Efficacy and safety evaluation of stereotactic body radiation therapy based on tomotherapy for hepatocellular carcinoma / 肿瘤

ABSTRACT

Objective: To evaluate the primary outcomes and adverse reactions of patients with hepatocellular carcinoma treated by stereotactic body radiation therapy (SBRT) using tomotherapy. Methods: From December 2012 to December 2015, Forty-six patients with hepatocellular carcinoma who received SBRT in Zhongshan Hospital Affiliated to Fudan University were enrolled. The clinical and pathological data and follow-up data of all cases were collected. The median diameter of tumors was 2.5 cm, ranging from 0.9 to 5.8 cm. All cases were performed by four-dimensional CT (4-DCT) scan and image-guided matching calibration before SBRT. Total irradiation dose ranged from 48 to 50 Gy in 5 to 10 fractions. The supportive treatments of liver protection and nutritional support were administrated during SBRT. The curative tumor response was evaluated using the modifed Response Evaluation and Criteria in Solid Tumors (mRECIST) 6 months after SBRT. The adverse reactions were evaluated using National Cancer Institute- Common Terminology Criteria for Adverse Events 3.0 (NCI-CTC 3.0). The cumulative probability of survival was calculated according to Kaplan-Meier method. Results: All cases completed SBRT. They were followed up every 3 months after treatment. Based on mRECIST, 58.7% of patients achieved complete response (CR), 32.6% achieved partial response (PR), and there were 4.3% patients with stable disease, and 2.61% patients with tumor progression. The total effective rate (CR+PR) was 91.3%. The overall survival (OS) rates at 1, 2 and 3 years were 95.4%, 75.7% and 69.9%, respectively. For the adverse reaction, only 5 cases of grade? bone marrow suppression, 2 cases of gradeII bone marrow suppression and 2 cases of grade? transaminase increase were found; no radiation-induced liver disease (RILD) occurred. Conclusion: Tomotherapy is a safe and effective treatment for the patients with unresectable hepatocellular carcinoma. So SBRT using tomotherapy is worth promoting as an alternative treatment for unresectable hepatocellular carcinoma unsuitable for standard treatment.