射波刀立体定向放射治疗小肝癌的临床效果

Clinical effect of Cyber Knife stereotactic radiosurgery in treatment of patients with small hepatocellular carcinoma

目的评价小肝癌(s HCC)患者接受射波刀立体定向放射外科治疗的疗效和安全性。方法收集2011年3月-2012年12月解放军第三○二医院行射波刀治疗的28例s HCC患者。射波刀治疗总剂量35~60 Gy/3~5次,连续治疗3~6 d。中位随访时间36个月。依据改良版实体瘤疗效评价标准(mRECIST)进行近期疗效评价,以1、2、3年总生存率和局部控制率作为远期疗效评价指标。采用Kaplan-Meier法分析计算累积生存率和局部控制率。结果 28例患者中,完全缓解17例,部分缓解8例,稳定2例,疾病进展1例,近期有效率89.28%。1、2、3年生存率分别为92.86%、85.71%和78.57%;1、2、3年局部控制率分别为96.43%、92.86%和89.28%。毒性反应主要表现为Ⅰ~Ⅱ级事件。结论射波刀治疗s HCC是安全、有效的,具有较高的局部控制率、生存率和低毒性反应,可以作为不适合手术治疗的s HCC的替代治疗。

Objective To investigate the clinical effect and safety of CyherKnife stereotactic radiosurgery in the treatment of small hepato- cellular carcinnma （sHCC）. Methods Twenty - eight patients with sHCC who underwent CyberKnifie radiosurgery in 302 hospital of PLA form March 2011 to Decemher 2012 were enrolled. The total dose of Cyher Knife radiosurgery was 35 - 60 Gy in 3 - 5 fractions for 3 - 6 consecutive days. The median follow - up was 36 months. Modified Response Evaluation Criteria in Solid Tumors was used as assessment indices for short - term therapeutic effect, and the 1 - , 2 - , and 3 - year overall survival rates and h）eal control rates were used as assessment indices for long - term therapeutic effect. The Kaplan - Meier method was used to calculate cumulative survival rate and local control rate. Resuits Among the 28 patients, 17 achieved complete remission （CR）, 8 achieved partial remission （PR）, 2 achieved a stable disease, amt 1 had a progressive disease, resulting in a short - tetra response rate （ CR ＋ PR） of 89.28%. The 1 - , 2 - , and 3 - year survival rates were 92.86% , 85.71% , and 78.57% , respectively, and the I - , 2 - , and 3 - year local control rates were 96.43% , 92.86% , and 89. 28% , respectively. Toxic reactions were mainly grade 1 and 2 events. Conclusion CyberKnife is a safe and effective option for sHCC and has the features of high local control rate, high survival rate, and few toxic reactions. Therefore, it can be used as an alternative treatment for patients with inoperable sHCC.