
There is a growing body of literature supporting the use of stereotactic ablative body radiotherapy (SABR) in the management of primary hepatocellular carcinoma (HCC). This systematic review and meta-analysis of the current published evidence for SABR for HCC assessed the impact of treatment dose, fractionation and tumour size on the outcomes of local control (LC), overall survival (OS) and toxicity. A systematic search was independently performed by two authors for articles published in peer-reviewed journals between January 2005 and December 2019. A DerSimonian and Laird random effects model was used to assess pooled results. A multivariate meta-regression analysis incorporated the effect of explanatory variables (radiation dose in EQD2 fractionation and tumour size) on outcomes of OS, LC and toxicity. Forty-nine cohorts involving 2846 HCC patients with 3088 lesions treated with SABR were included. Pooled 1-, 2- and 3-year LC rates were 91.1% (95% confidence interval [CI] 88.3-93.2), 86.7% (95% CI 82.7-89.8) and 84.2% (95% CI 77.9-88.9) respectively. Pooled 1-, 2- and 3-year OS rates were 78.4% (95% CI 73.4-82.6), 61.3% (55.2-66.9) and 48.3% (95% CI 39.0-57). Population-weighted median grade 3 toxicity rates were 6.5% (IQR 3.2-16) and mean grade 4/5 rates were 1.4% (IQR 0-2.1). Within EQD2 ranges of 40 to 83.33 Gy corresponding to common dose-fractionation regimens of 30-50 Gy in 5 fractions, there was a multivariate association between superior LC and OS with increasing EQD2 , with a proportionately smaller increase in grade 3 toxicity and no association with grade 4/5 toxicity. Stereotactic ablative body radiotherapy is a viable treatment option for HCC with high LC rates and low rates of reported grade 3/4 toxicity. Increasing EQD2 was associated with improvements in LC and OS with a comparatively smaller increase in toxicity. Prospective randomised trials are warranted to define optimal patient selection and dose-fractionation regimens.
越来越多的文献支持立体定向消融体放射治疗（SABR）在原发性肝细胞癌（HCC）治疗中的应用。本系统评价和荟萃分析目前发表的关于 HCC 的 SABR 证据，评估了治疗剂量、分割和肿瘤大小对局部控制（LC）、总生存率（OS）和毒性的影响。两位作者独立对 2005 年 1 月至 2019 年 12 月期间在同行评议期刊上发表的文章进行了系统检索。采用 DerSimonian 和 Laird 随机效应模型评估汇总结果。多变量荟萃回归分析纳入了辐射剂量（EQD2 分割）和肿瘤大小对 OS、LC 和毒性结局的影响。纳入了 49 项队列研究，共纳入了 2846 例 HCC 患者的 3088 个病灶，接受了 SABR 治疗。汇总的 1、2 和 3 年 LC 率分别为 91.1%（95%CI，88.3-93.2）、86.7%（95%CI，82.7-89.8）和 84.2%（95%CI，77.9-88.9）。汇总的 1、2 和 3 年 OS 率分别为 78.4%（95%CI，73.4-82.6）、61.3%（55.2-66.9）和 48.3%（95%CI，39.0-57）。人群加权中位 3 级毒性发生率为 6.5%（IQR，3.2-16），平均 4/5 级毒性发生率为 1.4%（IQR，0-2.1）。在 EQD2 范围为 40 至 83.33Gy 时，相当于常见的 30-50Gy 剂量分割方案，5 次分割，LC 和 OS 的多变量分析显示，EQD2 越高，LC 和 OS 越好，3 级毒性的增加比例较小，与 4/5 级毒性无关。立体定向消融体放射治疗是 HCC 的一种可行治疗选择，具有高 LC 率和低报告 3/4 级毒性率。EQD2 的增加与 LC 和 OS 的改善相关，毒性增加相对较小。需要前瞻性随机试验来确定最佳的患者选择和剂量分割方案。
