Role of stereotactic body radiation therapy for hepatocellular carcinoma

The integration of new technologies has raised an interest in liver tumor radiotherapy,with literature evolving to support its efficacy.These advances,particularly stereotactic body radiation therapy(SBRT),have been critical in improving local control or potential cure in liver lesions not amenable to first-line surgical resection or radiofrequency ablation.Active investigation of SBRT,particularly for hepatocellular carcinoma(HCC),has recently started,yielding promising local control rates.In addition,data suggest a possibility that SBRT can be an alternative option for HCC unfit for other local therapies.However,information on optimal treatment indications,doses,and methods remains limited.In HCC,significant differences in patient characteristics and treatment availability exist by country.In addition,the prognosis of HCC is greatly influenced by underlying liver dysfunction and treatment itself in addition to tumor stage.Since they are closely linked to treatment approach,it is important to understand these differences in interpreting outcomes from various reports.Further studies are required to validate and maximize the efficacy of SBRT by a large,multi-institutional setting.

Stereotactic body radiation therapy in patients with hepatocellular carcinoma: A mini-review

Stereotactic body radiation therapy(SBRT) is an emerging treatment for hepatocellular carcinoma. This technique results in excellent local control rates with favorable toxicity profile despite being predominantly used in heavily pretreated patients or those unsuitable for other local therapies. SBRT may be used as a sole treatment or in combination with other local therapies as well as a bridging strategy for patient awaiting liver transplants. This brief review describes current practice of SBRT with respect to radiation technique, patient selection and treatment concepts. It summarizes available evidence from retroand prospective studies evaluating SBRT alone, SBRT in combination with other treatments and SBRT compared to other local treatment approaches.

High rate of complete histopathological response in hepatocellular carcinoma patients after combined transarterial chemoembolization and stereotactic body radiation therapy

BACKGROUND Liver transplantation(LT)presents a curative treatment option in patients with early stage hepatocellular carcinoma(HCC)who are not eligible for resection or ablation therapy.Due to a risk of up 30%for waitlist drop-out upon tumor progression,bridging therapies are used to halt tumor growth.Transarterial chemoembolization(TACE)and less commonly stereotactic body radiation therapy(SBRT)or a combination of TACE and SBRT,are used as bridging therapies in LT.However,it remains unclear if one of those treatment options is superior.The analysis of explant livers after transplantation provides the unique opportunity to investigate treatment response by histopathology.AIM To analyze histopathological response to a combination of TACE and SBRT in HCC in comparison to TACE or SBRT alone.METHODS In this multicenter retrospective study,27 patients who received liver transplantation for HCC were analyzed.Patients received either TACE or SBRT alone,or a combination of TACE and SBRT as bridging therapy to liver transplantation.Liver explants of all patients who received at least one TACE and/or SBRT were analyzed for the presence of residual vital tumor tissue by histopathology to assess differences in treatment response to bridging therapies.Statistical analysis was performed using Fisher-Freeman-Halton exact test,Kruskal-Wallis and Mann-Whitney-U tests.RESULTS Fourteen patients received TACE only,four patients SBRT only,and nine patients a combination therapy of TACE and SBRT.There were no significant differences between groups regarding age,sex,etiology of underlying liver disease or number and size of tumor lesions.Strikingly,analysis of liver explants revealed that almost all patients in the TACE and SBRT combination group(8/9,89%)showed no residual vital tumor tissue by histopathology,whereas TACE or SBRT alone resulted in significantly lower rates of complete histopathological response(0/14,0%and 1/4,25%,respectively,P value<0.001).CONCLUSION Our data suggests that a combination of TACE and SBRT increases the rate of complete histopathological response compared to TACE or SBRT alone in bridging to liver transplantation.

