立体定向放疗联合或不联合经导管动脉化疗栓塞治疗不可切除结直肠癌肝转移的回顾性研究

目的:比较单纯立体定向放疗或经导管动脉栓塞化疗联合立体定向放疗治疗不可手术结直肠癌肝转移的疗效及安全性。 方法:回顾性分析23例不可手术结直肠癌肝转移患者资料，所有患者曾接受一线标准的全身化疗，化疗后肝脏病灶接受或者经导管动脉栓塞化疗。单纯接受立体定向治疗的13例患者为SBRT组，接受经导管动脉栓塞化疗和立体定向放疗的10例患者为TACE-SBRT组，比较两组患者的肝内病灶局部治疗后的疾病缓解率(RR)、疾病控制率(DCR)和疾病进展时间（TTP），同时观察并发症发生情况，采用Kaplan-Meier、Log-rank检验，Cox回归模型分析中位无进展生存时间(mPFS)和总生存时间(mOS)。结果:SBRT组和TACE-SBRT组的局部治疗反应RR和DCR无统计学意义（P=0.685）；与SBRT组相比，TACE-SBRT组的无疾病进展时间延长，差异有统计学意义（11.77±1.56 vs 25.40±5.81，P=0.019）。TACE-SBRT的mPFS优于SBRT组，分别为17.4个月和15.1个月（P<0.05），但是mOS两组之间无统计学意义。同时，仅有1例患者出现Ⅲ级肝功能损伤，治疗后恢复。Cox 回归比例风险模型分析确诊肝转移时CEA水平和同时性转移是无进展生存期和总生存期的预后不良因素(P<0.05)。结论:全身化疗后联合SBRT和TACE治疗不可切除的结直肠癌肝转移是一种安全有效的方法，是一种可接受的替代治疗方法，但仍需进一步研究。

Retrospective comparative analysis on stereotactic body radiotherapy combinations with and without transcatheter arterial chemoembolization for unresectable colorectal liver metastases

Objective:To evaluate and compare the efficacy and safety of stereotactic body radiotherapy combined with transcatheter arterial chemoembolization for unresectable colorectal liver metastases.Methods:Twenty-three unresectable colorectal liver metastases patients previously received first-line systemic chemotherapy treated with stereotactic body radiotherapy or combined with transcatheter arterial chemoembolization between January 2009 and May 2018 were reviewed.A total of 13 patients underwent stereotactic body radiotherapy alone(SBRT group),and 10 patients underwent transcatheter arterial chemoembolization combined with stereotactic body radiotherapy(TACE-SBRT group).The response rates(RR),disease control rates(DCR),time to progress(TTP)and treatment-related complications were observed.The Kaplan-Meier method,log-rank test and Cox multivariate analyses were adopted to analyze median progression-free survival(mPFS),median overall survival(mOS)in patients with unresectable colorectal liver metastases.Results:Similar rates of RR and DCR were observed for the SBRT and TACE-SBRT group,and the difference between the two groups was no statistically significant(P=0.685).TACE-SBRT group had a longer disease-free time,there was statistically significant difference(11.771.56 vs 25.405.81,P=0.019).The mPFS of TACE-SBRT group was superior to that of SBRT group(17.4 months vs 15.1 months,respectively,P<0.05),but there was no statistically significant difference between mOS.Moreover,only 1 patient had 3-grade acute hepatic injury,which was recovered after treatment.Cox multivariate analyses found synchronous metastasis and CEA level at diagnosis of liver metastasis was identified as significant prognostic factors for mPFS and mOS(P<0.05).Conclusion:Stereotactic body radiotherapy combinations with transcatheter arterial chemoembolization for unresectable colorectal liver metastases is a safe and effective method,suggesting an acceptable alternative therapy for patients with unresectable colorectal liver metastases,but should be further studied in a larger series.