探索肝细胞癌放射治疗的安全指标:一个现实世界的研究
Xueyi Xie1, Xi Zhang2, Honghua Peng2
1Department of Oncology, Third Xiangya Hospital, Central South University, Changsha 410013, China. doctorxxy1995@163.com.
概括
外部光束辐射疗法 (EBRT) 对肝细胞癌 (HCC) 是安全有效的. 剩余残留功能性肝体积 (rRFLVx) 是辐射诱导肝病 (RILDs) 的更可靠指标,而不是平均肝剂量 (MLD) 或残留肝体积 (RLV).
科学领域:
- 在瘤学瘤学.
- 辐射疗法 辐射疗法
- 肝病学 肝病学是一种肝病学.
背景情况:
- 肝细胞癌 (HCC) 的发病率和死亡率很高,外部束辐射疗法 (EBRT) 是常见的治疗方法.
- 缺乏HCC放射治疗的标准化安全指标,高剂量辐射可能会损害正常的肝脏组织.
- 在x Gy辐射后,残留的功能性肝体积 (RFLV) 和残留的功能性肝体积 (rRFLVx) 是评估受辐射肝功能的建议指标.
研究的目的:
- 评估rRFLVx作为HCC放射治疗的安全剂量指标的性能.
- 探索EBRT在HCC患者中的安全性和有效性.
- 分析与辐射诱导肝病 (RILDs) 相关的剂量参数.
主要方法:
- 一项针对113名HCC患者的前性研究,这些患者接受了立体体辐射疗法 (SBRT) 或强度调节辐射疗法 (IMRT).
- 分析RILD发生率和剂量参数,包括平均肝剂量 (MLD),残余肝体积 (RLV) 和rRFLVx,使用二进制逻辑回归.
- 评估无进展生存期 (PFS) 和总生存期 (OS) 以评估治疗疗效.
主要成果:
- 12名患者出现了RILD,主要是IMRT组 (11/78) 与SBRT组 (1/35) 相比.
- rRFLV25,rRFLV20,rRFLV15,以及它们与标准肝体积 (SLV) 的比率与IMRT组的RILD显著相关 (P<0.05),而不是MLD和RLV (P=0.88).
- 与IMRT相比,SBRT表现出较高的中位PFS (16.4 vs 5.6个月) 和OS (33.5 vs 12.2个月),具有更高的局部控制率.
结论:
- 在不同阶段,EBRT是一种安全有效的治疗HCC.
- rRFLVx和rRFLVx/SLV是预测IMRT后RILD的更可靠指标,而不是MLD和RLV.
- 同时的抗病毒治疗对于接受放射治疗的肝炎阳性患者是安全的,需要密切监测病毒载量.
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