Liver magnetic resonance imaging for evaluation of response to treatment after stereotactic body radiation therapy of hepatocellular carcinoma

BACKGROUND Although stereotactic body radiation therapy(SBRT)is increasingly used,its application has not yet been regulated by the main international guidelines,leaving the decision to multidisciplinary teams.AIM To assess magnetic resonance imaging(MRI)features of hepatocellular carcinoma(HCC)treated with SBRT,highlighting the efficacy of the treatment and the main aspects of the lesion before and after the procedure.METHODS As part of a retrospective study,49 patients who underwent SBRT for HCC between January 2013 and November 2019 were recruited.Each patient under went a pre-treatment MRI examination with a hepatospecific contrast agent and a similar followup examination within 6 mo of therapy.In addition,22 patients underwent a second follow-up examination after the first 6 mo.The following characteristics were analysed:Features analysed compared to pre-treatment MRI examination,presence or absence of infield and outfield progression,ring-like enhancement,signal hyperintensity in T2-weighted sequences in the perilesional parenchyma,capsular retraction,and"band"signal hypointensity in T1-weighted gradient echo fat saturated sequences obtained during hepatobiliary excretion.RESULTS Signal hyperintensity in the T2-weighted sequences showed a statistically significant reduction in the number of lesions at the post-SBRT first control(P=0.0006).Signal hyperintensity in diffusionweighted imaging-weighted sequences was decreased at MRI first control(P<0.0001).A statistically significant increase of apparent diffusion coefficient values from a median of 1.01 to 1.38 at the first post-control was found(P<0.0001).Capsular retraction was increased at the late evaluation(P=0.006).Band-like signal hypointensity in the hepatobiliary phase was present in 94%at the late control(P=0.006).The study of the risk of outfield progression vs infield progression revealed a hazard ratio of 9.CONCLUSION The efficacy of SBRT should be evaluated not in the first 6 mo,but at least 9 mo post-SBRT,when infield progression persists at very low rates while the risk of outfield progression increases significantly.

Rare esophageal carcinoma-primary adenoid cystic carcinoma of the esophagus: A case report

BACKGROUND Esophageal adenoid cystic carcinoma(EACC)is an exceedingly rare malignant tumor of the esophagus,posing significant challenges in the clinic.CASE SUMMARY This report detailed the case of a 72-year-old male whose diagnosis of EACC was confirmed through postoperative histopathological examination.The patient underwent thoracoscopy-assisted radical resection of the esophageal tumor,coupled with lymph node dissection.Pathological findings revealed an adenoid cystic carcinoma infiltrating the entire layer of the muscularis propria,locally extending into the outer membrane of the esophageal fiber,involving the cardia and exhibiting no lymph node metastasis.The patient’s condition was classified as primary EACC,T3N0M0,per the American Joint Committee on Cancer(2017;8th edition).One month after surgery,the patient received postoperative adjuvant radiation therapy.CONCLUSION In addressing the rarity and high potential for biopsy misdiagnosis of EACC,this study delved into its diagnostic methods and treatment.

Unraveling the efficacy network: A network meta-analysis of adjuvant external beam radiation therapy methods after hepatectomy

BACKGROUND Primary liver cancer is a malignant tumor with a high recurrence rate that significantly affects patient prognosis.Postoperative adjuvant external radiation therapy(RT)has been shown to effectively prevent recurrence after liver cancer resection.However,there are multiple RT techniques available,and the differ-ential effects of these techniques in preventing postoperative liver cancer re-currence require further investigation.AIM To assess the advantages and disadvantages of various adjuvant external RT methods after liver resection based on overall survival(OS)and disease-free survival(DFS)and to determine the optimal strategy.METHODS This study involved network meta-analyses and followed the PRISMA guidelines.The data of qualified studies published before July 10,2023,were collected from PubMed,Embase,the Web of Science,and the Cochrane Library.We included relevant studies on postoperative external beam RT after liver resection that had OS and DFS as the primary endpoints.The magnitudes of the effects were determined using risk ratios with 95%confidential intervals.The results were analyzed using R software and STATA software.RESULTS A total of 12 studies,including 1265 patients with hepatocellular carcinoma(HCC)after liver resection,were included in this study.There was no significant heterogeneity in the direct paired comparisons,and there were no significant differences in the inclusion or exclusion criteria,intervention measures,or outcome indicators,meeting the assumptions of heterogeneity and transitivity.OS analysis revealed that patients who underwent stereotactic body radiotherapy(SBRT)after resection had longer OS than those who underwent intensity modulated radiotherapy(IMRT)or 3-dimensional conformal RT(3D-CRT).DFS analysis revealed that patients who underwent 3D-CRT after resection had the longest DFS.Patients who underwent IMRT after resection had longer OS than those who underwent 3D-CRT and longer DFS than those who underwent SBRT.CONCLUSION HCC patients who undergo liver cancer resection must consider distinct advantages and disadvantages when choosing between SBRT and 3D-CRT.IMRT,a RT technique that is associated with longer OS than 3D-CRT and longer DFS than SBRT,may be a preferred option.

