Ultrasound Department, The First Affiliated Hospital of Xi'an Jiaotong University, No. 277 West Yanta Road, Xi'an, Shaanxi, 710061, People's Republic of China.
Gastroenterological Center, Yokohama City University Medical Center, 4-57 Urafune-cho, Minami-ku, Yokohama, Kanagawa, 232-0024, Japan.
BMC Cancer. 2021 Oct 30;21(1):1169. doi: 10.1186/s12885-021-08897-z.
In clinical practice, many hepatocellular carcinoma (HCC) patients in Barcelona Clinical Liver Cancer (BCLC) stage A4-B1 cannot receive the curative treatments of liver transplantation, resection, and radiofrequency ablation (RFA), which are the recommended options according to liver cancer guidelines. Our aim is to study the feasibility of RFA and stereotactic body radiotherapy (SBRT) as a curative treatment for different multifocal HCCs in BCLC stage A4-B1 patients.
From September 2014 to August 2019, 39 multifocal HCC lesions (median diameter: 16.6 mm) from 15 patients (median age: 73 years) were retrospectively selected. Among them, 23 were treated by RFA and the other 16 by SBRT because of predictable insufficiency and/or risk related to RFA performance. The indicators for evaluating this novel therapy were the tumor response, prognosis (recurrence and survival), and adverse effects (deterioration of laboratory test values and severe complications).
The median follow-up duration was 31.3 months (range: 15.1-71.9 months). The total patients with a one-year complete response, stable disease, or disease progression were 11, 1, and 3, respectively. In total, 8 and 2 patients had confronted intrahepatic or local recurrence, respectively. The one-year progression-free survival rate and local control rate were 80% (12/15 patients) and 97.4% (38/39 lesions), respectively. The median time to progression was 20.1 (2.8-45.1) months. The one- and two-year survival rates were 100 and 88.9%, respectively. In up to five months' observation, no patient showed severe complications. Seven, four, and two patients had slight changes in their white blood cells, platelet count, or albumin-bilirubin grade, respectively.
For patients with BCLC stage A4-B1, RFA and SBRT treatment for different multifocal HCCs may be a potential option because of the favorable prognosis and safety. However, before its application in clinical practice, prospective, controlled, large-scale studies are needed to further confirm our conclusions.
在临床实践中，许多巴塞罗那临床肝癌（BCLC）分期 A4-B1 期的肝细胞癌（HCC）患者不能接受肝移植、切除术和射频消融（RFA）等肝癌指南推荐的治愈性治疗。我们的目的是研究 RFA 和立体定向体放射治疗（SBRT）作为 BCLC 分期 A4-B1 期患者不同多发 HCC 的治愈性治疗的可行性。
2014 年 9 月至 2019 年 8 月，回顾性选择了 15 例患者的 39 个多发 HCC 病灶（中位直径：16.6mm）。其中 23 例采用 RFA 治疗，另 16 例因 RFA 性能预测不足和/或风险而采用 SBRT 治疗。评估这种新疗法的指标是肿瘤反应、预后（复发和生存）和不良反应（实验室检查值恶化和严重并发症）。
中位随访时间为 31.3 个月（范围：15.1-71.9 个月）。一年完全缓解、稳定疾病或疾病进展的患者分别为 11、1 和 3 例。共有 8 例和 2 例患者分别出现肝内或局部复发。一年无进展生存率和局部控制率分别为 80%（15 例患者中的 12 例）和 97.4%（39 个病灶中的 38 个）。中位进展时间为 20.1（2.8-45.1）个月。一年和两年生存率分别为 100%和 88.9%。在长达五个月的观察期内，没有患者出现严重并发症。有 7、4 和 2 例患者的白细胞、血小板计数或白蛋白-胆红素分级略有变化。
对于 BCLC 分期 A4-B1 的患者，RFA 和 SBRT 治疗不同多发 HCC 可能是一种有前途的选择，因为其预后良好且安全。然而，在将其应用于临床实践之前，需要进行前瞻性、对照、大规模的研究来进一步证实我们的结论。
