原发性肝癌肝移植前射波刀降期治疗(附2例报道)  

Cyberknife used as downstaging therapy before liver transplantation for patients with hepatocellular carcinoma(report of 2 cases)

作　　者：杜玉娟 王佳 段学章[1] 孙静 何卫平[1] 张弢 Du Yu -juan;Wang Jia;Duan Xue- zhang;Sun Jing;He Wei- ping;Zhang Tao(Radiation Oncology Center,Hospital 302,Beijing 100039,China)

机构地区：[1]解放军第三○二医院放疗中心,北京100039

出　　处：《肝脏》2018年第6期484-487,共4页Chinese Hepatology

摘　　要：目的探讨射波刀在原发性肝癌肝移植前降期治疗中的作用。方法收集2例行射波刀降期治疗的原发性肝癌患者临床资料,采用mRESISI标准评价降期治疗后的肿瘤退缩情况,以及治疗后接受肝移植的时间、肝移植术后病理诊断,并对肝移植后随访1年以上评估移植后无疾病生存期。根据放疗前后肝功能Child-Pugh分级变化来评估射波刀降期治疗的安全性。结果病例1为BCLC-C期,肝内肿瘤放疗剂量为50 Gy/10f,治疗后疗效评价:PR,放疗结束3月后接收肝移植,随访1年以上,无转移及复发征象。病例2为BCLC-B期,肝内肿瘤放疗剂量48 Gy/8f,疗效评价:PR,放疗结束1年后接收肝移植,移植前定期复查病情平稳;移植术后随访1年以上,无转移及复发征象。2例患者移植术后病理均提示肿瘤明显缩小。2例患者放疗前后肝功能分别为A6和B7,肝功能损伤轻微。结论立体定向射波刀治疗因不良作用轻微、降期效果明显,可以作为一种有效的肝移植前降期治疗方案。Objective To investigate the role of cyberknife in downstaging therapy before liver transplantation for patients with hepatocellular carcinoma.Methods The clinical data of 2 patients with primary liver cancer who had been treated with cyberknife during the last 2 years in our department were collected.Modified Response Evaluation Criteria in Solid Tumors Criteria was used to evaluate tumor shrinkage after downstaging treatment.Time from radiotherapy to liver transplantation and postoperative pathology diagnosis were recorded.Disease-free survival time was assessed in both patients 1 year after liver transplantation.Child-Pugh grading before and after radiotherapy was applied for evaluating the safety of radiographic knife as downstaging treatment.Results Patient 1 was in Barcelona Clinic Liver Cancer stage C（BCLC-C）,who received a radiotherapy dose of 50 Gy/10 f and achieved partial response（PR）after treatment.Liver transplantation was performed 3 months after radiotherapy in the patient,and no metastasis or recurrence occurred in the1-year follow-up.Patient 2 was in BCLC-B stage,and received a radiotherapy dose of 48 Gy/8 f and achieved PR after treatment.Liver transplantation was performed 1 year after radiotherapy in the patient and no sign of metastasis or recurrence was observed in the 1-year follow-up after transplantation.Postoperative pathology showed significant shrinkage of tumors.Liver functions of both patients before and after radiotherapy were A6 and B7,which were slightly impaired.Conclusion Cyberknife can be used as an effective downstaging treatment before liver transplantation because of its mild side effects and satisfying downstaging effects.

关 键 词：原发性肝癌 射波刀 立体定向放疗 肝移植 降期治疗 

分 类 号：R735.7[医药卫生—肿瘤]