Stereotactic body radiation therapy versus radiofrequency ablation in patients with small hepatocellular carcinoma:a systematic review and meta-analysis

Background:This study aimed to compare the clinical outcomes and toxicity between small hepatocellular carcinoma(HCC)patients treated with stereotactic body radiation therapy(SBRT)and those treated with radiofrequency ablation(RFA).Methods:We searched databases for relevant clinical studies.The primary outcomes of interest were overall survival(OS)at 1 and 2 years,freedom from local progression(FFLP)rate at 2 years,and complications.Results:Five cohorts from 5 retrospective studies and 4,814 patients with HCC were included.Pooled OS at 2 years was significantly lower for SBRT than for RFA[odds ratio(OR):0.63;95%confidence interval(CI):0.51-0.79;P<0.0001],but the pooled FFLP rate at 2 years was higher for SBRT than for RFA(OR:1.66;95%CI:1.05-2.61;P=0.03).In addition,there was no significant difference in the local and liver toxicities of the two treatments.The contradictory conclusion between the OS and FFLP outcome may be attributed to the difference in radiological dose and location,but there were no uniform criteria to illustrate the radiological dose and location in the included studies.Conclusions:SBRT had a higher local control ratio but poorer prognosis than RFA in patients with small HCC.The local toxicity was comparable in both treatments.Further trials should be designed with uniform standards for SBRT and RFA treatments.

Efficacy and safety of stereotactic body radiation therapy combined with transarterial chemoembolization for Chinese intermediate-to advanced-stage hepatocellular carcinoma patients: a systematic review and meta-analysis

Aim:According to the current guidelines,transarterial chemoembolization(TACE)remains the first-line therapies for hepatocellular carcinoma(HCC)patients at Barcelona Clinic Liver Cancer(BCLC)B-stage and sorafenib is a small molecule target drug for BCLC C-stage.In clinical practice,clinicians have attempted to use stereotactic body radiation therapy(SBRT)plus TACE for treating intermediate-to advanced-stage HCC.However,the therapeutic effects are still inconsistent.This meta-analysis was conducted to elucidate the validity and safety of the combination therapy of SBRT plus TACE in the patients with intermediate-to advanced-stage HCC.Methods:PubMed,MEDLINE,Web of Science,China Biology Medicine,Chinese Knowledge resources integrated and Chinese Scientific Journal Full-Text Database was searched from their inception date to November 2018.The survival rates(half-year,one-year and two-year)were analyzed and compared between the observation groups and the control groups.The negative conversion rate of AFP and the total effective rate were also assessed.Risk ratios(RR)and 95%CI were calculated to express therapeutic effects. ;Results:A total of 1,210 patients from 13 eligible studies were included.The cooperation of TACE and SBRT notably ameliorated the whole survival rates of half-year,one-year,two-year,the negative conversion rate of AFP,and the total effective rate,compared with TACE or SBRT monotherapy[RR(the total effective rate),1.412,95%CI:1.309-1.523,P<0.001],[RR(half-year survival rate),1.196,95%CI:1.121-1.276,P<0.001],[RR(one-year survival rate),1.327,95%CI:1.236-1.424,P<0.001],[RR(two-year survival rate),1.479,95%CI:1.284-1.703,P<0.001]and[RR(negative conversion rate of AFP),1.756,95%CI:1.502-2.059,P<0.001].Sensitivity analysis supported the above results.Conclusion:Combination therapy of SBRT and TACE provides survival benefits in intermediate-to advanced-stage HCC patients compared to monotherapy of SBRT or TACE.

