SIB-IMRT 联合阿帕替尼治疗经肝动脉化疗栓塞术治疗反应不佳的不可切除肝细胞癌。

SIB-IMRT combined with apatinib for unresectable hepatocellular carcinoma in patients with poor response to transarterial chemoembolization.

机构信息

Department of Oncology, Chongqing Rongchang People's Hospital, Chongqing 402460, China.

Department of Interventional Radiology, Chongqing University, Three Gorges Hospital/Chongqing Three Gorges Central Hospital, Chongqing 404000, China.

出版信息

Clin Res Hepatol Gastroenterol. 2022 Jun-Jul;46(6):101897. doi: 10.1016/j.clinre.2022.101897. Epub 2022 Feb 28.

DOI:10.1016/j.clinre.2022.101897

PMID:35240318

Abstract

BACKGROUND

Radiotherapy combined with apatinib exhibits synergistic anti-tumor effect, while the application of simultaneous integrated boost intensity modulated radiotherapy (SIB-IMRT) combined with apatinib in HCC patients is scarce. Hence, this study aimed to explore the treatment response, survival, and safety profile of the SIB-IMRT combined with apatinib in unresectable HCC (uHCC) patients.

METHODS

A total of 19 uHCC patients with deficient response to transarterial chemoembolization (TACE), who scheduled for SIB-IMRT combined with apatinib treatment were enrolled. The SIB-IMRT was applied at the following dose: 95% planning target volume (PTV) at 30-50 Gy/2-2.5 Gy/15-20f and 90% Boost of 45-72 Gy/3-4.5 Gy/15-20f at 5 times per week with cone beam computerized tomography validation. During and after radiotherapy, the apatinib was administrated orally with the initial dose of 500 mg per day.

RESULTS

The complete response, partial response, stable disease, and progressive disease rates were 31.6%, 36.8%, 21.1% and 10.5%, respectively. Consequently, the objective response rate and disease control rate were 68.4% and 89.5%, respectively. During a median follow-up duration of 9.0 months, the median progression-free survival (PFS) was 6.0 (95% confidential interval (CI): 4.9-7.1) months with 1-year PFS rate of 42.1%; the median overall survival (OS) was not reached with 1-year OS rate of 54.6%. The safety profile was acceptable with the most common adverse events including myelosuppression (42.1%), skin reaction (36.8%), and albuminuria (26.3%).

CONCLUSION

SIB-IMRT combined with apatinib exhibits a good efficacy and tolerable safety profile, which could be considered as a potential treatment choice for uHCC patients who have deficient response to TACE.

摘要

背景

放疗联合阿帕替尼具有协同抗肿瘤作用，而同步整合推量调强放疗（SIB-IMRT）联合阿帕替尼在 HCC 患者中的应用较为少见。因此，本研究旨在探讨 SIB-IMRT 联合阿帕替尼治疗经肝动脉化疗栓塞（TACE）疗效不佳的不可切除 HCC（uHCC）患者的治疗反应、生存和安全性。

方法

共纳入 19 例 TACE 疗效不佳的 uHCC 患者，计划接受 SIB-IMRT 联合阿帕替尼治疗。SIB-IMRT 采用以下剂量：95%计划靶区（PTV）30-50Gy/2-2.5Gy/15-20f，90%推量 45-72Gy/3-4.5Gy/15-20f，每周 5 次，采用锥形束 CT 验证。放疗期间和放疗后，阿帕替尼口服，初始剂量为 500mg/天。

结果

完全缓解、部分缓解、疾病稳定和疾病进展率分别为 31.6%、36.8%、21.1%和 10.5%，客观缓解率和疾病控制率分别为 68.4%和 89.5%。中位随访 9.0 个月时，中位无进展生存期（PFS）为 6.0（95%可信区间：4.9-7.1）个月，1 年 PFS 率为 42.1%；中位总生存期（OS）未达到，1 年 OS 率为 54.6%。安全性可接受，最常见的不良反应包括骨髓抑制（42.1%）、皮肤反应（36.8%）和蛋白尿（26.3%）。