射波刀治疗肝细胞癌腹腔淋巴结转移的疗效分析  

Therapeutic effect of Cyberknife in the treatment for abdominal lymph node metastases of primary hepatocellular carcinoma

作　　者：肖崇娟 张弢 孙静 范毓泽 段学章 何卫平 XIAO Chong-juan;ZHANG Tao;SUN Jing;FAN Yu-ze;DUAN Xue-zhang;HE Wei-ping(Department of Radiation Oncology,The Fifth Medical Center of PLA General Hospital,Beijing 100039,China)

机构地区：[1]解放军总医院第五医学中心肿瘤医学部放射治疗科,北京100039

出　　处：《肝脏》2022年第10期1069-1072,共4页Chinese Hepatology

摘　　要：目的 评价肝细胞癌(HCC)腹腔淋巴结转移患者接受射波刀立体定向放射治疗的疗效和安全性。方法2015年1月至2017年9月解放军总医院第五医学中心行射波刀治疗的HCC腹腔淋巴结转移患者37例。射波刀治疗总剂量40~63 Gy,单次剂量5~10 Gy/次,照射次数4~10次。近期疗效依据实体瘤的疗效评价标准(RECIST1.1),采用常见不良反应事件标准(CTCAE4.0)评价不良反应。以1、2、3年总生存率和局部控制率作为远期疗效评价指标。采用Kaplan-Meier法计算总生存率和局部控制率,log-rank检验分析不同分组患者之间总生存期差异。结果 共随访2~58个月,中位随访时间14个月。37例患者中,完全缓解8例(21.62%),部分缓解24例(64.86%),稳定4例(10.81%),进展1例(2.70%)。有效率86.48%,疾病控制率97.29%。1、2、3年总生存率分别为61.8%、39.4%和22.1%;1、2、3年局部控制率分别为86.0%、80.3%和63.1%;中位生存期为16.0个月(2~58个月)。19例腹部或腰背部疼痛患者中,12例(63.2%)在治疗完成3次后疼痛症状即有减轻,14例(73.7%)在治疗结束时疼痛消失。射波刀治疗总剂量≥45 Gy患者生存期明显长于总剂量<45 Gy患者,差异有统计学意义(P<0.01)。无疼痛症状患者的生存期明显长于有疼痛症状患者,差异有统计学意义(P=0.004)。Ⅰ、Ⅱ级胃肠道反应发生率为13.5%(5/37),无Ⅲ级及以上不良事件。结论 射波刀治疗HCC淋巴结转移是安全有效的,能有效提高生存率和肿瘤局部控制率,且不良反应小。Objective To investigate the effect and safety of CyberKnife stereotactic radiotherapy in the treatment for abdominal lymph node metastases of primary hepatocellular carcinoma(PHCC).Methods Thirty-seven patients with abdominal lymph node metastases of PHCC who underwent CyberKnife radiotherapy in our hospital from January 2015 to September 2017 were enrolled.The total dose of CyberKnife radiotherapy ranged from40Gy to 63Gy.The single dose ranged from5Gy to 10Gy,divided into 4-10 fractions.Short-term therapeutic effect was assessed by Modified Response Evaluation Criteria in Solid Tumors.Long-term therapeutic effect was assessed by 1,2,and 3-year overall survival rates and local control rates.The Kaplan-Meier method was used to calculate cumulative survival rate and local control rate.The log-rank test was used for the comparison of overall survival time between groups.Results The patients were followed up for 2-58 months,with an average of 14 months.Among all 37 patients,8(21.62%)achieved complete remission,24(64.86%)achieved partial remission,4(10.81%)achieved a stable condition,and 1(2.70%)experienced disease progression.The effective rate was 86.48%,and the disease control rate was 97.29%.The 1,2 and3-year overall survival rates were 61.8%,39.4% and 22.1%,respectively;The 1,2 and 3-year local control rates were 86.0%,80.3% and63.1%,respectively;The median overall survival time was 16.0 months(range from2 to 58 months).Among the 19patients with abdominal pain or lower back pain,12(63.2%)achieved alleviation of pain symptoms after 3 times of treatment,14(73.7%)achieved complete remission at the end of treatment.Survival rate of patients with a total dose of≥45 Gy treated with CyberKnife radiotherapy was significantly higher than that of patients with a total dose of<45 Gy,and there was significant difference between the 2 groups(P=0.000).The survival rate of patients without pain symptoms was significantly higher than that of patients with pain symptoms,and the difference was statistically significant(P=0.004)

关 键 词：肝细胞癌 腹腔淋巴结转移 射波刀 疗效 安全性 

分 类 号：R735.7[医药卫生—肿瘤]