Combined transarterial chemoembolization and stereotactic body radiation therapy as a bridge therapy to liver transplant for hepatocellular carcinoma

Liver transplant(LT)is the curative treatment for patients with hepatocellular carcinoma(HCC).Bridge therapies are local treatments given to patients on the LT waitlist,to prevent tumor progression and to reduce the dropout rate.Case presentation:We reported a 40-year-old man diagnosed with Barcenola-Clinic Liver Cancer BCLC intermediate stage HCC and Child-Pugh A5 hepatitis B virus cirrhosis who underwent combined bridge therapies to LT.Firstly,the patient received transarterial chemoembolization(TACE)for two times and showed a partial response.Then he underwent stereotactic body radiation therapy(SBRT)with a total dose of 45 Gy in 3 fractions.Three months later,the tumor size and serum protein induced by Vitamin K absence or antagonists-II,alpha fetoprotein levels decreased gradually.In June 2019 a suitable donor was found and his LT was successfully performed.Conclusion:We propose that a combination of TACE and SBRT was feasible as bridge therapy for HCC patients on the LT waitlist.

Comprehending the therapeutic effects of stereotactic body radiation therapy for small hepatocellular carcinomas based on imagings

Surgical resection or radiofrequency ablation(RFA)is considered first-choice treatment for small hepatocellular carcinomas(HCCs).When a patient has a small HCC that is inoperable or unsuitable for RFA,what are alternative treatments?Some oncologists recommend transarterial chemoembolization(TACE),chemotherapy,molecular-targeted therapy,or immunotherapy.However,these treatments have minimally beneficial effects in small HCCs.Stereotactic body radiation therapy(SBRT)is a liver-directed radical therapy for small HCCs,with treatment outcomes similar to those for surgical resection or RFA,but many oncologists do not comprehend its efficacy or accept this therapy.We herein discuss 11 typical patients who received SBRT for various indications:refusal to undergo resection or RFA;surgical resection or RFA considered difficult or unfeasible;residual cancer after surgical resection or RFA or incomplete iodized oil retention after TACE;or tumor recurrence after resection or RFA.We describe each case,including the radiation field,tumor radiation dose,and response to SBRT in both the tumor and liver parenchyma.These clinical data should help readers understand this new therapeutic technique.We also conducted a literature review and found evidence to support survival benefit with SBRT,including good three-and five-year overall survival rates.The purpose of this article is to encourage readers to accept the concept that SBRT is a low-toxicity and effective therapeutic option for patients with small HCCs,which offers substantial local control and improved overall survival,especially for patients with a tumor that is unresectable or unsuitable for RFA,residual tumor after local therapy,or intrahepatic recurrent tumor.

Indications of external radiotherapy for hepatocellular carcinoma from updated clinical guidelines: Diverse global viewpoints

The etiology and disease patterns of hepatocellular carcinoma(HCC)significantly vary among regions. Modern standard treatments commonly require multidisciplinary approaches, including applications of up-to date medicine and advanced procedures, and necessitate the support of socioeconomic systems. For these reasons, a number of clinical guidelines for HCC from different associations and regions have been presented. External beam radiation therapy was contraindicated for HCC until a few decades ago, but with the development of new technologies, its application has rapidly increased as selective irradiation for tumorous lesions became possible. Most of the guidelines had been opposed or indifferent to radiotherapy in the past, but several guidelines have introduced indications and recommendations for radiotherapy in their updated versions. This review will discuss the characteristics of important guidelines and their contents regarding radiotherapy and will also provide guidance to physicians who are considering applications of locoregional modalities that include radiotherapy.

