无法手术切除的胆管细胞癌经体部立体定向放射治疗的效果及安全性分析  

Efficacy and safety of stereotactic body radiation therapy in treatment of patients with unresectable cholangiocarcinoma

作　　者：赵晓芳[1] 张爱民 李文刚 孙静 常小云 张弢 何卫平 段学章[1,2] ZHAO Xiaofang;ZHANG Aimin;LI Wengang;SUN Jing;CHANG Xiaoyun;ZHANG Tao;HE Weiping;DUAN Xuezhang(Chinese PLA Medical College,Beijing 100039,China;Department of Oncology and Radiotherapy,The Fifth Medical Center of Chinese PLA General Hospital,Beijing 100039,China)

机构地区：[1]中国人民解放军医学院,北京100039 [2]中国人民解放军总医院第五医学中心肿瘤放射治疗科,北京100039

出　　处：《临床肝胆病杂志》2023年第11期2657-2662,共6页Journal of Clinical Hepatology

基　　金：国家自然科学基金面上项目(81972856)。

摘　　要：目的观察体部立体定向放疗治疗无法手术切除的胆管细胞癌患者的生存情况及不良反应。方法选取2012年2月—2020年7月于解放军总医院第五医学中心行体部立体定向放射治疗的27例无法手术切除的单发无转移的胆管细胞癌患者。计划靶区(PTV)处方剂量42~60 Gy,分5~8次,5~11 Gy/次。其中有5例联合肝动脉化疗栓塞术(TACE)和化疗治疗。以6个月、12个月、18个月和24个月的总生存率、无进展生存率和局部控制率作为疗效评价指标。使用不良事件通用术语标准(CTCAE)v.4.03评估不良反应。采用Kaplan-Meier法计算总生存率、无进展生存率和局部控制率。结果中位随访时间17个月。27例患者的6个月、12个月、18个月和24个月的总生存率分别为100%、88%、57.5%和47.9%,无进展生存率分别为74.1%、58.6%、47.9%和35.9%,局部控制率分别为96.3%、91.9%、84.8%和76.4%。未出现3级及以上毒性反应。5例患者诊断为放射性肝损伤,无因放射性肝损伤死亡病例。结论体部立体定向放疗治疗不可切除胆管细胞癌安全、有效,具有较高的生存率、无进展生存率和局部控制率,且毒性反应低,可作为不适合手术治疗的胆管癌的替代治疗。Objective To investigate the survival and adverse reactions of patients with unresectable cholangiocarcinoma after stereotactic body radiation therapy(SBRT).Methods A total of 27 patients with unresectable solitary cholangiocarcinoma without metastasis who underwent SBRT in The Fifth Medical Center of Chinese PLA General Hospital from February 2012 to July 2020 were enrolled.The prescribed dose to planning target volume was 42-60 Gy in 5-8 fractions,with 5-11 Gy/fraction.Among these patients,five patients were also treated with chemotherapy and transcatheter arterial chemoembolization.The 6-,12-,18-,and 24-month overall survival(OS)rates,progression-free survival(PFS)rates,and local control(LC)rates were used as the assessment indices for treatment outcome;Common Terminology Criteria for Adverse Events v.4.03 was used to evaluate adverse reactions;the Kaplan-Meier method was used to calculate OS,PFS,and LC rates.Results The median follow-up time was 17 months.For all 27 patients,the 6-,12-,18-,and 24-month OS rates were 100%,88%,57.5%,and 47.9%,respectively;the 6-,12-,18-,and 24-month PFS rates were 74.1%,58.6%,47.9%,and 35.9%,respectively;the 6-,12-,18-,and 24-month LC rates were 96.3%,91.9%,84.8%,and 76.4%,respectively.No grade 3 or above toxic reactions were observed.Five patients were diagnosed with radiation-induced liver injury,but there was no death due to radiation-induced liver injury.Conclusion SBRT is safe and effective in the treatment of unresectable cholangiocarcinoma,with relatively high survival rate,PFS rate,and LC rate and low toxicity,and therefore,SBRT can be used as an alternative treatment method for patients with cholangiocarcinoma who are not candidates for surgery.

关 键 词：胆管上皮癌 放射外科手术 治疗结果 

分 类 号：R735.8[医药卫生—肿瘤]