Department of Radiation Oncology, Shanghai Changhai Hospital, the Navy Medical University, 200433, Shanghai, China.
Department of Radiation Oncology, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin Medical University Cancer Institute & Hospital, National Clinical Research Center for Cancer, 300060, Tianjin, China.
BMC Cancer. 2023 Jan 21;23(1):73. doi: 10.1186/s12885-023-10519-9.
Stereotactic Body Radiation Therapy (SBRT) has been found beneficial for adrenal gland metastases (AGMs) with a high local control rate and low toxicity. The role of SBRT for AGMs in patients with liver cancer has not been well-discussed before. We, therefore, report our two-institution experience to further elaborate on the feasibility and effectiveness of SBRT in the treatment of AGMs from liver cancer.
A total of 23 liver cancer patients (19 males, 4 females) with 24 AGMs treated by SBRT from July 2006 to April 2021 were retrospectively included in this study. Toxicity was assessed based on clinical adverse events using the Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. The effectiveness was assessed based on local control (LC), progression-free survival (PFS), and overall survival (OS), which were calculated using the Kaplan-Meier method. Univariate analyses were compared by log-rank test. The relevant covariates were evaluated using Cox proportional hazards models.
The median dose was 40 Gy in 5 fractions, with the corresponding median biological effective dose (BED10, α/β = 10 Gy) of 72 Gy. The median overall follow-up time was 15.4 months (range: 4.2-70.6 months). The complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD) rates were 25.0%, 20.8%, 33.3%, and 20.8%, respectively. All 6 patients with AGMs accompanying symptoms had varying degrees of alleviation after SBRT. The 0.5-, 1-year and 2-year LC rates were 87.5%, 77.8%, and 77.8%, respectively. The 0.5-, 1-year and 2-year OS rates were 95.5%, 66.8%, and 41.1%, respectively. The treatments were all tolerated with only one patient reporting a grade-3 hepatic injury. The univariate analysis concluded that only gross tumor volume (GTV) < 34.5 ml (p = 0.039) was associated with a favorable LC rate. After multivariate analysis, favorable predictors correlated with OS were GTV < 34.5 ml (p = 0.043), systemic therapy (p = 0.017), and without additional organ metastasis after SBRT (p = 0.009).
Our results suggest that SBRT is a safe and effective technique to treat AGM from liver cancer, especially for small GTV (< 34.5ml). Moreover, the small metastatic lesion volume, fewer metastatic lesions, and intervention of systemic therapy are more likely to improve OS.
立体定向体部放射治疗（SBRT）已被证明对肾上腺转移瘤（AGMs）具有较高的局部控制率和较低的毒性。SBRT 治疗肝癌患者的 AGMs 的作用尚未得到充分讨论。因此，我们报告了我们的两机构经验，以进一步阐述 SBRT 在治疗肝癌来源的 AGMs 中的可行性和有效性。
回顾性纳入 2006 年 7 月至 2021 年 4 月期间接受 SBRT 治疗的 23 例肝癌患者（19 名男性，4 名女性）共 24 个 AGMs。毒性根据临床不良事件使用通用不良事件术语标准（CTCAE）版本 5.0 进行评估。根据局部控制（LC）、无进展生存期（PFS）和总生存期（OS）评估疗效，使用 Kaplan-Meier 方法计算。单因素分析采用对数秩检验比较。使用 Cox 比例风险模型评估相关协变量。
中位剂量为 5 次分割 40 Gy，相应的中位生物有效剂量（BED10，α/β=10 Gy）为 72 Gy。中位总随访时间为 15.4 个月（范围：4.2-70.6 个月）。完全缓解（CR）、部分缓解（PR）、稳定疾病（SD）和进展疾病（PD）的比例分别为 25.0%、20.8%、33.3%和 20.8%。所有 6 例伴有症状的 AGMs 患者在 SBRT 后均有不同程度的缓解。0.5、1 年和 2 年的 LC 率分别为 87.5%、77.8%和 77.8%。0.5、1 年和 2 年的 OS 率分别为 95.5%、66.8%和 41.1%。治疗均耐受良好，仅 1 例患者报告 3 级肝损伤。单因素分析表明，只有肿瘤总体积（GTV）<34.5ml（p=0.039）与良好的 LC 率相关。多因素分析后，与 OS 相关的有利预测因素为 GTV<34.5ml（p=0.043）、全身治疗（p=0.017）和 SBRT 后无其他器官转移（p=0.009）。
我们的结果表明，SBRT 是治疗肝癌来源的 AGMs 的一种安全有效的技术，特别是对于较小的 GTV（<34.5ml）。此外，较小的转移病灶体积、较少的转移病灶数量以及全身治疗的干预更有可能改善 OS。
