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肝癌立体定向放疗（SBRT）进 StrategyfortreatmentassignmentinpatientswithHCCaccordingtotheproposalfromtheBCLCstagingsystemTarget:OS:20

Target:OS:11

Target:OS:<3AASLD,ESMO,andEASL,etal.Managementofhepatocellular2SequentialPhaseIandIITrialsSBRTforLocallyAdvanced-------(StudyofPrincessMargaret patientswithHCCunsuitableforOP,RFA,TACEChild-Turcotte-PughclassAdisease,≥700mLof -HCCliver.TheSBRTdoserangewas24to54Gyinsixfractions.AlexisBujold,LauraA.DawsonTreatment +5mm（8mmTrail-CTV2includeliverparenchyma,RFAcavities,orpost-TACEvolumesadjacentto Contrast-enhancingTVTwasincludedasCTV1, enhancingthrombosiswasgenerallyincludedPTVmarginsof5mmweretailoredfromthepatient’sbreathingmotionandmotionCRTwith5-10 coplanarbeamsof6to18MV.(IMRTwerePTV1:30to54Gy(24to54GyinTrial1)/6f,3F/Week,TVTplusPTVmargin:30GyifOARConstrainDosetoPTV1wasdeterminedaccordingtoanRILDnormaltissuecomplicationprobabilitymodelbasedontheeffectiveirradiatedlivervolumeStrictdoseconstraintsweremaintainedforthesurroundingorgansatinapopulationofpatientsforwhomcurativelocaltreatmentoptionsarenotavailable,SBRTcanleadtosustainedlocalcontrol,associatedwithsurvivalrateshigherthanhistoricalcontrols,withalowriskofserioustoxicity.DiseaseprogressionoutsidethetargetedHCCremainsaproblem,providingrationaleforcombiningSBRTwithregionalorsystemictherapies.(RTOG1112).----phaseIIIrandomizedtrialforlocallyadvancedHCCSorafenibVSSorafenib+SBRTKCCHKCCHStudy:SBRTforHCCasaLocalSalvageTreatment pletePhase2trialofSBRTasalocalsalvagetreatment TACEinpatientswithfocusedontumorresponseandLCage>18 ECOG:0-InitialdiagnosisofprimaryHCCorinoperableorrefusalunsuitabilityforRFAorWBC>2000/lL,Hb>8.0g/dL,PLT>50,000/lL,absoluteneutrophilcount≥1500/lL,ASTandALT<5times;bilirubin3.0mg/Dl,ChPAorB;pleteresponseafterTACEafter1to5asinglelesionormultiplelesions,includingportalveintumorDimenter<10noevidenceofanuncontrolledlesionatanyotherPTV=ITV+4mm(S-I),2mm(L-R,A-BreathControl:compresstheMi-SookKim,Cancer thecurrenttrialdemonstratesthatSBRTafter pleteTACEforinoperableHCCachievespromisingresponseandLCrates.However,alongerfollow-upwillberequiredtoconfirmthisfinding.Onthebasisoftheresultsfromthisstudy,weareplanninganewmulti-institutionalphase2trialtoreduceGItoxicitiesand CaseCasefromTianjinCancerPET-

6monthsafter6monthsafterPET-16monthsafterTheThecaseofpatientreceivingTACEplusCase1: Case2:OurunpublishedpatientCyberknifehascurativeeffectforHCCStageIStageICyberknifeVSOperatingInclusionInclusionpathologicaldiagnosisofhepatocellularcarcinoma(HCC)StageI(AJCC7R0resectionforsurgicalRadicalradiotherapyforcyberknife49223leftlobeRightlobecaudatelobeTumordiametersFollowingToxicity(CTC3.0≧2 IntestinalstenosisIntestinalfistula

LocalLocalefficacyofRecenteffect LocalcontrolAFPAFP1-2mafter3-6mafter1-2mafter3-6mafterHistogramof ComparisonComparisonofPFS/OSbetweencyberknifeandsurgeryCauseof CasesofCauseofTumor-8-tumor-*PTumorTumorspecial ThisstudyhasmadeapreliminaryexplorationintheselectionofnewtreatmentsforStageIhepatocellularcarcinomaandaninvestigationontheefficacyofCyberKnifetreatment.CyberKnifetreatmentforStageIhepatocellularcarcinomaisequivalenttothatofsurgicalexcision,withmilderadverseevents.LargeLargetumor,closetotheGIandInoperable,notfeasible,orCCRT-CCRT-SBRTSBRTTACE+PalliativeJiangW,etal.Oncology2013;84(S1):69-

LeeIJ,etal.GutandLiver2012;6:139-EligibilitycriteriafordifferenttreatmentNaokoSanuki,WorldJGastroenterol2014;20(12):3100-TypicalliverlocationssuitforProspectivestudiesofSBRTforRetrospectivestudiesofSBRTforSBRTforHCCshowthecurativepotentialforthelocaldisease.SBRTfor )-coplanarRadiationusually8-12 accordingtothedifferentSizeandcontrolofIGRTtoimproveset-upaccuracyandtreatmentThemostcommonsiteoffirstrecurrencewasthelivertheirradiatedvolume(RTOG-majorSBRT-inducedcomplicationsincludeRILD