肝转移癌立体定向放疗的疗效分析

Analysis of Efficacy of Stereotactic Body Radiotherapy for Liver Metastases

目的探讨立体定向放疗(stereotactic body radiotherapy,SBRT)治疗肝转移癌患者的疗效及安全性。方法回顾性分析2018年1月—2021年10月福建医科大学附属漳州市医院收治的28例肝转移癌患者临床资料。原发肿瘤为结直肠癌13例、非结直肠癌15例。采用腹板腹部加压固定体位,4D-CT扫描模拟定位,给予肝转移癌病灶立体定向放疗。每次治疗前使用锥形束CT进行在线位置验证,图像引导放疗。处方剂量PTV 50 Gy/10 F。并分析年龄、性别、原发肿瘤部位、肝病灶个数、肝外转移灶、有无全身治疗与肝转移癌患者预后关系。结果28例患者共治疗34个肝转移病灶,均顺利完成放疗。放疗后肝转移癌1年局部控制率、无进展生存率及总生存率分别为71.43%、57.14%及75.00%。结直肠癌患者、非结直肠癌患者的1年总生存率分别为92.31%、60.00%,两组之间差异有统计学意义(HR=10.01,P=0.044)。1~2级急性不良反应发生率为39.3%,未出现3级以上不良反应。结论立体定向放射治疗肝转移癌安全有效。原发肿瘤结直肠癌患者相比非结直肠癌患者具有更高生存期。

Objective To investigate the efficacy and safety of stereotactic body radiotherapy(SBRT)in the treatment of liver metastatic carcinoma.Methods The clinical data of 28 patients with liver metastatic cancer admitted to Zhangzhou Affiliated Hospital of Fujian Medical University from January 2018 to October 2021 were retrospectively analyzed.The primary with colorectal cancer was 13 cases and non-colorectal cancer was 15 cases.Stereotactic body radiotherapy was given to liver metastases using a fixed position of abdominal compression on the web and simulated positioning by 4D-CT scan.Cone-beam CT was used for online position verification and image-guided radiotherapy before each treatment.Prescription dose PTV 50 Gy/10 F.The prognostic relationship between age,sex,primary tumor site,number of liver lesions,extrahepatic metastases,and systemic therapy was analyzed.Results A total of 34 liver metastases were treated in 28 patients,and all of them successfully completed radiotherapy.Local control rate,progression-free survival rate and overall survival rate at 1 year after radiotherapy were 71.43%,57.14%and 75.00%.The 1-year overall survival rates of colorectal cancer patients and non-colorectal cancer patients were 92.31%and 60.00%,with significant difference between the two groups(HR=10.01,P=0.044).The incidence of grade 1-2 acute adverse reactions was 39.3%,and no grade 3 or above adverse reactions occurred.Conclusion Stereotactic body radiotherapy is safe and effective for liver metastases.Patients with primary colorectal cancer have a higher survival time than patients without colorectal cancer.