单中心使用立体定向体放射治疗（SBRT）治疗不可切除的胆管癌的原位肝移植方案的经验。

Single center experience using stereotactic body radiation therapy (SBRT) on orthotopic liver transplant protocol for unresectable cholangiocarcinoma.

机构信息

Department of Radiation Oncology, University of California, Los Angeles, 200 Medical Plaza Driveway, Suite B265, Los Angeles, CA, 90095, USA.

出版信息

HPB (Oxford). 2024 Mar;26(3):444-450. doi: 10.1016/j.hpb.2023.12.004. Epub 2023 Dec 10.

DOI:10.1016/j.hpb.2023.12.004

PMID:38142182

Abstract

PURPOSE

To evaluate tolerability, pathologic response, and disease outcomes utilizing pre-operative stereotactic body radiation therapy (SBRT) followed by consolidation chemotherapy (CHT) prior to orthotopic liver transplant (OLT) in unresectable cholangiocarcinoma (CCA).

METHODS

This was a retrospective chart review of patients treated on OLT protocol at a single tertiary center from 2012 to 2019. Patients received pre-operative SBRT (40-50 Gy in 5 fractions) followed by CHT until progression or OLT. Progression-free survival (PFS) and overall survival (OS) were compared via log-rank test and Cox proportional hazards regression.

RESULTS

26 patients (84.6% hilar, 15.4% intrahepatic) were identified for analysis. Eight patients (30.8%) patients developed acute toxicity after SBRT, mostly grade 1 nausea. Nine (34.6%) patients underwent OLT of which 4 (44.4%) achieved a pathologic complete response (pCR). Five (55.6%) OLT patients, including 2 pCR, developed recurrence at a median time of 49.9 weeks after OLT. 3-year OS for the OLT and dropout cohort was 75% and 9%, respectively (p < 0.0001). OS in hilar tumors only was statistically different for those that achieved a pCR (p = 0.014).

CONCLUSIONS

Pre-operative SBRT is a well-tolerated and effective radiation technique as part of OLT protocol for unresectable CCA and conferred in a pCR rate of 44% within our cohort.

摘要

目的

评估不可切除的胆管细胞癌（CCA）患者在接受原位肝移植（OLT）前，使用术前立体定向体放射治疗（SBRT）联合巩固化疗（CHT）的耐受性、病理反应和疾病转归。

方法

这是对 2012 年至 2019 年在一家三级中心接受 OLT 方案治疗的患者进行的回顾性图表审查。患者接受术前 SBRT（5 次分割，每次 40-50Gy），然后进行 CHT 治疗，直至进展或接受 OLT。通过对数秩检验和 Cox 比例风险回归比较无进展生存期（PFS）和总生存期（OS）。

结果

共纳入 26 例患者（84.6%为肝门部，15.4%为肝内）进行分析。8 例（30.8%）患者在 SBRT 后出现急性毒性反应，主要为 1 级恶心。9 例（34.6%）患者接受了 OLT，其中 4 例（44.4%）获得了病理完全缓解（pCR）。5 例（55.6%）OLT 患者，包括 2 例 pCR，在 OLT 后中位时间 49.9 周后复发。OLT 和失访组的 3 年 OS 分别为 75%和 9%（p<0.0001）。仅在肝门部肿瘤中，pCR 患者的 OS 存在统计学差异（p=0.014）。