肝细胞肝癌经动脉化疗栓塞后行立体定向放疗的初步疗效观察

摘要

目的:评估肝细胞肝癌患者经动脉化疗栓塞(transarterial chemoembolization,TACE)治疗后,针对残存病灶,采用立体定向放疗(stereotactic body radiation therapy,SBRT)作为巩固治疗的安全性及有效性.方法:回顾性分析复旦大学附属中山医院2012年12月至2015年12月收治的16例行TACE联合SBRT的肝细胞肝癌患者的临床资料.患者年龄41~80岁,中位年龄55岁;TACE后残存肿瘤以单个为主,平均直径为2.8 cm.SBRT计划前均行四维CT定位,可见肿瘤残留病灶,SBRT治疗采用图像引导放射治疗,总照射剂量为48~50 Gy,分割次数为5~10次,治疗期间结合对症支持治疗.采用改良的实体瘤疗效评价(modified response evaluation and criteria in solid tumors,mRECIST)标准判断肿瘤治疗反应.结果:16例患者均按计划完成治疗.根据mRECIST标准,完全缓解(CR) 9例(56.3%),部分缓解(PR)6例(37.5%),病情稳定(SD)1例(6.25%),无照射野内进展(PD);总的客观缓解率(CR+PR)为93.8%.16例患者的1年、2年、3年总生存率分别为100%、93.6%和93.6%.所有患者均未出现放射性肝损伤.结论:对于TACE后符合指征且伴残存病灶的肝细胞肝癌患者,采用SBRT以巩固治疗安全有效;TACE联合SBRT是针对中晚期肝癌的有效治疗组合,值得进一步研究.%Objective:To evaluate the safety and primary outcome of stereotactic body radiation therapy(SBRT) for the consolidation treatment in patients with residual hepatocellular carcinoma after transarterial chemoembolization(TACE).Methods:From December 2012 to December 2015, clinical data of sixteen patients with hepatocellular carcinoma who received TACE combination with SBRT in Zhongshan Hospital affiliated to Fudan University were analyzed retrospectively.The median age was 55 years (range 41-80 years),and the residual tumor was single (the median diameter was 2.8 cm).All cases were performed by 4-dimensional CT positioning, showing the visible residual tumor lesions.Image guided-radiation therapy was used, total irradiation doses ranged from 48 Gy to 50 Gy in 5 to 10 fractions, and the supportive treatment was administrated during SBRT.Tumor responses were evaluated using the modified Response Evaluation and Criteria in Solid Tumors (mRECIST).Results:All of 16 cases completed SBRT.Based on mRECIST, 9 patients (56.3%) achieved complete response (CR), 6 cases (37.5%) achieved partial response (PR), but there were 1 patient (6.25%) with stable disease (SD)and no patient with progressive disease (PD) in radiation field.The overall objective response rate (CR+PR) was 93.8%.The overall survival (OS) rate at 1, 2, and 3 years was 100%, 93.6% and 93.6%, respectively.No radiation-induced liver disease was appeared.Conclusions:SBRT is safety and effective to treat patients with residual hepatocellular carcinoma after TACE.TACE combination with SBRT, as an effective combination for the treatment of advanced liver cancer, is worthy of further study.