原发性肝癌伴门静脉癌栓立体定向放射治疗的疗效分析

Effectiveness of Stereotactic Body Radiotherapy for Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis

【目的】门静脉和下腔静脉癌栓是影响原发性肝癌预后的重要因素。本研究旨在评价体部立体定向放射治疗（SBRT）对于肝癌伴门静脉和/或下腔静脉癌栓的有效性和安全性。【方法】2010年8月至2013年6月,共入组41例原发性肝癌合并门静脉和/或下腔静脉癌栓患者,实施以容积旋转调强治疗（VMAT）为形式的SBRT,其中肝癌合并门静脉癌栓33例,下腔静脉癌栓8例。中位放疗剂量36 Gy（30~48 Gy）,两周内分6次照射。根据CTCAE 3.0标准评价治疗毒性,采用KaplanMeier法进行生存分析。【结果】41例患者均顺利完成治疗,全组中位随访时间12.1月。4例（9.8%）达到完全缓解,19例（46.3%）部分缓解,有效率56.1%。SBRT治疗后3月内无患者发生放射性肝炎和4/5级治疗相关毒性,仅1例出现3级胆红素升高。全组1年生存率为50.3%,中位生存期13.0月。多因素分析显示,放疗近期疗效是影响总生存的独立预后因素。【结论】VMAT-SBRT治疗肝癌伴门静脉和/或下腔静脉癌栓的疗效满意,安全性良好。

【Objective】 Portal vein tumor thrombosis（PVTT） and inferior vena cava tumor thrombosis（IVCTT） are important prognostic factors for patients with advanced hepatocellular carcinoma（HCC）. The purpose of this study was to report the feasibility and efficacy of stereotactic body radiotherapy（SBRT） for the treatment of PVTT and / or IVCTT in HCC. 【Methods】 Forty-one patients treated with SBRT using volumetric modulated arc therapy（VMAT） for HCC with PVTT / IVCTT between August 2010 and June 2013 were analyzed. Of these, 33 had PVTT and 8 had IVCTT. SBRT was designed to target the tumor thrombosis and deliver a median dose of 36 Gy（range, 30-48 Gy） in six fractions during two weeks. Treatment-associated acute and late toxicities were scored according to the Common Terminology Criteria for Adverse Events（CTCAE; version 3.0）. The Kaplan-Meier method was used to analyze the overall survival（OS）. 【Results】 All patients completed the planned radiotherapy and the median follow-up period was12.1 months. At the time of analysis, 4（9.8%） achieved complete response, 19（46.3%） achieved partial response, yielding an objective response rate of 56.1%. No radiation-induced liver disease or treatment-related Grade 4 / 5 toxicity was seen within three months after SBRT. One patient had Grade 3 elevation of bilirubin. The 1-year OS rate was 50.3%, with a median survival of 13.0months. Multivariate analysis revealed that the only independent predictive factor associated with better survival was response to radiotherapy. 【Conclusion】 VMAT-based SBRT is a very safe and effective treatment option for PVTT / IVCTT in patients with HCC.