CAJ | 학술논문

目的：探讨体部伽玛刀立体定向放射治疗（ SBRT）肝细胞癌术后复发的疗效及安全性。方法采用超级伽玛刀（ SGS-I型）立体定向放射治疗肝细胞癌术后复发不愿或不能再次手术的患者92例。肿瘤体积4．5～958．3cm3，等剂量曲线50％～80％，周边照射总剂量35～44Gy，分割处方剂量3．5～5．5Gy，重复治疗7～12次，5次/周。治疗2～3个月后采用RE-CIST 1．1版标准评价近期疗效，检测治疗前后甲胎蛋白（AFP）和谷丙转氨酶（ALT）水平，同时对患者进行远期随访并分析总生存期（ OS）及1、3、5年生存率。采用RTOG/EORTC标准评价毒副反应。结果92例患者均可评价疗效，其中获CR者51例，PR 36例，SD 5例，有效率为94．6％。治疗后的AFP为（157．93±93．67）μg/L，低于治疗前的（846．57±258．39）μg/L，差异有统计学意义（P＜0．05）；治疗前后 ALT 水平分别为（87．73±21．56）U/L 和（53．55±19．33）U/L，差异无统计学意义（P＞0．05）。全组病例的中位OS为16．0个月。1、3、5年生存率分别为71．6％、31．8％和13．0％。毒副反应主要为骨髓抑制、消化道反应、乏力及放射性肝损伤，均为1～2级，对症处理后缓解。结论 SBRT治疗肝细胞癌术后复发临床疗效确切，毒副反应较轻，值得临床推广。
목적：탐토체부가마도입체정향방사치료（ SBRT）간세포암술후복발적료효급안전성。방법채용초급가마도（ SGS-I형）입체정향방사치료간세포암술후복발불원혹불능재차수술적환자92례。종류체적4．5～958．3cm3，등제량곡선50％～80％，주변조사총제량35～44Gy，분할처방제량3．5～5．5Gy，중복치료7～12차，5차/주。치료2～3개월후채용RE-CIST 1．1판표준평개근기료효，검측치료전후갑태단백（AFP）화곡병전안매（ALT）수평，동시대환자진행원기수방병분석총생존기（ OS）급1、3、5년생존솔。채용RTOG/EORTC표준평개독부반응。결과92례환자균가평개료효，기중획CR자51례，PR 36례，SD 5례，유효솔위94．6％。치료후적AFP위（157．93±93．67）μg/L，저우치료전적（846．57±258．39）μg/L，차이유통계학의의（P＜0．05）；치료전후 ALT 수평분별위（87．73±21．56）U/L 화（53．55±19．33）U/L，차이무통계학의의（P＞0．05）。전조병례적중위OS위16．0개월。1、3、5년생존솔분별위71．6％、31．8％화13．0％。독부반응주요위골수억제、소화도반응、핍력급방사성간손상，균위1～2급，대증처리후완해。결론 SBRT치료간세포암술후복발림상료효학절，독부반응교경，치득림상추엄。
Objective To investigate the effect and safety of stereotactic body radiotherapy ( SBRT) with body gamma-knife in patients with hepatocellular carcinoma ( HCC) of postoperative recurrence. Methods A total of 92 HCC patients with postoperative recurrence were treated with stereotactic body radiotherapy with super-gamma-knife ( type SGS-I ) . The volume of tumors was 4. 5-958. 3cm3. The total radiation dose was 35-44Gy, 3. 5-5. 5Gy/f (50%-80% isodose line), 7-12f, 5 days/week. The curative effect was analyzed by RECIST version 1. 1. The levels of alpha fetoprotein (AFP) and alanine aminotransferase (ALT) were measured before and after treatment. The patients were followed up for overall survival ( OS) and 1-, 3-, 5-year survival rates. The adverse reaction was evaluated by RTOG/EORTC criteria. Results A total of 92 patients could be evaluated, among whom 51 achieved CR, 36 PR and 5 SD with the response rate of 94. 6%. The level of AFP after treatment was (157. 93±93. 67)μg/L, lower than (846. 57±258. 39)μg/L before treatment with statistical difference (P<0. 05). The levels of ALT were (87. 73±21. 56) U/L and (53. 55±19. 33) U/L without significant difference ( P>0. 05) . The medium OS was 16. 0 months with the 1-, 3-, 5-year survival rates of 71. 6%, 31. 8% and 13. 0%, respectively. The main adverse reactions during treatment were bone marrow suppression, gastrointestinal reactions, fatigue and radiation induced liver injury, mainly in grade 1-2, and all could be releaved by symptomatic treatment. Conclusion SBRT with super-gamma-knife exerts a definite effect on HCC patients with postoperative recurrence with mild side effect.