立体定向放射治疗肝脏转移瘤的临床疗效

Clinical efficacy of stereotactic body radiation therapy on liver metastases

目的探讨立体定向放射(stereotactic body radiation therapy,SBRT)治疗肝脏转移瘤的临床疗效。方法回顾性分析2016年12月至2020年5月同济大学附属东方医院收治的43例肝脏转移瘤患者的临床资料。所有患者均采用4D⁃CT或呼吸门控技术进行CT模拟定位,共58个病灶接受SBRT治疗,总剂量为36~70 Gy,分割次数为5~10次,1天1次,1周5次。结果43例患者均顺利完成全程放疗,中位随访时间为15.6个月(范围:2.0~31.9个月)。2年总生存率、局部控制率和无进展生存率分别为55.4%、86.0%和5.9%。常见的Ⅰ~Ⅱ级不良反应为食欲减退(6例)、疲劳(6例)、骨髓抑制(3例)和肝脏疼痛(1例),未发现Ⅲ级及以上不良反应。EQ⁃5D⁃5L生活质量量表的平均效用得分为0.848(标准差=0.277)。结论立体定向放射治疗肝脏转移瘤局部控制率良好且不良反应较少,其远期疗效和安全性值得开展随机对照研究进一步探索。

Objective To investigate the clinical efficacy of stereotactic body radiation therapy(SBRT)on liver metastases.Methods The clinical data of 43 patients with liver metastases admitted to Shanghai East Hospital of Tong Ji University from December 2016 to May 2020 were retrospectively analyzed.All the patients underwent 4D⁃CT or respiration gating for CT simulation;a total of 58 lesions received SBRT,with a radiation dose of 36⁃70 Gy;the number of splits was 5⁃10 times,once a day and 5 times a week.Results A total of 43 patients successfully completed the whole course of radiationtherapy.The median follow⁃up time was 15.6 months(range:2.0-31.9 months).The 2⁃year overall survival rate,local control rate and progression⁃free survival rate were 55.4%,86.0%and 5.9%,respectively.The common gradeⅠ⁃Ⅱadverse reactions were anorexia(6 cases),fatigue(6 cases),myelosuppression(3 cases)and liver pain(1 case),respectively,and no gradeⅢor above was found.The average score of the EQ⁃5D⁃5L quality of life questionnaire was 0.848(with a standard deviation of 0.277).Conclusions SBRT on liver metastases can obtain better local control rate and fewer adverse reactions.Its long⁃term efficacy and safety deserve further exploration in randomized controlled trials.