Qiu Bin, Fang Fang, Zhen Peng, Wang Junjie
Department of Radiation Oncology, Peking University Third Hospital, Beijing, 100191, China.
Department of Radiation Oncology, Chifeng Tumor Hospital, Inner Mongolia Autonomous Region, Chifeng, 024000, China.
Radiat Oncol. 2025 Jul 15;20(1):110. doi: 10.1186/s13014-025-02683-y.
Stereotactic radiotherapy with Gamma Master System delivered for portal vein tumor thrombosis (PVTT) located in the main portal vein is previously exploited. The study aimed to evaluate the efficacy and safety of stereotactic radiotherapy with Gamma Master System for palliation of hepatocellular carcinoma in patients with liver cirrhosis.
From March 2014 to March 2024, 96 patients (mean age, 59.7 ± 9.0, range, 39-87 years; 86, 89.6% males) with hepatocellular carcinoma and liver cirrhosis underwent stereotactic radiotherapy with Gamma Master System in our institute were retrospectively reviewed.
Of the 96 patients, 80 (83.3%) patients demonstrated disease control, defined as 8 (8.3%) complete response, 63 (65.6%) partial response, and 9 (9.4%) stable disease. Median progression-free survival (PFS) was 6.0 ± 0.6 months [interquartile range (IQR), 3-14 months], with a 1-year PFS rate of 26.9%, the median overall survival (OS) reached 14.0 ± 1.3 months (IQR, 8-27 months), with an estimated 1-year survival rate of 61.8%. Of the 61 painful patients, 59 (96.7%) reported pain relief. The AFP decreased from 1070.5 ± 364.4 ng/ml before radiotherapy to 688.6 ± 301.5 ng/ml after radiotherapy (p = 0.081). Child-Pugh classification (A 74 cases, 77.1%, and B 22 cases, 22.6%) before radiotherapy was similar to that (A 74 cases, 77.1%, and B 22 cases, 22.6%) after radiotherapy, with 1 case changed from A to B and 1 case changed from B to A. Only one patient experienced grade 4 hematologic toxicity, which was managed with transfusion. Immune-related dermatitis occurred in 2 (7.1%) of the 28 patients combined with immunotherapy/targeted therapy. No other major complications were observed.
Stereotactic radiotherapy with Gamma Master System for palliation appears effective and safe in liver cirrhosis patients with hepatocellular carcinoma yielding a high rate of tumor response. This treatment may provide a valuable option for pain relief. Further study is warranted.
先前已采用伽马刀立体定向放射治疗主门静脉的门静脉肿瘤血栓形成（PVTT）。本研究旨在评估伽马刀立体定向放射治疗对肝硬化肝细胞癌患者进行姑息治疗的疗效和安全性。
回顾性分析2014年3月至2024年3月在我院接受伽马刀立体定向放射治疗的96例肝细胞癌合并肝硬化患者（平均年龄59.7±9.0岁，范围39 - 87岁；86例，89.6%为男性）。
96例患者中，80例（83.3%）疾病得到控制，定义为8例（8.3%）完全缓解、63例（65.6%）部分缓解和9例（9.4%）病情稳定。中位无进展生存期（PFS）为6.0±0.6个月[四分位间距（IQR），3 - 14个月]，1年PFS率为26.9%，中位总生存期（OS）达14.0±1.3个月（IQR，8 - 27个月），估计1年生存率为61.8%。61例疼痛患者中，59例（96.7%）报告疼痛缓解。甲胎蛋白（AFP）从放疗前的1070.5±364.4 ng/ml降至放疗后的688.6±301.5 ng/ml（p = 0.081）。放疗前Child-Pugh分级（A 74例，77.1%，B 22例，22.6%）与放疗后（A 74例，77.1%，B 22例，22.6%）相似，1例从A变为B，1例从B变为A。仅1例患者出现4级血液学毒性，经输血处理。28例接受免疫治疗/靶向治疗的患者中有2例（7.1%）发生免疫相关皮炎。未观察到其他严重并发症。
伽马刀立体定向放射治疗姑息治疗对肝硬化肝细胞癌患者似乎有效且安全，肿瘤缓解率高。这种治疗可能为缓解疼痛提供有价值的选择。有必要进一步研究。
