Diamond Brett H, Banson Kara, Ayash Jonathan, Lee Peter, Shukla Utkarsh C, Jones Gavin, Rava Paul, Fitzgerald Thomas J, Sioshansi Shirin
Department of Radiation Oncology, Tufts Medical Center, Boston, Massachusetts.
Department of Radiation Oncology, New York University, New York, New York.
Adv Radiat Oncol. 2024 Nov 4;9(12):101631. doi: 10.1016/j.adro.2024.101631. eCollection 2024 Dec.
For patients with hepatocellular carcinoma (HCC), stereotactic body radiation therapy (SBRT) has emerged as a locoregional treatment. Our purpose was to report outcomes in patients with HCC with Child-Pugh A (CP A) versus Child-Pugh B or C (CP B/C) liver dysfunction treated with SBRT.
A retrospective analysis of 80 patients with HCC, with a total of 94 tumors treated with SBRT, was conducted at a single institution. Outcomes were compared between patients with CP A (n = 51) and CP B/C (n = 29) liver dysfunction. Outcomes of interest included local control, overall survival (OS), and toxicity.
Median tumor size was 3.2 cm. There were 59 tumors included in the CP A cohort and 35 tumors in the CP B/C cohort. Median radiation dose was 50 Gy in 5 fractions for the CP A cohort and 40 Gy in 5 fractions for the CP B/C cohort. The rates of pathologic complete response were similar between the 2 groups at 63% for the CP A group and 61% for the CP B/C group. The estimated 1-year local control rates were similar between the 2 groups at 93% for the CP A group and 91% for the CP B/C group ( = .59). The 1-year OS for the CP A group was 85%, whereas the 1-year OS for the CP B/C group was 61% ( = .19). There was a 5.9% rate of grade 3+ toxicity in the CP A group and a 20.7% rate of grade 3+ toxicity in the CPB/C group.
Our findings suggest that SBRT is feasible and effective in patients with both CP A and CP B/C liver dysfunction with similar rates of local control and pathologic complete response despite lower radiation doses in the CP B/C cohort. In patients with more advanced CP B/C cirrhosis, toxicities were higher and must be weighed against possible treatment benefits. Further studies characterizing the optimal role of SBRT in patients with advanced cirrhosis are warranted.
对于肝细胞癌（HCC）患者，立体定向体部放疗（SBRT）已成为一种局部区域治疗方法。我们的目的是报告接受SBRT治疗的肝功能为Child-Pugh A（CPA）与Child-Pugh B或C（CP B/C）的HCC患者的治疗结果。
在一家机构对80例HCC患者进行了回顾性分析，共94个肿瘤接受了SBRT治疗。比较了肝功能为CPA（n = 51）和CP B/C（n = 29）的患者的治疗结果。感兴趣的结果包括局部控制、总生存期（OS）和毒性。
肿瘤中位大小为3.2 cm。CPA队列中有59个肿瘤，CP B/C队列中有35个肿瘤。CPA队列的中位放疗剂量为50 Gy，分5次给予；CP B/C队列的中位放疗剂量为40 Gy，分5次给予。两组的病理完全缓解率相似，CPA组为63%，CP B/C组为61%。两组的估计1年局部控制率相似，CPA组为93%，CP B/C组为91%（P = 0.59）。CPA组的1年总生存率为85%，而CP B/C组的1年总生存率为61%（P = .19）。CPA组3级及以上毒性发生率为5.9%，CP B/C组为20.7%。
我们的研究结果表明，SBRT对于肝功能为CPA和CP B/C的患者都是可行且有效的，尽管CP B/C队列的放疗剂量较低，但局部控制率和病理完全缓解率相似。在CP B/C期肝硬化更严重的患者中，毒性更高，必须权衡可能的治疗益处。有必要进一步开展研究，明确SBRT在晚期肝硬化患者中的最佳作用。
