肝细胞癌脑转移瘤的立体定向放射治疗

Stereotactic radiotherapy for brain metastases of hepatocellular carcinoma

目的探讨立体定向放射治疗加或不加全脑放疗对肝细胞癌有限数目脑转移瘤治疗的疗效.方法回顾性分析2008年8月-2018年7月武警部队上海肿瘤放射诊疗中心及海军军医大学附属东方肝胆外科医院肿瘤放疗中心收治的肝细胞癌脑转移瘤(1~4枚)患者75例,其中行立体定向放射治疗的患者45例,立体定向放射治疗加全脑放疗的患者30例.分析两组患者治疗的肿瘤客观缓解率、总生存期、放射治疗后的不良反应情况并行多因素分析.结果立体定向放射治疗组与立体定向放射治疗加全脑放疗组的客观缓解率分别为88.9%和80.0%,未见统计学差异(P=0.537);全组患者的中位总生存期为5.7个月,其中立体定向放射治疗组为6.2个月,立体定向放射治疗加全脑放疗组为5.4个月,未见统计学差异(P=0.380);多因素分析显示病灶数目(P=0.041)、病灶总体积(P=0.012)及肝内病灶的控制情况(P=0.006)是影响脑转移瘤患者总生存期的主要因素;两种治疗方式均未见严重不良反应.结论立体定向放射治疗是肝细胞癌有限数目脑转移瘤患者安全有效的治疗方式,单纯立体定向放射治疗可取得与立体定向放射治疗加全脑放疗相似的疗效.

Objective To analyze the effects of stereotactic radiotherapy (SRT) with or without whole-brain radiotherapy (WBRT) in the treatment of limited number brain metastasis of hepatocellular carcinoma.Methods A retrospective analysis of 75 hepatocellular carcinoma patients with brain metastases within 4 lesions.45 cases were treated with SRT alone and 30 cases were treated with SRT + WBRT.Tumor response rate,overall survival and radiotherapy side effects of the two groups were compared.Multivariate analysis was made for overall survival.Results Tumor response rates of SRT group and WBRT+SRT group were 88.9% and 80.0%,respectively.No significant differences were found between the two groups (P=0.537).For the whole patients,the median overall survival time was 5.7 months.There was no difference between SRT group and SRT+WBRT group (6.2 months vs 5.4 months,P=0.380).Multivariate analysis showed that the number (P=0.041),the total volume of lesions (P=0.012) and the control situations of intrahepatic tumors (P=0.006) were the main factors affecting overall survival of the patients.No serious side effects were found in either of two groups.Conclusions Stereotactic radiotherapy is an effective and safe treatment for limited number brain metastases of hepatocellular carcinoma.Patients who accepted SRT alone or SRT + WBRT have a similar tumor response rate and overall survival time.