ANGIOGENIC BLOCKADE AND RADIOTHERAPY IN HEPATOCELLULAR CARCINOMA
ANGIOGENIC BLOCKADE AND RADIOTHERAPY IN HEPATOCELLULAR CARCINOMA
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DOI：
10.1016/j.ijrobp.2009.07.1725
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发表时间：
2010-09-01
影响因子：
7
通讯作者：
Mehta, Minesh P.
中科院分区：
文献类型：
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作者：
Chi, Kwan-Hwa;Liao, Chao-Sheng;Mehta, Minesh P.
目的：我们报告了我们的初步经验，结合舒尼替尼和螺旋断层治疗晚期HCC患者。方法和材料：晚期肝癌（HCC）患者的记录与螺旋断层治疗和舒尼替尼放射治疗（RI）后，从2007年3月至2008年8月进行了回顾性分析。我们报告了急性毒性、放射学反应、系列甲胎蛋白（AFP）动力学和生存率。在23例可评估的患者中，60%有≥ 2个肝脏病变，5例存在肝外病变（21.7%），所有患者均在治疗前至少1周、治疗期间、13例患者在RI后继续舒尼替尼维持治疗直至疾病进展。输送了中位靶剂量为52.5戈伊/15次的大分割RI。74%的患者获得了客观缓解。1年生存率为70%，中位生存期为16个月。多变量分析显示，舒尼替尼维持治疗是影响生存率的最重要因素。维持组的进展时间为10个月，而对照组为4个月。21例AFP升高患者中有18例（85.7%）在RT后2个月内AFP下降≥ 50%。有3次上消化道出血和1次胰腺炎; 10例患者有≥ 2级肝酶升高，15例有≥ 2级血小板减少。这些初步结果表明，舒尼替尼和螺旋断层放射治疗在晚期HCC中产生了较高的实体瘤反应评价标准（RECIST）和AFP反应率，具有可接受的安全性。RI后维持舒尼替尼治疗可能延长生存期。需要进行随机试验。(C)2010年爱思唯尔公司
Purpose: We report our preliminary experience of combining sunitinib and helical tomotherapy in patients with advanced HCC.Methods and Materials: Records of patients with advanced hepatocellular carcinoma (HCC) treated with helical tomotherapy and sunitinib after radiation therapy (RI) from March 2007 to August 2008 were retrospectively reviewed. We report acute toxicities, radiologic response, serial alpha-fetoprotein (AFP) kinetics, and survival.Results: Of 23 evaluable patients, 60% had >= 2 hepatic lesions, extrahepatic disease was present in 5 (21.7%), and all received 2 tablets (25 mg) of sunitinib at least 1 week before, during, and 2 weeks after RT. Thirteen patients continued maintenance sunitinib after RI until disease progression. Hypofractionated RI with a median target dose of 52.5 Gy/15 fractions was delivered. An objective response was achieved in 74% of patients. The 1-year survival rate was 70%, with median survival of 16 months. Multivariate analysis showed that maintenance sunitinib was the most significant factor for survival. The time to progression was 10 months in the maintenance group compared with 4 months in the control group. Eighteen out of 21 patients with elevated AFP (85.7%) had >= 50% decline of AFP within 2 months after RT. There were three episodes of upper gastrointestinal bleeding and one episode of pancreatitis; 10 patients had >= Grade 2 elevation of liver enzymes, and 15 had >= Grade 2 thrombocytopenia.Conclusions: These preliminary results suggest that sunitinib and helical tomotherapy yield high Response Evaluation Criteria in Solid Tumors (RECIST) and AFP response rates in advanced HCC with an acceptable safety profile. Maintenance sunitinib after RI potentially prolongs survival. A randomized trial is warranted. (C) 2010 Elsevier Inc.