Stereotactic body radiation therapy for the management of HCC

Hepatocellular carcinoma(HCC)is a common malignant tumor in China.After years of efforts,there has been great progress in the management of liver cancer,but overall,it is still not ideal.At present,there are many therapies for liver cancer,including surgical resection,transcatheter arterial chemoembolization(TACE),ablation,molecular targeted therapy,stereotactic body radiation therapy,chemotherapy,immunotherapy,and so on.Studies have reported that TACE combined with radiotherapy can shrink the tumor,and some of the remainder will be resectable,resulting in cure.For HCC with tumor thrombus,the tumor thrombus was reduced and then resected after neoadjuvant radiotherapy.The survival time of the patients with portal vein tumor thrombus was significantly longer than that of the patients without neoadjuvant radiotherapy.Large liver cancer will be reduced to small liver cancer after comprehensive treatment,which can be transformed into stereotactic radiotherapy or radiofrequency ablation,and can also be palliative to radical treatment.Individualized and multidisciplinary therapy for liver cancer is the direction of future development.More clinical evidence-based level of radiotherapy treatment of liver cancer should be done in the future.

Stereotactic body radiation therapy for primary liver tumors with adverse factors

Aim:To test the efficacy and safety of liver stereotactic body radiation therapy(SBRT)in patients who harbor adverse factors.Methods:We retrospectively evaluated the outcomes of liver SBRT in a single cancer center.We invented criteria consisting of two physical factors and two tumor factors to measure the treatment difficulty in each case.The clinical outcomes and toxicity were evaluated by stratification of the harboring factors.Results:A total of 24(23 hepatocellular carcinoma and 1 intrahepatic cholangiocarcinoma)patients were eligible for this study,with a median follow-up duration of 18 months.Of all eligible patients,21 patients(88%)had one or more factors.The local control,progression-free survival,and overall survival rates for all patients at 2 years were 89%,42%,and 76%respectively.In the patients with physical and tumor adverse factors,local control/progression-free survival/overall survival rates at 2 years were 100%/42%/69%and 80%/23%/78%,respectively.The subgroup of 11 patients with 2 or more factors showed comparable local control rate at 2 years to the subgroup of 13 patients with 0 to 1 factors(100%vs.86%,P=0.59).One patient(4.2%)experienced a decline in the Child-Pugh score by 2 points at 3 months after the treatment.Grade 2 to 3 gastrointestinal toxicity was observed in three patients.Conclusion:SBRT showed a high local control rate with acceptable toxicity for the group of liver cancer patients harboring both physical and tumor adverse factors as long as conducted following patient selection and dose constraints that were used in this study.

立体定向放射治疗肝细胞癌患者血清肿瘤坏死因子-α浓度及其变化对预后的影响

目的探讨接受立体定向放射治疗(stereotactic body radiation therapy,SBRT)的肝细胞癌患者血清肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)基线浓度和SBRT前后TNF-α浓度的变化对患者预后的影响。方法回顾性分析2016年10月至2021年6月在复旦大学附属中山医院接受SBRT治疗的42例肝细胞癌患者的临床资料。纳入的患者肿瘤均局限于肝内,且SBRT前后均进行血清TNF-α浓度的检测。患者血清TNF-α基线浓度采用上四分位数进行分组。计算生存率采用Kaplan-Meier法,生存比较采用log-rank检验。影响患者预后的独立因素分析采用Cox比例风险回归模型。结果患者血清TNF-α基线浓度>10.05 pg/mL和≤10.05 pg/mL的患者1年总生存(overall survival,OS)率分别为77.8%和100.0%,2年OS率为22.2%和82.6%。两组患者OS比较,差异具有统计学意义(P=0.001)。SBRT后血清TNF-α浓度较基线上升的患者1、2和3年无进展生存(progression-free survival,PFS)率分别为72.1%、51.9%和38.9%,较基线下降的患者则分别为26.2%、17.5%和0%。两组患者PFS比较,差异具有统计学意义(P=0.039)。患者血清TNF-α基线浓度是影响OS的独立因素(HR=7.668,95%CI:1.316~44.688,P=0.024)。SBRT前后TNF-α浓度的变化是影响患者PFS的独立因素(HR=0.432,95%CI:0.190~0.979,P=0.044)。结论肝细胞癌患者血清TNF-α基线浓度和SBRT前后血清TNF-α浓度变化可能影响患者SBRT的预后。

