Hernandez Ludovic, Parent Laure, Molinier Victoire, Suc Bertrand, Izar Françoise, Moyal Elisabeth, Peron Jean-Marie, Otal Philippe, Lusque Amélie, Modesto Anouchka
Department of Radiotherapy, University Cancer Institute of Toulouse-Oncopole, 31100 Toulouse, France.
Department of Digestive Surgery and Liver Transplantation, Rangueil University Hospital, 31059 Toulouse, France.
Clin Transl Radiat Oncol. 2024 Nov 21;50:100892. doi: 10.1016/j.ctro.2024.100892. eCollection 2025 Jan.
Stereotactic body radiation therapy (SBRT) is a therapeutic option in the guidelines for liver primaries after standard strategies like surgery or thermoablation have failed. To assess its efficacy and safety, we reviewed all patients treated by SBRT for a hepatocellular carcinoma (HCC) over a six-year period.
The study included all patients treated by SBRT for HCC between April 2015 and November 2021 in the University Cancer Institute at Toulouse-Oncopole. All patients were inoperable and not eligible for thermoablation, or after a failure. All tumor sizes were included and cirrhosis up to Child-Pugh B was accepted. Local control (LC), overall survival (OS) and progression-free survival (PFS) were estimated by the Kaplan-Meier method. Treatment response was assessed using mRECIST criteria. Toxicity was graded using CTCAE (v4.0).
One hundred and nine patients with 118 lesions were treated. Half underwent prior standard treatment. Median dose was 50 Grays in five fractions for most patients. Chronic liver disease represented 90.8 % of cases with a median age of 69 years. Median tumor size was 4.0 cm. Median follow-up was 22.2 months [95 %CI: 15.1-30.4]. LC, OS and PFS at two years were 82.4 % [95 %CI: 71.3; 89.5], 73.2 % [95 %CI: 61.5; 81.8] and 35.8 % [95 %CI: 25.1; 46.7], respectively. Acute toxicities occurred in 20.2 % of patients, including 10.1 % grade 3-4 and 1.8 % grade 5. Late toxicities occurred in 5.5 % of patients including 4.6 % grade 3-4. Grade ≥ 3 toxicity was related to digestive perforation or liver failure.
SBRT provides good LC with an acceptable safety profile. It can be used in several settings such as salvage therapy or in combination with validated treatment. Prospective randomized trials are needed to validate SBRT as a standard alternative.
立体定向体部放射治疗（SBRT）是在手术或热消融等标准治疗策略失败后用于肝脏原发性肿瘤的指南中的一种治疗选择。为评估其疗效和安全性，我们回顾了在六年期间接受SBRT治疗肝细胞癌（HCC）的所有患者。
该研究纳入了2015年4月至2021年11月在图卢兹肿瘤学中心大学癌症研究所接受SBRT治疗HCC的所有患者。所有患者均无法手术且不符合热消融条件，或在标准治疗失败后。纳入所有肿瘤大小，Child-Pugh B级及以下的肝硬化患者也被纳入。采用Kaplan-Meier法估计局部控制（LC）、总生存期（OS）和无进展生存期（PFS）。使用mRECIST标准评估治疗反应。使用CTCAE（v4.0）对毒性进行分级。
109例患者共118个病灶接受了治疗。半数患者曾接受过标准治疗。大多数患者的中位剂量为50格雷，分5次给予。慢性肝病患者占90.8%，中位年龄为69岁。中位肿瘤大小为4.0厘米。中位随访时间为22.2个月[95%CI：15.1 - 30.4]。两年时的LC、OS和PFS分别为82.4%[95%CI：71.3；89.5]、73.2%[95%CI：61.5；81.8]和35.8%[95%CI：25.1；46.7]。20.2%的患者发生急性毒性反应，其中3 - 4级为10.1%，5级为1.8%。5.5%的患者发生晚期毒性反应，其中3 - 4级为4.6%。≥3级毒性反应与消化穿孔或肝衰竭有关。
SBRT可提供良好的局部控制，安全性可接受。它可用于多种情况，如挽救治疗或与已证实的治疗方法联合使用。需要进行前瞻性随机试验以验证SBRT作为标准替代方案的有效性。
