Hilal Lara, Reyngold Marsha, Wu Abraham J, Araji Abdallah, Abou-Alfa Ghassan K, Jarnagin William, Harding James J, Gambarin Maya, El Dika Imane, Brady Paul, Navilio John, Berry Sean L, Flynn Jessica, Zhang Zhigang, Tuli Richard, Zinovoy Melissa, Romesser Paul B, Cuaron John J, Crane Christopher H, Hajj Carla
Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.
J Gastrointest Oncol. 2021 Aug;12(4):1743-1752. doi: 10.21037/jgo-21-116.
More than 70% of patients with hepatocellular carcinoma (HCC) are not candidates for curative therapy or recur after curative-intent therapy. There is growing evidence on the use of ablative radiation therapy (RT) for liver tumors. We aimed to analyze outcomes of HCC patients treated with conventional versus ablative RT.
We retrospectively analyzed medical records of HCC patients treated with liver RT from 2001 to 2019. We defined ablative RT as biologically effective dose (BED) ≥80 Gy. RECIST 1.1 was used to define early responses at 3-6 months after RT, and local control (LC) at last follow-up (FU). Data was analyzed using Fisher exact test, Kaplan-Meier, cumulative incidence rates, Cox proportional hazards model and Fine-Gray competing risks.
Forty-five patients were identified, of whom 14 (31.1%) received ablative RT using a stereotactic technique. With median FU of survivors of 10.1 months, 1-year cumulative incidence of LC was 91.7% for ablative and 75.2% for BED <80 Gy. At early FU, patients treated with ablative RT had better responses compared to BED <80 Gy, with 7% progressing versus 19%, and 21.4% with complete response versus none (P=0.038). On univariate analysis (UVA), Child-Pugh (CP) score [hazard ratio (HR): 3 for CP-B, HR: 16 for CP-C] and BED (HR: 7.69 for BED <80 Gy) correlated with deterioration of liver function, leading to liver failure. Most liver failure cases were due to disease progression. No RT-related liver failure occurred in the ablative RT group. On UVA, only BED ≥80 Gy was associated with improved overall survival (OS) (HR: 0.4; P=0.044). Median OS (mOS) and 1-year OS were 7 months and 35% respectively for BED <80 Gy compared to 28 months and 66% for BED ≥80 Gy. No grade 3+ bowel toxicity was reported in either group.
Greater than 90% LC was achieved after stereotactic ablative RT, which was associated with minimized tumor- and treatment-related liver failure and improved survival for highly selected inoperable HCC patients.
超过70%的肝细胞癌（HCC）患者不适合接受根治性治疗，或在接受根治性治疗后复发。关于肝肿瘤使用消融性放射治疗（RT）的证据越来越多。我们旨在分析接受传统RT与消融性RT治疗的HCC患者的结局。
我们回顾性分析了2001年至2019年接受肝脏RT治疗的HCC患者的病历。我们将消融性RT定义为生物等效剂量（BED）≥80 Gy。采用RECIST 1.1来定义RT后3至6个月的早期反应以及最后随访（FU）时的局部控制（LC）。使用Fisher精确检验、Kaplan-Meier法、累积发病率、Cox比例风险模型和Fine-Gray竞争风险对数据进行分析。
共纳入45例患者，其中14例（31.1%）采用立体定向技术接受消融性RT。幸存者的中位FU为10.1个月，消融性RT组1年LC累积发病率为91.7%，BED<80 Gy组为75.2%。在早期FU时，与BED<80 Gy组相比，接受消融性RT治疗的患者反应更好，进展者为7%，而BED<80 Gy组为19%，完全缓解者为21.4%，BED<80 Gy组无完全缓解者（P=0.038）。单因素分析（UVA）显示，Child-Pugh（CP）评分[风险比（HR）：CP-B为3，CP-C为16]和BED（BED<80 Gy时HR为7.69）与肝功能恶化导致肝衰竭相关。大多数肝衰竭病例是由于疾病进展。消融性RT组未发生与RT相关的肝衰竭。UVA显示，仅BED≥80 Gy与总生存期（OS）改善相关（HR：0.4；P=0.044）。BED<80 Gy组的中位OS（mOS）和1年OS分别为7个月和35%，而BED≥80 Gy组分别为28个月和66%。两组均未报告3级及以上肠道毒性。
立体定向消融性RT后实现了超过90%的LC，这与肿瘤和治疗相关肝衰竭最小化以及高度选择的不可手术HCC患者的生存期改善相关。
