立体定向体部放射治疗在肝内复发性小肝细胞癌治疗结果中的作用
The Role of Stereotactic Body Radiation Therapy in the Outcomes of Intrahepatic Recurrent Small Hepatocellular Carcinoma.
作者信息
Shui Yongjie, Dai Dongjun, Yang Yang, Yang Jia, Xuan Feng, Chen Haiyan, Liu Lihong, Yu Qianqian, Guo Yinglu, Yu Risheng, Lou Jianying, Wei Qichun
机构信息
Department of Radiation Oncology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Department of Radiation Oncology, Wushan Campus of Hangzhou First People's Hospital, Hangzhou, China.
出版信息
J Clin Exp Hepatol. 2025 Sep-Oct;15(5):102561. doi: 10.1016/j.jceh.2025.102561. Epub 2025 Mar 28.
BACKGROUND AND AIM
To retrospectively evaluate the role of stereotactic body radiation therapy (SBRT) played for the outcomes of intrahepatic recurrent small hepatocellular carcinoma (HCC).
METHODS
We collected 51 intrahepatic recurrent ≤5 cm small HCC patients between January 2016 and December 2021. SBRT was given as 4-5 fractions with 32.5-50Gy. The baseline data of the patients and the radiotherapy strategy data were collected and survival analyses were performed among these factors. The outcomes comprised overall survival (OS), freedom from local progression (FFLP), and progression-free survival (PFS), with the 95% confidence interval (95%CI). The follow-up time was calculated from the date of the SBRT to the date of the last follow-up communication, hospitalization, or death. Survival analysis was conducted by the Kaplan-Meier methods and log-rank test.
RESULTS
The median follow-up time was 48 months (range: 4.8-90). The 1-year, 3-year, and 5-year OS rates of the overall cohort were 95.9% (95%CI: 0.905-1.000), 84.9% (95%CI: 0.751-0.959) and 69.1% (95%CI: 0.553-0.862), respectively. The 1-year, 3-year, and 5-year FFLP rates of the overall cohort were 97.5% (95%CI: 0.928-1.000), 82.0% (95%CI: 0.697-0.965), and 72.8% (95%CI: 0.578-0.918), respectively. The 1-year, 3-year, and 5-year PFS rates of the overall cohort were 85.7% (95%CI: 0.758-0.970), 43.4% (95%CI: 0.296-0.635), and 27.3% (95%CI: 0.149-0.498), respectively. The 5-year FFLP rate of lesions less than 2 cm [72.5% (95%CI: 0.52-1)] and those 2-5 cm [71.9% (95%CI: 0.514-0.976)] were similar. We suggested that the lesions received 45Gy/50Gy with 5 fractions were associated with a higher 5-year FFLP rate [74.6% (95%CI: 0.57-0.976)] than 40Gy/5F [40.0% (95%CI: 0.137-1)].
CONCLUSION
We found SBRT was effective in patients with lesion size of 2-5 cm, with similar results in those with tumor size of 0-2 cm. We suggested that the lesions received over 85.5Gy of biological effective dose with α/β = 10Gy were associated with a higher FFLP.
背景与目的
回顾性评估立体定向体部放射治疗（SBRT）对肝内复发性小肝细胞癌（HCC）治疗效果的作用。
方法
收集2016年1月至2021年12月期间51例肝内复发性直径≤5 cm的小HCC患者。SBRT给予4 - 5次分割，剂量为32.5 - 50Gy。收集患者的基线数据和放疗策略数据，并对这些因素进行生存分析。观察指标包括总生存期（OS）、局部无进展生存期（FFLP）和无进展生存期（PFS），并计算95%置信区间（95%CI）。随访时间从SBRT日期计算至最后一次随访沟通、住院或死亡日期。采用Kaplan-Meier法和对数秩检验进行生存分析。
结果
中位随访时间为48个月（范围：4.8 - 90个月）。整个队列的1年、3年和5年OS率分别为95.9%（95%CI：0.905 - 1.000）、84.9%（95%CI：0.751 - 0.959）和69.1%（95%CI：0.553 - 0.862）。整个队列的1年、3年和5年FFLP率分别为97.5%（95%CI：0.928 - 1.000）、82.0%（95%CI：0.697 - 0.965）和72.8%（95%CI：0.578 - 0.918）。整个队列的1年、3年和5年PFS率分别为85.7%（95%CI：0.758 - 0.970）、43.4%（95%CI：0.296 - 0.635）和27.3%（95%CI：0.149 - 0.498）。直径小于2 cm的病灶5年FFLP率[72.5%（95%CI：0.52 - 1）]与2 - 5 cm的病灶[71.9%（95%CI：0.514 - 0.976）]相似。我们发现接受45Gy/5次分割或50Gy/5次分割的病灶5年FFLP率[74.6%（95%CI：0.57 - 0.976）]高于40Gy/5次分割[40.0%（95%CI：0.137 - 1）]。
结论
我们发现SBRT对病灶大小为2 - 5 cm的患者有效，对肿瘤大小为0 - 2 cm的患者效果相似。我们认为，α/β = 10Gy时，生物等效剂量超过85.5Gy的病灶FFLP率更高。
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