Radiation Oncology Department, University Hospital RWTH Aachen, Pauwelsstraße 30, 52074, Aachen, Germany.
Site: Aachen, Center for Integrated Oncology Aachen, Bonn, Cologne and Duesseldorf (CIO ABCD), Aachen, Germany.
Strahlenther Onkol. 2024 Aug;200(8):715-724. doi: 10.1007/s00066-024-02235-5. Epub 2024 Apr 30.
Hepatocellular carcinoma (HCC) poses a unique challenge due to its predilection for developing on compromised livers, often limiting surgical options. Stereotactic body radiotherapy (SBRT) has emerged as a promising local treatment modality for HCC. This study aims to assess the effectiveness of SBRT in HCC patients not suitable for surgery, focusing on local control, optimal radiation dosing, and prognostic factors.
In this retrospective analysis, 52 HCC patients treated with SBRT were examined. The study assessed local control, progression-free survival (PFS), and overall survival (OS) while conducting dosimetric analyses. The relationship between mean liver dose and Child-Pugh score (CPS) progression was also explored.
SBRT demonstrated 93.4% freedom from local progression (FFLP) at 12 months. Notably, a near minimum dose (D98%) below 61 Gy as an equivalent dose in 2‑Gy fractions with α/β 10 Gy (EQD2) was associated with reduced FFLP (p-value 0.034). Logistic regression analysis revealed a dose-response relationship for FFLP and D98% with 95% and 98% probability of FFLP at a dose of 56.9 and 73.1 Gy, respectively. The study observed OS rates of 63.7% at 1 year and 34.3% at 3 years. Patients with portal vein tumor thrombus (PVTT) and larger tumors (≥ 37 cm) experienced decreased PFS and OS. Multivariate analysis identified PVTT, larger tumor volume, and performance status as independent predictors of reduced OS. Notably, classical radiation-induced disease (cRILD) was absent, but nonclassical (nc) RILD occurred in 7.7% of patients. Regression analysis linked a mean EQD2 dose to the liver (12.8-12.6) with a 10% likelihood of ncRILD.
SBRT offers a compelling option for achieving high local control and promising survival outcomes in HCC. The study supports a radiation dose range of 61-73.1 Gy, coupled with a mean liver dose under 12.6-12.8 Gy as EQD2, to achieve favorable FFLP rates, with acceptable toxicity rates.
由于肝癌（HCC）易于在受损肝脏上发展，因此治疗具有独特的挑战性，往往限制了手术选择。立体定向体放射治疗（SBRT）已成为 HCC 的一种有前途的局部治疗方式。本研究旨在评估不适合手术的 HCC 患者接受 SBRT 的效果，重点关注局部控制、最佳放疗剂量和预后因素。
在这项回顾性分析中，对 52 名接受 SBRT 治疗的 HCC 患者进行了检查。该研究评估了局部控制、无进展生存期（PFS）和总生存期（OS），同时进行了剂量学分析。还探讨了平均肝剂量与 Child-Pugh 评分（CPS）进展之间的关系。
SBRT 在 12 个月时的局部无进展率（FFLP）为 93.4%。值得注意的是，低于 61Gy 的最小剂量（D98%）作为 2Gy 分数的等效剂量（EQD2），α/β 为 10Gy 时，与降低 FFLP 相关（p 值为 0.034）。Logistic 回归分析显示，FFLP 和 D98%存在剂量反应关系，FFLP 的概率分别为 95%和 98%，相应剂量为 56.9 和 73.1Gy。该研究观察到 1 年时的 OS 率为 63.7%，3 年时为 34.3%。门静脉癌栓（PVTT）和肿瘤较大（≥37cm）的患者 PFS 和 OS 降低。多变量分析确定 PVTT、较大的肿瘤体积和表现状态是 OS 降低的独立预测因素。值得注意的是，没有发生经典的放射性疾病（cRILD），但有 7.7%的患者发生了非经典（nc）RILD。回归分析将平均 EQD2 剂量与肝脏（12.8-12.6）联系起来，发生 ncRILD 的概率为 10%。
SBRT 为 HCC 提供了一种实现高局部控制和有希望的生存结果的有吸引力的选择。该研究支持 61-73.1Gy 的放疗剂量范围，并结合平均肝脏剂量低于 12.6-12.8Gy 的 EQD2，以获得良好的 FFLP 率，同时具有可接受的毒性率。