Management of recurrent hepatocellular carcinoma after liver transplant

Hepatocellular carcinoma(HCC) is the leading cause of deaths in patients with hepatitis B or C, and its incidence has increased considerably over the past decade and is still on the rise. Liver transplantation(LT) provides the best chance of cure for patients with HCC and liver cirrhosis. With the implementation of the MELD exception system for patients with HCC waitlisted for LT, the number of recipients of LT is increasing, so is the number of patients who have recurrence of HCC after LT. Treatments for intrahepatic recurrence after transplantation and after other kinds of surgery are more or less the same, but long-term cure of posttransplant recurrence is rarely seen as it is a "systemic" disease. Nonetheless, surgicalresection has been shown to be effective in prolonging patient survival despite the technical difficulty in resecting graft livers. Besides surgical resection, different kinds of treatment are also in use, including transarterial chemoembolization, radiofrequency ablation, highintensity focused ultrasound ablation, and stereotactic body radiation therapy. Targeted therapy and modulation of immunosuppressants are also adopted to treat the deadly disease.

Strategies to tackle the challenges of external beam radiotherapy for liver tumors

Primary and metastatic liver cancer is an increasingly common and difficult to control disease entity.Radiation offers a non-invasive treatment alternative for these patients who often have few options and a poor prognosis.However,the anatomy and aggressiveness of liver cancer poses significant challenges such as accurate localization at simulation and treatment,management of motion and appropriate selection of dose regimen.This article aims to review the options available and provide information for the practical implementation and/or improvement of liver cancer radiation programs within the context of stereotactic body radiotherapy and image-guided radiotherapy guidelines.Specific patient inclusion and exclusion criteria are presented given the significant toxicity found in certain sub-populations treated with radiation.Indeed,certain sub-populations,such as those with tumor thrombosis or those with larger lesions treated with transarterial chemoembolization,have been shown to have significant improvements in outcome with the addition of radiation and merit special consideration.Implementing a liver radiation programrequires three primary challenges to be addressed:(1) immobilization and motion management;(2) localization;and(3) dose regimen and constraint selection.Strategies to deal with motion include simple internal target volume(ITV) expansions,non-gated ITV reduction strategies,breath hold methods,and surrogate marker methods to enable gating or tracking.Localization of the tumor and organs-at-risk are addressed using contrast infusion techniques to take advantage of different normal liver and cancer vascular anatomy,imaging modalities,and margin management.Finally,a dose response has been demonstrated and dose regimens appear to be converging.A more uniform approach to treatment in terms of technique,dose selection and patient selection will allow us to study liver radiation in larger and,hopefully,multicenter randomized studies.

Stereotactic ablative radiotherapy for hepatocellular carcinoma

Patients with hepatocellular carcinoma(HCC)often present with underlying liver disease and significant comorbidities,limiting treatment tolerance.With the development of improved toxicity models and highly conformal radiation delivery systems,external beam radiotherapy has become a valuable treatment option for liver cancer.Using cutting edge technology,stereotactic ablative radiotherapy(SABR)allows for the delivery of ablative doses in few fractions while sparing uninvolved liver tissue.This approach permits dose escalation and precise tumor targeting with minimal risk of radiation induced liver disease.This review clarifies SABR's role alongside liver-directed treatments such as radiofrequency ablation,transarterial radioembolization,and transarterial chemoembolization in the management of HCC.It also examines the promising potential of SABR combined with immunotherapy to treat advanced HCC.

