Department of Radiation Oncology, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
J Cancer Res Clin Oncol. 2022 Sep;148(9):2405-2414. doi: 10.1007/s00432-021-03788-z. Epub 2021 Sep 6.
This study aims to evaluate the efficacy, feasibility, and safety of the magnetic resonance imaging (MRI)-guided tumor tracking hypofractionated radiotherapy (HFRT) and stereotactic body radiation therapy (SBRT) for portal vein tumor thrombus (PVTT) in hepatocellular carcinoma (HCC) patients.
We retrospectively reviewed the twelve cases of unresectable HCC with tumor thrombus in the main trunk or first branch of the portal vein that were treated with MRI-guided tumor tracking HFRT or SBRT using the ViewRay Linac MRIdian system between June 2019 and January 2021. The HFRT was performed with a total of 50 Gy in 10 fractions, and SBRT performed in a range of 36-50 Gy with 4-5 fractions. The median biologic effective dose (BED) with an a/b ratio of 10 was 75 Gy (range 68.4-100 Gy).
The median follow-up duration was 5.0 months (range 1.9-12.8 months). Ten patients (83.3%) showed an objective response of PVTT. At the time of analysis, ten patients (83.3%) showed local control. The 1-year intrahepatic control rate was 48.9%. Three patients (25%) showed mild gastrointestinal symptoms, and there were no cases of grade 3 or higher toxicity. For hepatic toxicity, there were no cases in which the Child-Pugh score increased by more than two points after RT without disease progression.
MRI-guided tumor tracking HFRT and SBRT was a feasible, effective, and safe treatment option in HCC patients with tumor thrombi in the main trunk or first branch of the portal vein.
本研究旨在评估磁共振成像（MRI）引导下肿瘤跟踪适形调强放疗（HFRT）和立体定向体部放疗（SBRT）治疗肝细胞癌（HCC）伴门静脉主干或一级分支癌栓的疗效、可行性和安全性。
我们回顾性分析了 2019 年 6 月至 2021 年 1 月期间，12 例不可切除的 HCC 伴门静脉主干或一级分支癌栓患者采用 ViewRay Linac MRIdian 系统行 MRI 引导下肿瘤跟踪 HFRT 或 SBRT 的资料。HFRT 总剂量 50Gy，10 次分割；SBRT 剂量 36-50Gy，4-5 次分割。中位生物有效剂量（BED），a/b 值为 10，为 75Gy（68.4-100Gy）。
中位随访时间为 5.0 个月（1.9-12.8 个月）。10 例（83.3%）患者门静脉癌栓客观缓解。分析时，10 例（83.3%）患者局部控制。1 年肝内控制率为 48.9%。3 例（25%）患者出现轻微胃肠道症状，无 3 级及以上毒性反应。肝脏毒性方面，RT 后无疾病进展时，Child-Pugh 评分增加 2 分以上的病例为 0。
MRI 引导下肿瘤跟踪 HFRT 和 SBRT 是治疗 HCC 伴门静脉主干或一级分支癌栓患者的一种可行、有效、安全的治疗选择。
