射波刀治疗肝细胞癌腹腔淋巴结转移的疗效分析

摘要/Abstract

摘要： 目的评价肝细胞癌(HCC)腹腔淋巴结转移患者接受射波刀立体定向放射治疗的疗效和安全性。方法 2015年1月至2017年9月解放军总医院第五医学中心行射波刀治疗的HCC腹腔淋巴结转移患者37例。射波刀治疗总剂量40～63 Gy, 单次剂量5～10 Gy/次,照射次数4～10次。近期疗效依据实体瘤的疗效评价标准(RECIST 1.1),采用常见不良反应事件标准( CTCAE4.0)评价不良反应。以1、2、3年总生存率和局部控制率作为远期疗效评价指标。采用Kaplan-Meier法计算总生存率和局部控制率,log-rank检验分析不同分组患者之间总生存期差异。结果共随访2～58个月,中位随访时间14个月。37例患者中,完全缓解8例( 21.62%),部分缓解24 例( 64.86%),稳定4例(10.81%),进展1例( 2.70%)。有效率 86.48%,疾病控制率97.29%。1、2、3年总生存率分别为61.8% 、39.4%和22.1%;1、2、3年局部控制率分别为86.0% 、80.3%和63.1%;中位生存期为16.0个月( 2～58个月)。19例腹部或腰背部疼痛患者中,12例(63.2%)在治疗完成3次后疼痛症状即有减轻,14例(73.7%)在治疗结束时疼痛消失。射波刀治疗总剂量≥45 Gy患者生存期明显长于总剂量＜45 Gy患者,差异有统计学意义(P<0.01)。无疼痛症状患者的生存期明显长于有疼痛症状患者,差异有统计学意义(P=0.004)。I、Ⅱ级胃肠道反应发生率为13.5％(5/37),无Ⅲ级及以上不良事件。结论射波刀治疗HCC淋巴结转移是安全有效的,能有效提高生存率和肿瘤局部控制率,且不良反应小。

关键词: 肝细胞癌, 腹腔淋巴结转移, 射波刀, 疗效, 安全性

Abstract: Objective To investigate the effect and safety of CyberKnife stereotactic radiotherapy in the treatment for abdominal lymph node metastases of primary hepatocellular carcinoma (PHCC). Methods Thirty-seven patients with abdominal lymph node metastases of PHCC who underwent CyberKnife radiotherapy in our hospital from January 2015 to September 2017 were enrolled. The total dose of CyberKnife radiotherapy ranged from 40Gy to 63Gy. The single dose ranged from 5Gy to 10Gy, divided into 4-10 fractions. Short-term therapeutic effect was assessed by Modified Response Evaluation Criteria in Solid Tumors. Long-term therapeutic effect was assessed by 1, 2, and 3-year overall survival rates and local control rates. The Kaplan-Meier method was used to calculate cumulative survival rate and local control rate. The log-rank test was used for the comparison of overall survival time between groups. Results The patients were followed up for 2-58 months, with an average of 14 months. Among all 37 patients, 8 (21.62%) achieved complete remission, 24 (64.86%) achieved partial remission, 4 (10.81%) achieved a stable condition, and 1 (2.70%) experienced disease progression. The effective rate was 86.48%, and the disease control rate was 97.29%. The 1, 2 and 3-year overall survival rates were 61.8%, 39.4% and 22.1%, respectively; The 1, 2 and 3- year local control rates were 86.0%, 80.3% and 63.1%, respectively; The median overall survival time was 16.0 months (range from 2 to 58 months). Among the 19 patients with abdominal pain or lower back pain, 12 (63.2%) achieved alleviation of pain symptoms after 3 times of treatment, 14 (73.7%) achieved complete remission at the end of treatment. Survival rate of patients with a total dose of ≥45 Gy treated with CyberKnife radiotherapy was significantly higher than that of patients with a total dose of <45 Gy, and there was significant difference between the 2 groups (P=0.000). The survival rate of patients without pain symptoms was significantly higher than that of patients with pain symptoms, and the difference was statistically significant (P=0.004). The incidence of gastrointestinal toxicities in Grade I and Ⅱ were 13.5％(5／37), no case appeared Grade III or above adverse events. Conclusion CyberKnife is safe and effective in the treatment of abdominal lymph node metastases of PHCC. CyberKnife stereotactic radiotherapy can effectively improve the survival rate and the local control rate, with less adverse reaction.

