Song Zhuo, Zheng Xuan, Wang Hongzhi, Dong Dezuo, Zhu Xianggao, Geng Jianhao, Li Shuai, Song Maxiaowei, Du Rongxu, Zhang Yangzi, Liu Zhiyan, Cai Yong, Li Yongheng, Wang Weihu
Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, 100142, People's Republic of China.
State Key Laboratory of Holistic Integrative Management of Gastrointestinal Cancers, Beijing Key Laboratory of Carcinogenesis and Translational Research, Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing, 100142, People's Republic of China.
J Hepatocell Carcinoma. 2025 May 31;12:1097-1110. doi: 10.2147/JHC.S519770. eCollection 2025.
This study explored the efficacy and safety of combining systemic therapy with stereotactic body radiotherapy (SBRT) for oligoprogressive (OP) and oligometastatic (OM) hepatocellular carcinoma (HCC).
From January 2017 to June 2023, 37 HCC patients (28 OP, 9 OM) receiving systemic therapy and SBRT were identified. OP is defined as up to 5 progressive lesions with others stable after systemic therapy and OM as newly identified metastatic disease with up to 5 metastatic lesions. SBRT was delivered in fractions of 5 Gy or more to all lesions. Clinical outcomes and toxicity were evaluated.
The median follow-up was 32.8 months. The objective response rates (ORRs) were 47.2%, 44.4%, and 55.5% for overall, OP, and OM cohorts. SBRT treated 48 OP and 17 OM lesions, achieving an ORR of 64.7%. For overall, OP, and OM cohorts, the 2-year local failure rates were 3.0%, 4.0%, and 0%, with median progression-free survival (PFS) of 11.2, 11.2, and 10.2 months, and median overall survival (OS) of 34.9 months, 32.6 months, and not reached (NR), respectively. In the OP cohort, 12 patients switched to next-line systemic therapy (OP-N) and 16 remained on current therapy (OP-C). Median PFS and OS were 11.6 months and NR for OP-N versus 16.5 months and 32.6 months for OP-C (P=0.89 and 0.47). Grade 3 acute and late treatment-related adverse events occurred in 40.5% and 5.4% of patients.
Systemic therapy combined with SBRT was effective and safe for OP and OM HCC. SBRT may delay next-line systemic therapy by blocking OP.
本研究探讨了全身治疗联合立体定向体部放疗（SBRT）治疗寡进展性（OP）和寡转移性（OM）肝细胞癌（HCC）的疗效和安全性。
2017年1月至2023年6月，共纳入37例接受全身治疗和SBRT的HCC患者（28例OP，9例OM）。OP定义为全身治疗后出现多达5个进展性病灶且其他病灶稳定，OM定义为新发现的转移性疾病且转移病灶多达5个。所有病灶均给予5 Gy或更高剂量的SBRT分次照射。评估临床疗效和毒性。
中位随访时间为32.8个月。总体、OP和OM队列的客观缓解率（ORR）分别为47.2%、44.4%和55.5%。SBRT治疗了48个OP病灶和17个OM病灶，ORR为64.7%。总体、OP和OM队列的2年局部失败率分别为3.0%、4.0%和0%，中位无进展生存期（PFS）分别为11.2个月、11.2个月和10.2个月，中位总生存期（OS）分别为34.9个月、32.6个月和未达到（NR）。在OP队列中，12例患者转为二线全身治疗（OP-N），16例患者继续接受当前治疗（OP-C）。OP-N的中位PFS和OS分别为11.6个月和NR，而OP-C为16.5个月和32.6个月（P = 0.89和0.47）。40.5%的患者发生3级急性治疗相关不良事件，5.4%的患者发生3级晚期治疗相关不良事件。
全身治疗联合SBRT治疗OP和OM HCC有效且安全。SBRT可能通过阻断OP来延迟二线全身治疗。
