射波刀在不可切除肝内胆管癌治疗中的应用

Application of CyberKnife in the treatment of unresectable intrahepatic cholangiocarcinoma

目的 探讨射波刀(CyberKnife)对不可手术切除的肝内胆管癌(ICC)的临床疗效。方法 随访2019年1月至2022年12月在海军军医大学第三附属医院使用射波刀治疗的38例不可切除的肝内胆管癌患者,放疗后每2~3个月进行一次核磁共振检查(MRI),评估治疗效果。采用Kaplan-Meier法评价患者的总生存期(OS)和无进展生存期(PFS),并使用多因素Cox回归分析影响患者总生存期的独立危险因素。结果 中位随访时间为10.5(3~62)个月,中位PFS为6(95%CI 2.605~9.395)个月,中位OS为18 (95%CI 6.474~29.526)个月。基于改进的实体瘤反应评价标准(mRECIST),射波刀治疗不可切除ICC的缓解率(RR)和疾病控制率(DCR)分别为60.5%和86.8%。1年、2年和3年总生存率分别为50.9%,35.8%和21.5%,而1年、2年和3年PFS分别为32.4%,10.8%和2.7%。基于Cox比例风险模型的多因素分析发现,肿瘤直径大、CA19-9水平高的患者总生存期较差(P<0.05)。在所有接受治疗的患者中,未观察到3级以上的毒副作用。结论 射波刀对于无法手术的ICC患者来说是安全有效的。

Objective To evaluate the clinical efficacy of CyberKnife for inoperable intrahepatic cholangiocarcinoma(ICC).Methods CyberKnife was performed in Third Affiliated Hospital of Naval Medical University from January 2019 to December 2022.Long‐term follow‐up was performed in 38 patients with unresectable ICC in CyberKnife.MRI was performed every 2-3 months after radiotherapy to assess the effectiveness of treatment.Kaplan‐Meier method was used to evaluate the overall survival(OS)and the pro‐gression‐free survival(PFS),and multi‐factor Cox regression was used to analyze independent risk factors affecting overall survival.Results The median follow‐up time was 10.5(3-62)months,the median PFS was 6(95%CI 2.605-9.395)months,and the median OS was 18(95%CI 6.474-29.526)months.Based on the modified solid tumor response evaluation criteria(mRECIST),the response rate(RR)and the disease control rate(DCR)of SBRT in unresectable ICC patients were 60.5%and 86.8%,respectively.The 1‐year,2‐year and 3‐year overall survival rates were 50.9%,35.8%and 21.5%,respectively,and the 1‐year,2‐year and 3‐year PFS were 32.4%,10.8%and 2.7%,respectively.Multivariate analysis based on Cox proportional hazards model showed that the patients with large tumor and high CA19‐9 level had poorer overall survival(P<0.05).No adverse effects above grade 3 were observed in all patients.Conclusion CyberKnife is safe and effective for inoperable ICC patients.