肝静脉和/或下腔静脉肿瘤血栓的肝细胞癌采用靶向治疗或免疫检查点抑制剂的放射治疗
Radiotherapy with Targeted Therapy or Immune Checkpoint Inhibitors for Hepatocellular Carcinoma with Hepatic Vein and/or Inferior Vena Cava Tumor Thrombi.
作者信息
Li Zhuoran, Zhai Yirui, Wu Fan, Cao Dayong, Ye Feng, Song Yan, Wang Shulian, Liu Yueping, Song Yongwen, Tang Yuan, Jing Hao, Fang Hui, Qi Shunan, Lu Ningning, Li Ye-Xiong, Wu Jianxiong, Chen Bo
机构信息
State Key Laboratory of Molecular Oncology, Department of Radiation Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, People's Republic of China.
Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences (CAMS) and Peking Union Medical College (PUMC), Beijing, People's Republic of China.
出版信息
J Hepatocell Carcinoma. 2024 Aug 5;11:1481-1493. doi: 10.2147/JHC.S464140. eCollection 2024.
PURPOSE
This study evaluated the clinical outcomes of patients with hepatocellular carcinoma (HCC) with hepatic vein tumor thrombus (HVTT) and/or inferior vena cava tumor thrombus (IVCTT) receiving radiotherapy (RT) combined with systemic therapies.
PATIENTS AND METHODS
Patients with HCC with HVTT and/or IVCTT who received RT were identified at our institution. The prescription doses were 30-65 Gy for planning target volume and 40-65 Gy for the gross tumor volume. Targeted therapy and immune checkpoint inhibitors were used concurrently if patients were at a high risk of or already had distant metastasis. After RT completion, follow-up was performed at 1, 3, 6, and 12 months, and 3 to 6 months thereafter. The objective response rate (ORR), overall survival (OS), progression-free survival (PFS) and toxicity were recorded.
RESULTS
Thirty-four patients were retrospectively enrolled between January 2016 and September 2021. Most patients received concurrent targeted therapy (70.6%) and/or post-RT (79.4%). The in-field ORR and disease control rates were 79.4% and 97.1%, respectively. The OS rates were 77.6% at 1 year and 36.3% at 2 years (median OS, 15.8 months). The median PFS and median in-field PFS were 4.2 months and not reached, respectively. The PFS and in-field PFS rates were 24.6% and 79.2% at 1 year, 19.7% and 72.0% at 2 years, respectively. An alpha-fetoprotein level >1000 ng/mL was a significant prognostic factor for worse OS (HR, 5.674; 95% CI, 1.588-20.276; p=0.008); in-field complete/partial response was a significant prognostic factor for better OS (HR, 0.116; 95% CI, 0.027-0.499; p=0.004). The most common site of first failure was the lungs (13/34 patients, 38.2%), followed by the liver (7/34 patients, 20.6%). No patients developed radiation-induced liver disease or pulmonary embolism during follow-up.
CONCLUSION
Combining RT and systemic therapy was safe and effective in treating patients with HCC with HVTT and IVCTT.
目的
本研究评估了接受放疗（RT）联合全身治疗的肝细胞癌（HCC）合并肝静脉肿瘤血栓（HVTT）和/或下腔静脉肿瘤血栓（IVCTT）患者的临床结局。
患者与方法
在我们机构确定了接受RT的HCC合并HVTT和/或IVCTT患者。计划靶体积的处方剂量为30 - 65 Gy，大体肿瘤体积的处方剂量为40 - 65 Gy。如果患者有远处转移的高风险或已经发生远处转移，则同时使用靶向治疗和免疫检查点抑制剂。RT完成后，在1、3、6和12个月进行随访，此后每3至6个月进行一次随访。记录客观缓解率（ORR）、总生存期（OS）、无进展生存期（PFS）和毒性。
结果
回顾性纳入了2016年1月至2021年9月期间的34例患者。大多数患者同时接受了靶向治疗（70.6%）和/或RT后治疗（79.4%）。靶区内ORR和疾病控制率分别为79.4%和97.1%。1年OS率为77.6%，2年OS率为36.3%（中位OS，15.8个月）。中位PFS和中位靶区内PFS分别为4.2个月和未达到。1年时PFS和靶区内PFS率分别为24.6%和79.2%，2年时分别为19.7%和72.0%。甲胎蛋白水平>1000 ng/mL是OS较差的显著预后因素（HR，5.674；95%CI，1.588 - 20.276；p = 0.008）；靶区内完全/部分缓解是OS较好的显著预后因素（HR，0.116；95%CI，0.027 - 0.499；p = 0.004）。首次失败最常见部位是肺（13/34例患者；38.2%）），其次是肝脏（7/34例患者，20.6%）。随访期间无患者发生放射性肝病或肺栓塞。
结论
RT与全身治疗联合应用治疗HCC合并HVTT和IVCTT患者是安全有效的。
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