Key words: Primary hepatocellular carcinoma, Abdominal lymph node metastases, Cyberknife, Curative effect, Safety

肖崇娟, 张弢, 孙静, 范毓泽, 段学章, 何卫平. 射波刀治疗肝细胞癌腹腔淋巴结转移的疗效分析[J]. 肝脏, 2022, 27(10): 1069-1072.

XIAO Chong-juan, ZHANG Tao, SUN Jing, FAN Yu-ze, DUAN Xue-zhang, HE Wei-ping. Therapeutic effect of Cyberknife in the treatment for abdominal lymph node metastases of primary hepatocellular carcinoma[J]. Chinese Hepatolgy, 2022, 27(10): 1069-1072.

参考文献

[1] Watanabe J, Nakashima O, Kojiro M. Clinicopathologic study on lymph node metastasis of hepatocellular carcinoma: a retrospective study of 660 consecutive autopsy case.Jpn J Clin Oncol,1994,24(1):37-41.
[2] Wang H, Li W. Recent update on comprehensive therapy for advanced hepatocellular carcinoma.World J Gastrointest Oncol,2021,13(8):845-855.
[3] Ni X, Li D, Dai S, et al. Development and evaluation of nomograms to predict the cancer-specific mortality and overall mortality of patients with hepatocellular carcinoma. Biomed Res Int,2021,1658403.
[4] Zhang K, Tao C, Wu F, et al. A practical nomogram from the SEER database to predict the prognosis of hepatocellular carcinoma in patients with lymph node metastasis. Ann Palliat Med,2021,10(4):3847-3863.
[5] Wee CW, Kim K,Chie EK, et al. Prognostic stratification and nomogram for survival prediction in hepatocellular carcinoma patients treated with radiotherapy for lymph node metastasis.Br J Radiol,2016,89(1065): 20160383.
[6] Kim Y, Park HC, Yoon SM,et al. Prognostic group stratification and nomogram for predicting overall survival in patients who received radiotherapy for abdominal lymph node metastasis from hepatocellular carcinoma: a multi-institutional retrospective study (KROG 15-02).Oncotarget,2017,8(55):94450-94461.
[7] Ikegami T, Yoshizumi T, Kawasaki J, et al. Surgical resection for lymph node metastasis after liver transplantation for hepatocellular carcinoma. Anticancer Res,2017,37(2):891-895.
[8] He C, Liu Y, Li Y, et al. Efficacy and safety of computed tomography-guided (125)I brachytherapy for lymph node metastatic from hepatocellular carcinoma. J Cancer Res Ther,2018,14(4):754-759.
[9] Park YJ, Lim DH, Paik SW,et al. Radiation therapy for abdominal lymph node metastasis from hepatocellular carcinoma.J Gastroenterol,2006,41(11): 1099-1106.
[10] Zhang H, Chen Y, Hu Y, et al. Image-guided intensity-modulated radiotherapy improves short-term survival for abdominal lymph node metastases from hepatocellular carcinoma. Ann Palliat Med,2019, 8(5):717-727.
[11] Matoba M, Tsuchiya H, Kondo T, et al. Stereotactic body radiotherapy delivered with IMRT for oligometastatic regional lymph node metastases in hepatocellular carcinoma: a single-institutional study. J Radiat Res,2020,61 (5):776-783.
[12] Yeung R, Hamm J, Liu Met al. Institutional analysis of stereotactic body radiotherapy(SBRT) for oligometastatic lymph node metastases.Radiat Oncol,2017,12:105-112.
[13] Rim CH, Kim CY, Yang DS,et al.The role of external beam radiotherapy for hepatocellular carcinoma patients with lymph node metastasis: a meta-analysis of observational studies.Cancer Manag Res,2018,10: 3305-3315.
[14] Chen YX, Zeng ZC, Fan J, et al. Defining prognostic factors of survival after external beam radiotherapy treatment of hepatocellular carcinoma with lymph node metastases. Clin Transl Oncol,2013,15(9):732-740.
[15] Lee DY, Park JW, Kim TH, et al. Prognostic indicators for radiotherapy of abdominal lymph node metastases from hepatocellular carcinoma. Strahlenther Onkol,2015,191 (11):835-844.
[16] Zeng ZC, Tang ZY, Fan J,et al. Consideration of role of radiotherapy for lymph node metastases in patients with HCC: retrospective analysis for prognostic factor from 125 patients. Int J radiat OncolBiolPhys,2005,63 (4):1067-1076.
[17] Cai ZS, Chen MJ, Tang TY,et al. Duodenum perforated after combination with sorafenib and radiotherapy for retroperitoneal lymph node metastasis of hepatocellular carcinoma.J Formos Med Assoc,2020,119(3):760-762.