Wang Feihang, Fan Shaonan, Shi Qin, Zhao Danyang, Sun Huiyi, Sothea Yav, Wu Mengfei, Song Huadan, Chen Yi, Cheng Jiemin, Zeng Zhaochong, Yan Zhiping, He Jian, Liu Lingxiao
Department of Interventional Radiology, Zhongshan Hospital, Fudan University, Shanghai, China.
Shanghai Institute of Medical Imaging, Fudan University, Shanghai, China.
Front Oncol. 2022 Aug 17;12:947284. doi: 10.3389/fonc.2022.947284. eCollection 2022.
This retrospective study compares the clinical results of cone beam CT (CBCT)-guided thermal ablation with those of helical tomotherapy in hepatocellular carcinoma (HCC) patients with pulmonary metastases.
A total of 110 patients undergoing thermal ablation or helical tomotherapy for pulmonary metastases from April 2014 to December 2020 were included in the study. The endpoints were local tumor progression-free survival (LTPFS), overall survival (OS), and complications. Univariate and multivariate analyses using the Cox proportional hazard model were conducted to identify independent factors (univariate: < 0.1; multivariate: < 0.05). The Kaplan-Meier method was used to calculate the LTPFS and OS rates.
The results of 106 patients were taken into the final analysis. The 1- and 3-year LTPFS rates were 50 and 19% for the thermal ablation group and 65 and 25% for the helical tomotherapy group. The median LTPFS in the thermal ablation group was 12.1 months, while it was 18.8 months in the helical tomotherapy group ( = 0.25). The 1- and 3-year OS rates were 75 and 26% for the thermal ablation group and 77 and 37% for the helical tomotherapy group. The median OS was 18.0 months in the thermal ablation group and 23.4 months in the helical tomotherapy group ( = 0.38). The multivariate analyses found that α-fetoprotein (AFP) at <400 ng/ml ( = 0.003) was significantly associated with better LTPFS. Tumor number <3 and AFP <400 ng/ml were favorable prognostic factors for OS. There were no grades 3-5 adverse events in both groups. Grade 2 was recorded in three patients (4.8%) in the thermal ablation group and two patients (4.7%) in the helical tomotherapy group.
For pulmonary metastases from HCC, CBCT-guided thermal ablation and helical tomotherapy provided comparable clinical effects and safety.
本回顾性研究比较了锥形束CT（CBCT）引导下热消融与螺旋断层放疗在肝细胞癌（HCC）肺转移患者中的临床效果。
本研究纳入了2014年4月至2020年12月期间110例接受热消融或螺旋断层放疗治疗肺转移的患者。观察终点为局部肿瘤无进展生存期（LTPFS）、总生存期（OS）和并发症。采用Cox比例风险模型进行单因素和多因素分析，以确定独立因素（单因素：<0.1；多因素：<0.05）。采用Kaplan-Meier法计算LTPFS和OS率。
106例患者的结果纳入最终分析。热消融组1年和3年LTPFS率分别为50%和19%，螺旋断层放疗组分别为65%和25%。热消融组的中位LTPFS为12.1个月，而螺旋断层放疗组为18.8个月（P=0.25）。热消融组1年和3年OS率分别为75%和26%，螺旋断层放疗组分别为77%和37%。热消融组的中位OS为18.0个月，螺旋断层放疗组为23.4个月（P=0.38）。多因素分析发现，甲胎蛋白（AFP）<400 ng/ml（P=0.003）与更好的LTPFS显著相关。肿瘤数量<3个和AFP<400 ng/ml是OS的有利预后因素。两组均无3-5级不良事件。热消融组3例患者（4.8%）记录为2级，螺旋断层放疗组2例患者（4.7%）记录为2级。
对于HCC肺转移，CBCT引导下热消融和螺旋断层放疗提供了相当的临床效果和安全性。
