射波刀治疗肝脏转移瘤的疗效及预后分析

目的:评价射波刀治疗肝脏转移瘤的疗效及预后影响因素。方法:2010年8月至2016年10月期间我院射波刀治疗的肝脏转移瘤患者39例，照射总剂量为36~56 Gy，62%~84%等剂量线作为处方剂量包绕PTV，分割次数为4~12次，1日1次，每周5次。结果:治疗后3~77个月随访所有患者，近期疗效评价显示患者的有效率和局控率分别为76.9%和89.7%。所有患者的局部中位无进展生存时间和总的中位生存时间 分别为13个月(95%CI:12.019~13.981)和14个月（95%CI:10.473~17.527），1年的局控率为58.2%，1年、2年、3年生存率分别为57.8%、25.3%和14.5%；治疗过程中及治疗后无严重毒副反应。Cox模型多因素分析表明肿瘤体积大小和是否合并其他转移灶是患者预后的独立影响因子。结论:射波刀能够提高肝脏转移瘤患者的生存期，是一种可靠的治疗选择，尤其对于小病灶且不合并其他转移灶的患者临床获益更加明显。

Efficacy and prognostic analysis of cyberknife for liver metastatses

Objective:To evaluate the efficacy and prognostic factors of cyberknife for liver metastatses.Methods:39 patients with liver metastatses were treated with cyberknife from August 2010 to October 2016 in our hospital.The total dose of irradiation was 36~56 Gy，and the PTV was covered by the 62%~84% isodose line.The total number of therapy was 4~12 times，and all patients were treated with irradiation once a day and five times a week.Results:All patients were followed up in 3 to 77 months after treatment.Short-term efficacy results showed that the efficient rate and the local control rate were 76.9% and 89.7%，respectively.The local median progression-free survival (PFS) was 13 months (95%CI:12.019~13.981)，and the median overall survival (OS) was 14 months (95%CI:10.473~17.527).The local control rate for one year was 58.2%.The 1-year，2-year and 3-year survival rates were 57.8%，25.3% and 14.5%，respectively.There was no serious side effect during or after treatment in all patients.Multivariate analysis showed that gross tumor volume (GTV) and existence of other metastases were independent prognostic indicators of OS in patients with liver metastatses by Cox proportional hazards regression model.Conclusion:Cyberknife is a reliable option for liver metastatses which could improve OS of patients，especially for patients with small lesions and non-combined other metastases.