螺旋断层放疗对肝细胞癌的治疗效果：关于中等剂量溢出情况

Treatment outcomes of helical tomotherapy for hepatocellular carcinoma in terms of intermediate-dose spillage.

作者信息

Bae Sun Hyun, Cho Kwang Hwan, Kim Young Seok, Kim Sang Gyune, Yoo Jeong-Ju, Lee Jae Myung, Lee Min Hee, Lim Sanghyeok, Jung Jae Hong, Lim Sung Hee

机构信息

Department of Radiation Oncology, Soonchunhyang University College of Medicine, Bucheon, Korea.

Division of Gastroenterology and Hepatology, Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea.

出版信息

Transl Cancer Res. 2021 Mar;10(3):1420-1429. doi: 10.21037/tcr-20-2912.

DOI:10.21037/tcr-20-2912

PMID:35116467

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8798435/

Abstract

BACKGROUND

Although helical tomotherapy (HT) tends to increase intermediate-dose spillage by increasing of low-dose region, this has not been fully determined in the clinical setting. Therefore, we investigated treatment outcomes of HT for hepatocellular carcinoma (HCC) with respect to intermediate-dose spillage.

METHODS

We retrospectively reviewed 20 HCC patients, who received high-dose radiotherapy (RT) using HT with radical intent between April 2014 and September 2017. In accordance with the Barcelona Clinic Liver Cancer (BCLC) classification, stage was 0 in 7 patients, A in 3 patients, B in 5 patients, and C in 5 patients. Baseline Child-Pugh class was A in 18 patients and B in 2 patients. The median tumor size was 2.5 cm (range, 1-11 cm). Helical intensity-modulated radiotherapy (IMRT) technique was applied in all patients: among these, 13 patients were treated with stereotactic body radiotherapy (SBRT). The median fraction size was 12 Gy (range, 2-15 Gy), and the median total dose was 50 Gy (range, 44-60 Gy). Intermediate-dose spillage was assessed by the Radiation Therapy Oncology Group recommendation from 22 HT planning data, as follows: R50% means the ratio of the 50% prescription isodose volume to the planning target volume (PTV).

RESULTS

The median follow-up period after HT was 22 months. The local progression-free survival (LPFS) and progression-free survival (PFS) rates were 89% and 59% at 1 year, and 82% and 30% at 2 years, respectively. The overall survival rate was 100% at 1 year and 85% at 2 years, respectively. In terms of intermediate-dose spillage, minor or major deviations were noted in the R50% of 20 HT plans (91%). However, 1 patient (5%) experienced classic radiation-induced liver disease, and severe toxicity ≥ grade 3 was not reported.

CONCLUSIONS

Although HT for HCC tends to increase intermediate-dose spillage, the treatment results were favorable with that reported in other published studies.

摘要

背景

尽管螺旋断层放射治疗（HT）往往会因低剂量区域的增加而导致中等剂量溢出，但在临床环境中这一点尚未完全明确。因此，我们针对中等剂量溢出情况，研究了HT治疗肝细胞癌（HCC）的治疗效果。

方法

我们回顾性分析了20例HCC患者，这些患者在2014年4月至2017年9月期间接受了以根治为目的的HT高剂量放射治疗（RT）。根据巴塞罗那临床肝癌（BCLC）分类，7例患者为0期，3例为A期，5例为B期，5例为C期。基线Child-Pugh分级中，18例患者为A级，2例为B级。肿瘤中位大小为2.5厘米（范围1-11厘米）。所有患者均采用螺旋调强放射治疗（IMRT）技术：其中13例患者接受了立体定向体部放射治疗（SBRT）。中位分次剂量为12 Gy（范围2-15 Gy），中位总剂量为50 Gy（范围44-60 Gy）。根据放射治疗肿瘤学组对22个HT计划数据的建议评估中等剂量溢出情况，如下：R50%是指50%处方等剂量体积与计划靶体积（PTV）的比值。

结果

HT后的中位随访期为22个月。1年时局部无进展生存率（LPFS）和无进展生存率（PFS）分别为89%和59%，2年时分别为82%和30%。1年和2年时的总生存率分别为100%和85%。在中等剂量溢出方面，20个HT计划的R50%出现了轻微或严重偏差（91%）。然而，1例患者（5%）出现了典型的放射性肝病，未报告≥3级的严重毒性反应。