Stereotactic body radiotherapy versus intensity-modulated radiotherapy for hepatocellular carcinoma with portal vein tumor thrombosis
Stereotactic body radiotherapy versus intensity-modulated radiotherapy for hepatocellular carcinoma with portal vein tumor thrombosis
复制标题
立体定向放疗与调强放疗治疗肝细胞癌合并门静脉癌栓的比较
DOI：
10.1007/s12072-021-10173-y
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发表时间：
2021-04-05
影响因子：
6.6
通讯作者：
Su, Ting-Shi
中科院分区：
文献类型：
--
作者：
Li, Li-Qing;Zhou, Ying;Su, Ting-Shi
目前尚不清楚机器人立体定向放疗（SBRT）是否优于调强放疗（IMRT）治疗晚期肝细胞癌（HCC）。本研究旨在比较SBRT和IMRT治疗合并门静脉肿瘤血栓形成（PVTT）的hcc患者的长期预后。方法回顾性分析2000年1月至2017年1月期间接受放疗的287例肝癌PVTT患者。其中，分别有154例和133例患者接受IMRT和SBRT治疗。通过单变量和倾向评分匹配分析评估总生存期（OS）、无进展生存期（PFS）、肝内控制期（IC）和局部控制期（LC）。结果经配对后，筛选出102例配对良好的患者。IMRT组和SBRT组的6、12、24和60个月累积OS（73.5、42.9、23.6、7.6% vs. 72.4、45.1、29.8、13.2%,p= 0.151）、PFS（53.9、29.3、21.8、7.5% vs. 54.5、19.3、12.0、9.6%,p= 0.744）、IC（61.4、45.7、39.0、26.8% vs. 75.1、45.8、35.9、28.7%,p= 0.144）和LC（85.2、56.5、52.1、47.4% vs. 87.4、65.2、62.1、62.1%,p= 0.191）无显著差异。假设A /b比为10 (BED10)≥100 Gy的生物有效剂量是预测接受SBRT患者的OS、PFS、IC和LC的最佳截止值。结论当高精度跟踪技术可用时，SBRT似乎是一种安全且更有效的治疗方法，对于局部晚期肝癌合并PVTT， SBRT的OS、PFS、IC和LC与IMRT相当。如果正常组织耐受，建议BED10≥100 Gy。图形抽象
BackgroundIt is unclear whether robotic stereotactic body radiotherapy (SBRT) is superior to intensity-modulated radiotherapy (IMRT) in advanced hepatocellular carcinoma (HCC). This study aimed to compare the long-term outcomes of SBRT with those of IMRT in HCCs with portal vein tumor thrombosis (PVTT).MethodsWe retrospectively evaluated 287 HCC patients with PVTT who underwent radiotherapy between January 2000 and January 2017. Of them, 154 and 133 patients were treated with IMRT and SBRT, respectively. Overall survival (OS), progression-free survival (PFS), intrahepatic control (IC), and local control (LC) were evaluated in univariable and propensity-score matched analyses.ResultsAfter matching, 102 well-paired patients were selected. There was no significant difference in the 6-, 12-, 24-, and 60-month cumulative OS (73.5, 42.9, 23.6, 7.6% vs. 72.4, 45.1, 29.8, 13.2%,p= 0.151), PFS (53.9, 29.3, 21.8, 7.5% vs. 54.5, 19.3, 12.0, 9.6%,p= 0.744), IC (61.4, 45.7, 39.0, 26.8% vs. 75.1, 45.8, 35.9, 28.7%,p= 0.144), and LC (85.2, 56.5, 52.1, 47.4% vs. 87.4, 65.2, 62.1, 62.1%,p= 0.191) between the IMRT and SBRT groups. A biologically effective dose assumed at an a/b ratio of 10 (BED10) of ≥ 100 Gy was the optimal cutoff for predicting the OS, PFS, IC, and LC in the patients who received SBRT.ConclusionsWhen high-precision tracking technology is available, SBRT appears to be a safe and more time-efficient treatment, achieving comparable OS, PFS, IC and LC to IMRT for local advanced HCC with PVTT. A BED10≥ 100 Gy is recommended if tolerated by normal tissue.Graphic abstract