射波刀治疗小肝癌前瞻性临床研究初步结果  

An initial report of CyberKnife stereotactic body radiotherapy in treatment of small hepatocellular carcinoma：a pilot study

作　　者：赵宪芝 张火俊 王晓艳 代智涛 朱晓斐 清水汪 居小萍 刘永明 Zhao Xianzhi;Zhang Huojun;Wang Xiaoyan;Dai Zhitao;Zhu Xiaofei;Qing Shuiwang;Ju Xiaoping;Liu Yongming(Department of Radiation Oncology, Shanghai Changhai Hospital, Shanghai 200433, Chin)

机构地区：[1]上海长海医院放疗科,200433

出　　处：《中华放射医学与防护杂志》2017年第11期843-849,共7页Chinese Journal of Radiological Medicine and Protection

摘　　要：目的 探讨射波刀-立体定向放疗技术治疗小肝癌的安全性和有效性。方法 前瞻性分析本院2014年6月至2016年12月应用立体定向放疗技术治疗33例小肝癌的患者资料，治疗后每3个月复查，采用修改后实体肿瘤疗效评价标准（mRECIST）进行疗效评价，采用常见不良反应事件评价标准（CTCAE）4.0分级标准评价治疗反应，采用Kaplan-Meier法计算生存率和局部控制（CR＋PR＋SD）率，并绘制生存曲线。结果 平均随访19.3（2.3~30.8）个月。截止随访日期，共有33个病例含33个靶点纳入研究。其中18个病灶（54.5%）完全缓解，7个病灶（21.2%）部分缓解，5个病灶（15.2%）稳定，3个（9.1%）进展。总有效（CR＋PR）率为75.8%，局部控制率为90.9%。1年局部控制率为100%，2年局部控制率为83.6%，中位疾病无进展生存期（DPFS）为15.0个月。未照射肝脏体积≥ 1 000 ml、治疗前甲胎蛋白（AFP）〈100 ng/ml、治疗后CTCAE分级≤ 1级均有助于延长生存期。V5与2级及以上不良反应相关（P=0.015）。治疗后乏力、纳差、恶心、呕吐等胃肠道反应和肝损伤主要为1、2级不良反应，1例出现3级肝功能损伤在治疗半年后缓解，1例出现4级肝不良反应在治疗后1年治愈。结论 射波刀治疗小肝癌不良反应可耐受，局部控制效果好。Objective To determine the effectiveness and safety of patients treated with stereotactic body radiotherapy （SBRT）-CyberKnife for small hepatocellular carcinoma. Methods A prospective analysis of treatment details and outcomes for 33 patients with small hepatocellular carcinoma treated by CyberKnife at CyberKnife center of Shanghai Changhai Hospital from June 2014 to December 2016 was presented. Patients were followed every 3 months. WHO modified response evaluation criteria in solid Tumors（mRECIST）was used to evaluate efficacy, Common Terminology Criteria for Adverse Events Version 4.0（CTCAE 4.0） to evaluate treatment response, Kaplan-Meier method to calculate survival rate and local control rate and plot survival curves. Results There were 33 patients, 33 targets included in the study at the date of the last follow-up. 18 lesions （54.5%） showed complete remission response, 7 lesions （21.2%） showed partial remission response, 5 lesions （15.2%） showed stable, and 3 lesions （9.1%） progressed. Response rate was 75.8%, and disease control rate was 90.9%. 1-and 2-year local control rate was 100% and 83.6%, respectively. The median disease progression free survival （DPFS） was 15.0 months. Non irradiated liver volume more than 100 ml, prior AFP less than 100 ng/ml, post-treatment CTCAE less than grade 2 could improve overall survival（OS）. V5 was a factor in grades 2-4 hepatic toxicity （P=0.015）. All patients tolerated the radiosurgery, with grade 1 and grade 2 fatigue, and the gastrointestinal reactions and liver injury was the main side effect. 1 patient with grade 3 liver damage relieved at 6 months after treatment and 1 patient with grade 4 liver damage cured at 12 months after treatment. No grade 5 toxicity was encountered. Conclusions CyberKnife seems to be a safe and effective treatment measure with tolerated adverse reaction and good local control rate for patients with small hepatocellular carcinoma.

关 键 词：小肝癌 射波刀 立体定向放疗 疗效 不良反应 

分 类 号：R735.7[医药卫生—肿瘤]