立体定向体部放疗联合粒细胞-巨噬细胞集落刺激因子治疗原发性肝癌患者的效果

目的探讨立体定向体部放疗(SBRT)联合粒细胞-巨噬细胞集落刺激因子(GM-CSF)治疗原发性肝癌患者的效果。方法纳入接受SBRT联合GM-CSF治疗的31例原发性肝癌患者。观察治疗后患者的近期疗效(疾病控制率、客观缓解率)和远期疗效(无病生存期、总生存期),分析治疗前后患者的免疫指标(CD4^(+)T淋巴细胞水平、CD8^(+)T淋巴细胞水平及CD4^(+)/CD8^(+)值)、肝功能指标(ALT、AST、总胆红素、白蛋白水平)、肝癌指标(甲胎蛋白、癌胚抗原水平)、生活质量[Karnofsky功能状态(KPS)评分]的变化。结果治疗后1个月、3个月、6个月和12个月的客观缓解率分别为77.42%、90.00%、58.62%和40.74%,疾病控制率分别96.77%、93.33%、75.86%和70.37%。31例患者的中位无病生存期为9.1个月,中位总生存期为21.0个月。不同临床特征患者的中位无病生存期和中位总生存期差异均无统计学意义(均P>0.05)。与治疗前1周比较,治疗后1周患者的CD4^(+)T淋巴细胞水平、CD8^(+)T淋巴细胞水平、CD4^(+)/CD8^(+)值、白蛋白水平下降,ALT、AST水平升高(均P<0.05);与治疗后1周比较,治疗后1个月、3个月患者的CD4^(+)T淋巴细胞水平、CD8^(+)T淋巴细胞水平、CD4^(+)/CD8^(+)值升高(均P<0.05),而ALT、AST、白蛋白水平恢复至治疗前水平。治疗后1周、1个月、3个月患者的血清癌胚抗原、甲胎蛋白水平较治疗前1周有所下降,治疗后患者的KPS评分呈先降低后升高的趋势(均P<0.05)。结论SBRT联合GM-CSF可改善原发性肝癌患者的生活质量,维持患者肝功能的稳定,增强患者的免疫功能,提高患者远期临床疗效,可作为失去手术指征的原发性肝癌患者的治疗方案。

无法手术的局部晚期气管支气管腺样囊性癌的调强放射治疗

目的分析气管腺样囊性癌(tracheal adenoid cystic carcinoma,TACC)患者的临床特征及治疗方式,探讨应用调强放射治疗在无法手术的局部晚期TACC中的治疗价值。方法回顾报道1例无法手术的局部晚期TACC进行调强放射治疗的患者资料,并结合文献报道分析不能手术TACC患者介入放射治疗的疗效。结果该患者经多程化疗及根治性放疗,给予气管及支气管、纵隔淋巴结引流区调强放射治疗DT46 GY/23F,后给予缩野气管及右主支气管肿瘤区推量至DT60 GY/30F。患者气短、咳嗽症状消失,气管及支气管病变完全缓解。结合既往文献报道,未行手术的局部晚期TACC患者行单纯放射治疗的生存期均在1年以上,部分患者在5年及10年以上。结论调强放射治疗对于局部晚期无法手术TACC的治疗具有积极的意义。

体部立体定向放射治疗周围型肺癌46例近期疗效观察

目的观察体部立体定向放射治疗（sBRT）周围型肺癌的近期疗效和副反应。方法46例周围型肺癌患者行静态调强适形放疗（IMRT），DT50Gy／4fx／2W，2～3次／N，95％以上PTV满足处方剂量，90％的处方等剂量线完全覆盖PTV，最大剂量点在靶区内，并控制在10％以内，严格控制肺V5〈55％，V20〈20％，心脏和脊髓等危及器官受量控制在正常范围，所有患者在投照前均行摄片和锥形束cT（cB（了）精度验证和配准。随访观察患者放疗的副反应和近期疗效。结果治疗后3～36个月，所有患者均获得随访，中位随访时间18个月，其中完全缓解（CR）率为50％（23／46），部分缓解（PR）率为43．5％（20／46），总有效率为93．5％（43／46）。1年生存率为94．7％（36／38），1年局控率为100％（38／38），2年生存率为52％（13／25），2年局控率为84％（21／25）；放疗期间未出现严重的放疗副反应，放射性肺炎发生率为4．35％（2／46），为Ⅱ级以下，未出现严重的Ⅲ级和Ⅳ放射性肺炎，出现3例肋骨疼痛。结论周围型肺癌行SBRT能够有效地提高肺癌的局部控制率和生存率，且并发症发生率较低，值得临床推广应用。