立体定向放射治疗大肝癌的疗效

摘要/Abstract

摘要： 目的评价立体定向放射治疗(SBRT)大肝癌的疗效及安全性,分析预后的影响因素。方法收集解放军总医院第五医学中心2012年1月至2014年12月应用射波刀SBRT治疗97例不能切除的大肝癌的临床资料。肿瘤直径为5.0~9.8 cm,单次分割剂量 5~11 Gy,照射次数5~10次,肿瘤处方剂量 40~56 Gy,每天照射1次。计算总存活(OS)率、无进展存活(PFS)率和局部控制(LC)率;Cox 回归模型分析影响预后的因素。根据美国国家癌症研究所的不良事件通用术语标准(CTCAE4.03)评估不良反应。结果 97例大肝癌患者接受射波刀治疗,OS为30个月。根据实体肿瘤的反应评估标准(RECIST),客观有效率为64.95%(63/97),疾病控制率为 80.41%(78/97),治疗后1、2、3、5年的OS率分别为77.3%、57.7%、43.3%、27.8%,PFS率为33.7%、21.7%、14.0%、6.4%,LC率为 92.3%、88.2%、88.2%、88.2%。Cox 回归分析显示,肝功能分级和门脉癌栓为OS的独立预后因素。急性不良反应轻微,耐受性良好。结论射波刀治疗大肝癌安全、有效、无创,严重不良反应低,Child-Pugh评分、门脉癌栓与SBRT后患者的存活率有关。

关键词: 肝细胞癌, 立体定向放射治疗, 射波刀, 疗效, 预后因素

Abstract: Objective To evaluate the efficacy and security of Cyberknife stereotactic body radiotherapy (SBRT) for unresectable large hepatocellular carcinoma (HCC) and analyze the prognostic factors affecting outcomes. Methods From January 2012 to December 2014, 97 patients with un-resectable large HCC treated with Cyberknife SBRT were retrospectively analyzed. The median size of tumors was 6.2cm (5.0~9.8 cm), Doses ranged from 40 Gy to 56 Gy were given in 5 to 11 fractions for 5 to 10 consecutive days. Overall survival rate (OS), progression free survival rate (PFS) and local control rate were calculated according to the Kaplan-Meier method. Cox proportional hazard models was used to analyze the prognostic factors for survival. Toxicity was evaluated according to the National Cancer Institute (NCI) Common Terminology Criteria for Adverse Events (CTCAE) v.4.03. Results A total of 97 patients were enrolled in this study. Based on Response Evaluation and Criteria in Solid Tumors (RECIST). The Objective response rate (ORR) was achieved in 64.95%. The disease control rate (DCR) was achieved in 80.41%. The local control rate at 1-, 2-, 3- and 5-years was 92.3%, 88.2% , 88.2% and 88.2%, respectively. Median OS was 30 months, and OS at 1-, 2-, 3- and 5-years was 77.3%, 57.7%, 43.3% and 27.8%, respectively, while PFS rates at 1-, 2-, 3- and 5-years were 33.7%, 21.7%, 14.0% and 6.4%. Median PFS was 8 months. Multivariate analysis revealed that Child-Pugh score and Portal vein tumor thrombosis were independent predictors of OS. Acute toxicities were mild and well tolerated. Conclusion Cyberknife SBRT is a non-invasive, safe and equally effective treatment for large HCCs with relatively low risk of severe toxicity. Child-Pugh score and Portal vein tumor thrombosis were associated with survival rate of patients after SBRT. These results suggested that Cyberknife SBRT can be a good alternative treatment for large HCCs which is unsuitable for standard treatment.

Key words: Hepatocellular carcinoma, Stereotactic body radiotherapy, Cyberknife, Efficacy, Prognostic factors

万芝清, 王权, 孙静, 常小云, 张爱民, 李文刚, 段学章. 立体定向放射治疗大肝癌的疗效[J]. 肝脏, 2025, 30(4): 431-434.

WAN Zhi-qing, WANG Quan, SUN Jing, CHANG Xiao-yun, ZHANG Ai-min, LI Wen-gang, DUAN Xue-zhang. Clinical observation of cyberknife stereotactic body radiation therapy for unresectable large hepatocellular carcinoma[J]. Chinese Hepatolgy, 2025, 30(4): 431-434.

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