部分弧形调强伴SIB治疗肝细胞性肝癌的安全性及其疗效影响因素研究

Study on the safety of partial arc-shaped intensity modulation combined with SIB in the treatment of hepatocellular carcinoma and the influencing factors of its efficacy

目的研究部分弧形调强伴局部同期推量(SIB)技术治疗肝细胞性肝癌的安全性及其疗效影响因素。方法选取厦门长庚医院2011—2020年利用部分弧形调强伴SIB技术治疗的肝细胞性肝癌患者共44例,共50个治疗病灶(部分患者多次治疗)。根据急性放射性肝损伤(RILD)及皮肤/黏膜急性放射损伤分级标准(RTOG/EORTC)评估安全性,并统计和分析其疗效及影响因素。结果所有病例均未出现RILD,未出现Ⅲ级以上放疗急性反应。1、2年局部控制率为66.6%;1年总体生存率为43.6%,2年总体生存率为30.0%;根据高量区中位生物等效剂量(BED)72.7 Gy分组,2组患者基础治疗数据[性别、美国东部肿瘤协作组(ECOG)评分、巴塞罗那分期(BCLC)、Child-Pugh分级、其他治疗情况]比较差异均无统计学意义(P>0.05)。较高剂量组(BED≥72.7 Gy)的局部控制率及总体生存率均高于较低剂量组(BED<72.7 Gy),差异均有统计学意义(P<0.05)。结论部分弧形调强伴SIB治疗肝细胞性肝癌的安全条件为“至少600 cm 3的正常肝脏受量小于15 Gy,全部正常肝组织平均受量小于30 Gy”;靶区内BED≥72.7 Gy可提高局部控制率及总体生存率。

Objective To study the safety of local arc intensity modulation with SIB technology in the treatment of hepatocellular carcinoma and the factors affecting its efficacy.Methods A total of 44 cases of liver cancer patients treated with partial arc intensity modulation and SIB technology in Xiamen Chang Gung Memorial Hospital from 2011 to 2020,with a total of 50 treatment lesions(some patients were treated multiple times).According to the acute radiation liver injury(RILD)and skin/mucosal acute radiation injury classification standards(RTOG/EORTC),the safety was evaluated,and the efficacy and its influencing factors were counted and analyzed.Results There was no RILD in all cases,and no acute reaction to radiotherapy above gradeⅢ.The local control rate for the first two years was 66.6%.The 1-year overall survival rate was 43.6%,and the 2-year overall survival rate was 30.0%.Groups were grouped according to the median bioequivalent dose(BED)of 72.7 Gy in the high-dose area.There was no statistically significant difference in basic treatment data(gender,ECOG score,BCLC,Child-Pugh classification,other treatment status)between the two groups of patients(P>0.05).The local control rate and overall survival rate of the higher-dose group(BED greater than or equal to 72.7 Gy)were higher than those of the lower-dose group(BED less than 72.7 Gy),and the differences were statistically significant(P<0.05).Conclusion The safety conditions for partial arc-shaped intensity modulation with SIB in the treatment of hepatocellular carcinoma are the normal liver dose of at least 600 cm 3 is less than 15 Gy,and“the average dose of all normal liver tissues is less than 30 Gy”.The BED in the target area is greater than 72.7 Gy can improve local control rate and overall survival rate.