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Exploración de los indicadores de seguridad para la radioterapia en el carcinoma hepatocelular: un estudio del mundo
Xueyi Xie1, Xi Zhang2, Honghua Peng2
1Department of Oncology, Third Xiangya Hospital, Central South University, Changsha 410013, China. doctorxxy1995@163.com.
Resumen
La radioterapia de haz externo (EBRT) es segura y efectiva para el carcinoma hepatocelular (HCC). El volumen hepático funcional residual residual (rRFLVx) es un indicador más confiable de la enfermedad hepática inducida por radiación (RILD) que la dosis hepática media (MLD) o el volumen hepático residual (RLV).
Área de la Ciencia:
- Oncología Oncología.
- La radioterapia es la radioterapia.
- Hepatología Hepatología.
Sus antecedentes:
- El carcinoma hepatocelular (HCC) presenta una alta incidencia y mortalidad, con radioterapia de haz externo (EBRT) como tratamiento común.
- Faltan indicadores de seguridad estandarizados para la radioterapia con HCC, y el tejido hepático normal puede ser dañado por la irradiación en dosis altas.
- El volumen hepático funcional remanente (RFLV) y el volumen hepático funcional remanente residual después de la irradiación x Gy (rRFLVx) son métricas propuestas para evaluar la función hepática irradiada.
Objetivo del estudio:
- Para evaluar el rendimiento de rRFLVx como indicador de dosis de seguridad para la radioterapia HCC.
- Para explorar la seguridad y eficacia de la EBRT en pacientes con CHC.
- Para analizar los parámetros dosimétricos asociados con las enfermedades hepáticas inducidas por radiación (RILD).
Principales métodos:
- Un estudio prospectivo de 113 pacientes con CHC tratados con radioterapia estereotáctica corporal (SBRT) o radioterapia de intensidad modulada (IMRT).
- Análisis de la ocurrencia de RILD y los parámetros dosimétricos, incluida la dosis hepática media (MLD), el volumen hepático remanente (RLV) y rRFLVx utilizando regresión logística binaria.
- Evaluación de la supervivencia libre de progresión (PFS) y la supervivencia global (OS) para evaluar la eficacia del tratamiento.
Principales resultados:
- RILDs ocurrieron en 12 pacientes, predominantemente en el grupo IMRT (11/78) en comparación con el grupo SBRT (1/35).
- rRFLV25, rRFLV20, rRFLV15, y sus ratios con el volumen hepático estándar (SLV) se asociaron significativamente con RILDs en el grupo IMRT (P<0.05), a diferencia de MLD y RLV (P=0.88).
- SBRT demostró una mediana superior de PFS (16,4 vs 5,6 meses) y OS (33,5 vs 12,2 meses) en comparación con IMRT, con tasas de control local más altas.
Conclusiones:
- La EBRT es un tratamiento seguro y eficaz para el CHC en varias etapas.
- rRFLVx y rRFLVx/SLV son indicadores más confiables para predecir RILDs después de IMRT que MLD y RLV.
- La terapia antiviral concomitante es segura para los pacientes con hepatitis positiva que se someten a radioterapia, lo que requiere una estrecha vigilancia de la carga viral.
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