SBRT 作为肝细胞癌肝移植的桥梁

StephenW

SBRT 作为肝细胞癌肝移植的桥梁

肝病学（马里兰州巴尔的摩）

带回家的消息

    本研究评估了立体定向放疗 (SBRT) 作为肝细胞癌 (HCC) 患者肝移植 (LT) 的桥接疗法与经动脉化疗栓塞 (TACE) 和高强度聚焦超声 (HIFU) 相比的安全性和有效性。主要终点是桥接治疗后 1 年的肿瘤控制率。结果显示SBRT后1年肿瘤控制率（92.3%）显着高于TACE和HIFU（分别为43.5%和33.3%；P=0.02）。 SBRT 的 1 年和 3 年进展时间也更优（SBRT 为 10.8% 和 18.5%；TACE 为 45.0% 和 54.9%；HIFU 为 47.6% 和 62.8%；P < .001）。与 TACE (25.0%) 和 HIFU (17.9%; P = .037) 相比，SBRT (48.1%) 后病理完全反应更频繁。

    SBRT 作为 LT 等候名单上的 HCC 患者的桥接疗法是安全有效的，并被推荐作为传统桥接疗法的替代疗法。

– 娜塔莎·冯·罗恩，医学博士
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背景和目标

没有关于立体定向放射治疗 (SBRT) 作为 HCC 肝移植桥梁的前瞻性数据。本研究旨在评估 SBRT 作为桥接疗法的有效性和安全性，并与经动脉化疗栓塞 (TACE) 和高强度聚焦超声 (HIFU) 进行比较。
方法和结果

患者根据 2015 年 7 月的标准化方案前瞻性纳入 SBRT，并与 2010 年接受 TACE 或 HIFU 的回顾性队列进行比较。主要终点是桥接治疗后 1 年的肿瘤控制率。次要终点包括辍学的累积发生率、毒性和移植后存活率。在研究期间，评估了 150 名患者（SBRT，n = 40；TACE，n = 59；HIFU，n = 51）。与 TACE 和 HIFU 相比，SBRT 后 1 年的肿瘤控制率显着更高（分别为 92.3%、43.5% 和 33.3%；P = 0.02）。通过竞争风险分析，SBRT（15.1% 和 23.3%）后上市后 1 年和 3 年的累积退出率低于 TACE（28.9% 和 45.8%；P = 0.034）和 HIFU（33.3% 和 45.1%） ; P = 0.032)。 SBRT 后 1 年和 3 年的进展时间也更优（SBRT 为 10.8%、18.5%，TACE 为 45%、54.9%，HIFU 为 47.6%、62.8%；P < 0.001）。围手术期毒性相似，围手术期并发症以及移植后患者和无复发生存率没有任何差异。与 TACE 和 HIFU 相比，SBRT 后病理完全缓解更频繁（分别为 48.1% 对 25% 对 17.9%；P = 0.037）。在多变量分析中，肿瘤大小 <3 cm、列出甲胎蛋白 <200 ng/mL、Child A 和 SBRT 显着降低了辍学风险。
结论

SBRT 是安全的，具有显着更高的肿瘤控制率，降低了候补名单退出的风险，应作为传统桥接疗法的替代方案。

StephenW

SBRT as a Bridge to Liver Transplantation for Hepatocellular Carcinoma

Hepatology (Baltimore, Md.)

TAKE-HOME MESSAGE

    This study evaluated the safety and efficacy of stereotactic body radiation therapy (SBRT) as a bridging therapy to liver transplantation (LT) for patients with hepatocellular carcinoma (HCC) compared with transarterial chemoembolization (TACE) and high-intensity focused ultrasound (HIFU). The primary endpoint was the tumor control rate at 1 year after bridging therapy. The results showed that the tumor control rate at 1 year was significantly higher after SBRT (92.3%) compared with TACE and HIFU (43.5% and 33.3%, respectively; P = .02). The time to progression at 1 and 3 years was also superior for SBRT (10.8% and 18.5% in SBRT; 45.0% and 54.9% in TACE; 47.6% and 62.8% in HIFU; P < .001). Pathological complete response was more frequent after SBRT (48.1%) compared with TACE (25.0%) and HIFU (17.9%; P = .037).

    SBRT is safe and effective as a bridging therapy in patients with HCC on waitlist for LT and is recommended as an alternative to conventional bridging therapies.

–  Natasha von Roenn, MD
abstract

This abstract is available on the publisher's site.
BACKGROUND AND AIMS

There are no prospective data on stereotactic body radiation therapy (SBRT) as a bridge to liver transplantation for HCC. This study aimed to evaluate the efficacy and safety of SBRT as bridging therapy, with comparison with transarterial chemoembolization (TACE) and high-intensity focused ultrasound (HIFU).
APPROACH AND RESULTS

Patients were prospectively enrolled for SBRT under a standardized protocol from July 2015 and compared with a retrospective cohort of patients who underwent TACE or HIFU from 2010. The primary endpoint was tumor control rate at 1 year after bridging therapy. Secondary endpoints included cumulative incidence of dropout, toxicity, and posttransplant survival. During the study period, 150 patients were evaluated (SBRT, n = 40; TACE, n = 59; HIFU, n = 51). The tumor control rate at 1 year was significantly higher after SBRT compared with TACE and HIFU (92.3%, 43.5%, and 33.3%, respectively; P = 0.02). With competing risk analysis, the cumulative incidence of dropout at 1 and 3 years after listing was lower after SBRT (15.1% and 23.3%) compared with TACE (28.9% and 45.8%; P = 0.034) and HIFU (33.3% and 45.1%; P = 0.032). Time-to-progression at 1 and 3 years was also superior after SBRT (10.8%, 18.5% in SBRT, 45%, 54.9% in TACE, and 47.6%, 62.8% in HIFU; P < 0.001). The periprocedural toxicity was similar, without any difference in perioperative complications and patient and recurrence-free survival rates after transplant. Pathological complete response was more frequent after SBRT compared with TACE and HIFU (48.1% vs. 25% vs. 17.9%, respectively; P = 0.037). In multivariable analysis, tumor size <3 cm, listing alpha-fetoprotein <200 ng/mL, Child A, and SBRT significantly reduced the risk of dropout.
CONCLUSIONS

SBRT was safe, with a significantly higher tumor control rate, reduced the risk of waitlist dropout, and should be used as an alternative to conventional bridging therapies.