Hypofractionated Stereotactic Body Radiotherapy for Primary and Metastatic Liver Tumors Using the Novalis Image-Guided System: Preliminary Results Regarding Efficacy and Toxicity
Hypofractionated Stereotactic Body Radiotherapy for Primary and Metastatic Liver Tumors Using the Novalis Image-Guided System: Preliminary Results Regarding Efficacy and Toxicity
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DOI：
10.1177/153303461000900610
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发表时间：
2010-12-01
影响因子：
2.8
通讯作者：
Utsunomiya, Setsuo
中科院分区：
文献类型：
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作者：
Iwata, Hiromitsu;Shibamoto, Yuta;Utsunomiya, Setsuo
本研究的目的是评估立体定向放射治疗（SBRT）对原发性和转移性肝肿瘤使用Novalis图像引导放疗系统的疗效和毒性。我们从2006年7月开始使用Novalis系统对肝脏肿瘤进行初步治疗，并于2008年2月开始了一项基于方案的研究。18名患者（6名原发性肝细胞癌患者和12名转移性肝肿瘤患者）接受55或50 Gy的治疗，这取决于他们的计划剂量分布和肝功能，在2周内分10次给予治疗。采用四根非共面静梁和三根共面静梁。患者年龄从54岁到84岁不等（中位：72岁）。Child-Pugh分级为A级17例，B级1例。肿瘤直径12 ~ 35mm（中位数：23mm）。根据不良事件通用术语标准4.0版评估毒性，并根据劳伦斯标准定义辐射性肝病（RILD）。中位随访期为14.5个月。所有患者的1年总生存率为94%，局部控制率为86%。5例患者观察到1级肝酶改变，但未观察到RILD或慢性肝功能障碍。使用Novalis图像引导系统的SBRT治疗原发性和转移性肝肿瘤安全有效。SBRT治疗肝脏肿瘤的进一步研究是有必要的。鉴于该方案观察到的可接受的毒性，我们已采用新的方案，以缩短总体治疗时间并增加剂量。
The purpose of this study was to evaluate the efficacy and toxicity of stereotactic body radiotherapy (SBRT) for primary and metastatic liver tumors using the Novalis image-guided radiotherapy system. After preliminarily treating liver tumors using the Novalis system from July 2006, we started a protocol-based study in February 2008. Eighteen patients (6 with primary hepatocellular carcinoma and 12 with metastatic liver tumor) were treated with 55 or 50 Gy, depending upon their planned dose distribution and liver function, delivered in 10 fractions over 2 weeks. Four non-coplanar and three coplanar static beams were used. Patient age ranged from 54 to 84 years (median: 72 years). The Child-Pugh classification was Grade A in 17 patients and Grade B in 1. Tumor diameter ranged from 12 to 35 mm (median: 23 mm). Toxicities were evaluated according to the Common Terminology Criteria of Adverse Events version 4.0, and radiation-induced liver disease (RILD) was defined by Lawrence's criterion. The median follow-up period was 14.5 months. For all patients, the 1-year overall survival and local control rates were 94% and 86%, respectively. A Grade 1 liver enzyme change was observed in 5 patients, but no RILD or chronic liver dysfunction was observed. SBRT using the Novalis image-guided system is safe and effective for treating primary and metastatic liver tumors. Further investigation of SBRT for liver tumors is warranted. In view of the acceptable toxicity observed with this protocol, we have moved to a new protocol to shorten the overall treatment time and escalate the dose.