摘要
目的:评价基于螺旋断层放疗技术的立体定向放疗(stereotactic body radiation therapy,SBRT)在治疗肝细胞肝癌中的疗效及不良反应。方法:收集复旦大学附属中山医院肿瘤放疗科2012年12月—2015年12月收治的46例肝细胞肝癌患者的临床病理资料和随访资料。所有患者均采用基于螺旋断层放疗技术的SBRT治疗。肿瘤平均直径为2.5 cm(范围:0.9~5.8 cm),采用四维CT(four-dimensional CT,4-DCT)的定位方法。治疗前行图像引导下的匹配校准,总照射剂量为48~50 Gy,分割次数为5~10次,SBRT治疗期间给予保肝和营养支持等对症支持治疗。治疗6个月后采用改良实体瘤疗效评价标准(modified response evaluation criteria in solid tumors,mRECIST)行疗效评价;不良反应评价采用美国国立癌症研究所事件通用术语标准3.0(National Cancer Institute-Common Terminology Criteria for Adverse Events 3.0,NCI-CTC 3.0);生存分析用Kaplan-Meier法。结果:所有患者均完成治疗,治疗后每隔3个月随访1次,其中完全缓解(complete remmision,CR)27例(58.7%),部分缓解(partial response,PR)15例(32.6%),病情稳定(stable disease,SD)2例(4.3%),疾病进展(progressive disease,PD)2例(4.3%),总有效率(CR+PR)为91.3%。自放疗之日开始计算生存率,46例患者的1年、2年和3年的生存率分别为95.4%、75.7%和69.9%。不良反应方面,仅有5例出现Ⅰ度骨髓抑制,2例出现Ⅱ度骨髓抑制,2例出现Ⅰ度转氨酶升高。结论:采用螺旋断层放疗是一种安全、有效的治疗手段。对于那些无法手术或射频消融的肝细胞肝癌患者,SBRT是一种行之有效的方法,值得进一步推广。
Objective： To evaluate the primary outcomes and adverse reactions of patients with hepatocellular carcinoma treated by stereotactic body radiation therapy （SBRT） using tomotherapy.Hethods： From December 2012 to December 2015, Forty-six patients with hepatocellular carcinoma who received SBRT in Zhongshan Hospital Affiliated to Fudan University were enrolled. The clinical and pathological data and follow-up data of all cases were collected. The median diameter of tumors was 2.5 cm, ranging from 0.9 to 5.8 cm. All cases were performed by four-dimensional CT （4-DCT） scan and image-guided matching calibration before SBRT. Total irradiation dose ranged from 48 to 50 Gy in 5 to 10 fractions. The supportive treatments of liver protection and nutritional support were administrated during SBRT. The curative tumor response was evaluated using the modifed Response Evaluation and Criteria in Solid Tumors （mRECIST） 6 months after SBRT. The adverse reactions were evaluated using National Cancer Institute- Common Terminology Criteria for Adverse Events 3.0 （NCI-CTC 3.0）. The cumulative probability of survival was calculated according to Kaplan-Meier method.Results： All cases completed SBRT. They were followed up every 3 months after treatment. Based on mRECIST, 58.7% of patients achieved complete response （CR）, 32.6% achieved partial response （PR）, and there were 4.3% patients with stable disease, and 2.61% patients with tumor progression. The total effective rate （CR＋PR） was 91.3%. The overall survival （OS） rates at 1, 2 and 3 years were 95.4%, 75.7% and 69.9%, respectively. For the adverse reaction, only 5 cases of grade I bone marrow suppression, 2 cases of gradelI bone marrow suppression and 2 cases of grade I transaminase increase were found; no radiation-induced liver disease （RILD） occurred.Conclusion： Tomotherapy is a safe and effective treatment for the patients with unresectable hepatocellular carcinoma. So SBRT using tomotherapy is worth promoting as an alternative treatm
出处
《肿瘤》
CAS
CSCD
北大核心
2017年第4期365-371,共7页
Tumor
基金
国家自然科学基金资助项目(编号:81602714)~~
