Radiation therapy for lymph node metastases from hepatocellular carcinoma.
Radiation therapy for lymph node metastases from hepatocellular carcinoma.
复制标题
肝细胞癌淋巴结转移的放射治疗。
作者：
R. Toya;R. Murakami;T. Yasunaga;Y. Baba;R. Nishimura;Shoji Morishita;J. Nishi;T. Beppu;H. Baba;Y. Yamashita;N. Oya
背景/目标
近年来，肝细胞癌患者预后的改善使得发现和治疗淋巴转移变得越来越重要。我们对放射治疗(RT)治疗肝细胞癌LN转移的疗效进行了回顾性评估。
方法论
23例肝细胞癌LN转移患者接受了放射治疗。每日剂量1.8~4Gy28~56Gy36~67.2Gy10(中位数58.5Gy10)，α/β比值为10。评价局部控制和生存的预测因素。
结果
完全缓解5例，部分缓解14例。有效率为83%；接受>；或=58Gy10的患者显著高于接受<；58Gy10的患者(P=0.014)。中位生存期为19个月。单因素分析显示Child-Pugh分级、肝肿瘤状况和LN转移部位是影响患者生存的重要因素。多变量分析显示，肝脏肿瘤的状况是唯一独立的生存预测因素。
结论
RT是局部控制肝细胞癌LN转移的有效方法，但无确切的生存效应。需要大于58Gy10的RT剂量才能获得更好的局部反应。
BACKGROUND/AIMS
Recent improvements in the prognosis of patients with hepatocellular carcinoma (HCC) render the discovery and treatment of lymph node (LN) metastasis increasingly important. We retrospectively evaluated the treatment outcomes of radiation therapy (RT) for LN metastases from HCC.
METHODOLOGY
Twenty-three patients with LN metastases from HCC underwent RT. A daily dose of 1.8-4 Gy was administered to deliver a total dose of 28-56 Gy, which was a biologic effective dose (BED) of 36-67.2 Gy10 (median 58.5 Gy10) with an alpha/beta ratio of 10. We evaluated predictive factors for local control and survival.
RESULTS
A complete response and partial response were recorded for 5 and 14 patients, respectively. The response rate was 83%; it was significantly higher in patients who had received > or =58 Gy10 rather than <58 Gy10 (P = 0.014). The median survival time was 19 months. Univariate analysis revealed that the Child-Pugh's classification, status of the liver tumor, and LN metastasis site were significant factors for survival. Multivariate analysis showed that the status of the liver tumor was the only independent predictor of survival.
CONCLUSIONS
RT is effective for the local control of LN metastases from HCC without a confirmed survival effect. RT doses greater than 58 Gy10 are required for a better local response.