肝细胞癌碳离子放疗后放射性肝损伤的预后分析
Prognostic analysis of radiation-induced liver damage following carbon-ion radiotherapy for hepatocellular carcinoma.
作者信息
Hayashi Kazuhiko, Suzuki Osamu, Wakisaka Yushi, Ichise Koji, Uchida Hirofumi, Anzai Makoto, Hasegawa Azusa, Seo Yuji, Shimizu Shinichi, Ishii Takayoshi, Teshima Teruki, Fujimoto Jiro, Ogawa Kazuhiko
机构信息
Department of Radiology, Osaka Heavy Ion Therapy Center, Osaka, Japan.
Department of Radiation Oncology, Osaka University Graduate School of Medicine, 2-2 (D10) Yamada-Oka, Suita, Osaka, Japan.
出版信息
Radiat Oncol. 2024 Apr 22;19(1):51. doi: 10.1186/s13014-024-02444-3.
BACKGROUND
Radiation-induced liver damage (RILD) occasionally occurs following carbon-ion radiotherapy (CIRT) for liver tumors, such as hepatocellular carcinoma (HCC), in patients with impaired liver function disease. However, the associated risk factors remain unknown. The present study aimed to determine the risk factors of RILD after CIRT.
METHODS
We retrospectively analyzed 108 patients with HCC treated with CIRT at the Osaka Heavy Ion Therapy Center between December 2018 and December 2022. RILD was defined as a worsening of two or more points in the Child-Pugh score within 12 months following CIRT. The median age of the patients was 76 years (range 47-95 years), and the median tumor diameter was 41 mm (range 5-160 mm). Based on the pretreatment liver function, 98 and 10 patients were categorized as Child-Pugh class A and B, respectively. We analyzed patients who received a radiation dose of 60 Gy (relative biological effectiveness [RBE]) in four fractions. The median follow-up period was 9.7 months (range 2.3-41.1 months), and RILD was observed in 11 patients (10.1%).
RESULTS
Multivariate analysis showed that pretreatment Child-Pugh score B (p = 0.003, hazard ratio [HR] = 6.90) and normal liver volume spared from < 30 Gy RBE (VS < 739 cm) (p = 0.009, HR = 5.22) were significant risk factors for RILD. The one-year cumulative incidences of RILD stratified by Child-Pugh class A or B and VS < 739 cm or ≥ 739 cm were 10.3% or 51.8% and 39.6% or 9.2%, respectively.
CONCLUSION
In conclusion, the pretreatment Child-Pugh score and VS of the liver are significant risk factors for RILD following CIRT for HCC.
背景
在对肝功能受损疾病患者的肝癌等肝脏肿瘤进行碳离子放射治疗（CIRT）后，偶尔会发生放射性肝损伤（RILD）。然而，相关危险因素仍不清楚。本研究旨在确定CIRT后RILD的危险因素。
方法
我们回顾性分析了2018年12月至2022年12月期间在大阪重离子治疗中心接受CIRT治疗的108例肝癌患者。RILD被定义为CIRT后12个月内Child-Pugh评分恶化两个或更多点。患者的中位年龄为76岁（范围47 - 95岁），中位肿瘤直径为41毫米（范围5 - 160毫米）。根据治疗前肝功能，98例和10例患者分别被分类为Child-Pugh A级和B级。我们分析了接受4次分割、剂量为60 Gy（相对生物效应[RBE]）的患者。中位随访期为9.7个月（范围2.3 - 41.1个月），11例患者（10.1%）出现RILD。
结果
多因素分析显示，治疗前Child-Pugh评分B（p = 0.003，风险比[HR] = 6.90）和肝脏正常体积未受＜30 Gy RBE（VS＜739 cm）照射（p = 0.009，HR = 5.22）是RILD的显著危险因素。按Child-Pugh A级或B级以及VS＜739 cm或≥739 cm分层的RILD的一年累积发生率分别为10.3%或51.8%以及39.6%或9.2%。
结论
总之，治疗前Child-Pugh评分和肝脏VS是肝癌患者CIRT后发生RILD的显著危险因素。
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