REPEAT IRRADIATION OF RECURRENT HEPATOCELLULAR CARCINOMA - A SINGLE INSTITUTE EXPERIENCE

肝癌的再次放射治療－單一中心回溯研究

李政彥(Cheng-Yen Lee) ； 楊凱琳(Kai-Lin Yang) ； 季懋欣(Mau-Shin Chi) ； 溫嘉綺(Chia-Chi Wen) ； 黃素禎(Su-Chen Huang) ； 柯卉玲(Hui-Ling Ko) ； 蕭仟翊(Chien-Yi Hsiao) ； 季匡華(Kwan-Hwa Chi)

《放射治療與腫瘤學》 23卷3期 (2016/09) Pp. 153-162

https://doi.org/10.6316/TRO/201623(3)153

摘要

目的：放射線治療為目前治療局部性肝癌之重要方式，但是對於再次放射治療仍少有著墨。由於肝癌為多發性疾病，當其他的治療方式都用盡時，我們仍須考慮再次放療的可能性。本文乃對於本院接受二次放療者的肝癌所作的回溯性分析。材料及方法：從2003至2013之間，共有19位肝癌復發患者（男／女=17／2；年齡中位數：64.4歲）於本院接受第二次放射治療，當中於前次治療部位復發者為8位，在放射部位之外復發者為11位。其主要收案條件為正常肝體積超過700毫升。在第二次治療的部位中，平均劑量為47.5Gy，而部分治療病患接受同步以及持續性之血管生成抑制藥物。本研究以單變項分析用於找出可能的預後因子。結果：在這19個病人中，有4位達到腫瘤完全反應，有6位達到腫瘤部分反應。所有病患的中位數總存活期為10.3月，一年及二年總存活率分別為47%以及26%。在單變項分析中，兩次放射治療期間較長者（＞ 6.2月）以及合併使用抗血管新生藥物者之總存活期有顯著差異。在研究的群組中，僅11%患者發生放射性肝炎。結論：在不超過重要器官劑量限制的情況下，以第二次的放射治療治療復發性的肝癌是可行的。兩次放射治療期間超過6.2月者有較長的平均存活期，而使用抗血管新生藥物可顯著的延長存活期。

關鍵字

肝癌 ； Sunitinib ； 放射治療

並列摘要

Purpose: Radiotherapy is recognized as an effective local treatment for hepatocellular carcinoma, but limited evidence exists for its efficacy in repeat liver irradiation. When other treatment modalities have been exhausted, repeat irradiation may be the only option. A single institution experience of repeat irradiation of hepatocellular carcinoma is reported here. Materials and Methods: Between 2003 and 2013, 19 patients (M/F = 17/2; median age = 64.4 years) with recurrent hepatocellular carcinoma (8 in-field and 11 out-field) and having had previous radiotherapy, were treated with repeat irradiation. The primary eligibility criteria for selecting these patients for repeat liver irradiation was normal liver volume greater than 700 mL. The median equivalent dose in 2 Gy (EQD2) delivered to tumors was 47.5 Gy (range: 30-71 Gy). A proportion of patients had concurrent and maintenance angiogenic blockades. Univariate analyses were used to identify statistically significant prognostic factors. Results: Among the 19 patients, complete response was achieved in 4 patients, and partial response in 6. The median overall survival for the entire series was 10.3 months. Overall survival rates at 1 and 2 years were 47% and 26% respectively. The presence of either longer treatment intervals between radiotherapies (＞ 6.2 months) or use of angiogenic blockades was associated with longer overall survival on univariate analysis. The incidence of radiation induced liver injury was 11%. Conclusions: Repeat hepatic irradiation is possible where the necessary dosimetric parameters can be met. Patients with longer intervals between radiotherapies may achieve longer survival rates in comparison to those without. Survival benefit is attainable with concomitant and maintenance angiogenic blockades.

並列關鍵字

Hepatocellular carcinoma ； Sunitinib ； Radiotherapy