Phase 2 study of stereotactic body radiotherapy and optional transarterial chemoembolization for solitary hepatocellular carcinoma not amenable to resection and radiofrequency ablation
Phase 2 study of stereotactic body radiotherapy and optional transarterial chemoembolization for solitary hepatocellular carcinoma not amenable to resection and radiofrequency ablation
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DOI：
10.1002/cncr.30008
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发表时间：
2016-07-01
期刊：
影响因子：
6.2
通讯作者：
Kunieda, Etsuo
中科院分区：
文献类型：
--
作者：
Takeda, Atsuya;Sanuki, Naoko;Kunieda, Etsuo
早期肝细胞癌（HCC）患者的治疗选择包括切除、肝移植和经皮消融治疗。然而，即使是孤立性HCC患者也不总是适合这些治疗。作者前瞻性研究了接受立体定向体部放疗（SBRT）治疗孤立性HCC的患者的临床结局。方法：在Child-Pugh分级为A或B且基础孤立性HCC（最大肿瘤直径4 cm）不适合切除和射频消融的患者中进行了涉及SBRT和可选经动脉化疗栓塞（TACE）的2期研究。处方剂量为35 - 40格雷，分5次。主要终点是3年局部肿瘤控制。从2007年到2012年，101例患者入组，90例可评价，中位随访时间为41.7个月（范围，6.8-96.2个月）。32例患者为初治患者，20例因新诊断的肝内衰竭接受治疗，38例因残留或复发HCC接受挽救治疗。32名患者未接受TACE，48名患者接受了不充分的TACE，10名患者达到了完全的碘油蓄积。3年局部控制率为96.3%，3年肝脏相关病因特异性生存率为72.5%，总生存率为66.7%。3级实验室检查异常，观察6例，8例Child-Pugh评分恶化了2 point.CONCLUSIONSSBRT实现了高的局部控制和总生存率与可行的毒性孤立性肝癌患者，尽管相当严格的条件。SBRT可以有效地治疗孤立性肝癌初治，肝内衰竭，残留的疾病，和复发的设置，利用其独特的特点。癌症2016;122：2041-9。(c)2016年美国癌症协会.立体定向体部放疗实现了高局部控制（3年局部控制率，96.3%）和总生存率，对于患有孤立性肝细胞癌（HCC）的患者，尽管条件相当严格，但毒性可接受。立体定向体部放射治疗可以有效地治疗孤立性肝癌初治，肝内衰竭，残留的疾病，和复发的设置，利用其独特的特点。
BACKGROUNDCurative treatment options for patients with early stage hepatocellular carcinoma (HCC) include resection, liver transplantation, and percutaneous ablation therapy. However, even patients with solitary HCC are not always amenable to these treatments. The authors prospectively investigated the clinical outcomes of patients who received stereotactic body radiotherapy (SBRT) for solitary HCC.METHODSA phase 2 study involving SBRT and optional transarterial chemoembolization (TACE) was conducted in patients with Child-Pugh grade A or B and underlying, solitary HCC (greatest tumor dimension, 4 cm) who were unsuitable candidates for resection and radiofrequency ablation. The prescription dose was 35 to 40 grays in 5 fractions. The primary endpoint was 3-year local tumor control.RESULTSFrom 2007 to 2012, 101 patients were enrolled, and 90 were evaluable with a median follow-up of 41.7 months (range, 6.8-96.2 months). Thirty-two patients were treatment-naive, 20 were treated for newly diagnosed intrahepatic failure, and 38 were treated for residual or recurrent HCC as salvage therapy. Thirty-two patients did not receive TACE, 48 received insufficient TACE, and 10 attained full lipiodol accumulation. The 3-year local control rate was 96.3%, the 3-year liver-related cause-specific survival rate was 72.5%, and the overall survival rate was 66.7%. Grade 3 laboratory abnormalities were observed in 6 patients, and 8 patients had Child-Pugh scores that worsened by 2 points.CONCLUSIONSSBRT achieved high local control and overall survival with feasible toxicities for patients with solitary HCC, despite rather stringent conditions. SBRT can be effective against solitary HCC in treatment-naive, intrahepatic failure, residual disease, and recurrent settings, taking advantage of its distinctive characteristics. Cancer 2016;122:2041-9. (c) 2016 American Cancer Society.Stereotactic body radiotherapy achieves high local control (3-year local control rate, 96.3%) and overall survival with acceptable toxicities for patients who have a solitary hepatocellular carcinoma (HCC), despite rather stringent conditions. Stereotactic body radiotherapy can be effective against solitary HCC in treatment-naive, intrahepatic failure, residual disease, and recurrent settings, taking advantage of its distinctive characteristics.