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文献概览
Wei X,Jiang Y,Zhang X et al. “NeoadjuvantThree-Dimensional Conformal Radiotherapy for Resectable HepatocellularCarcinoma With Portal Vein Tumor Thrombus: A Randomized, Open-Label,Multicenter Controlled Study”.
DOI: 10.1200/JCO.18.02184Journal of Clinical Oncology37,no.24 (August 20 ) 2141-2151.
This article was originally published online in the “Journal of ClinicalOncology” on July 08,. It is a randomized control clinical trial of 164 HCCpatients with resectable disease and portal vein thrombosis. The study group (n=82)received neoadjuvanct radiotherapy (RT) before undergoing hepatectomy, whilethe control group (n=82) received only surgical treatment. Significant clinicalbenefits were observed in the neoadjuvanct RT group as compared to the controlgroup.这篇文章于7月8日在线发表在《临床肿瘤杂志》上。这是一项纳入了164例HCC患者（可切除性肿瘤，且伴有II/III型门脉癌栓）的随机对照临床试验。研究组（n=82）在肝切除术前接受新辅助放疗（RT），对照组仅接受手术治疗。与对照组相比，新辅助放疗组有更优异的临床疗效。
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主要内容
Study details:HCCPatientswith resectable disease, aging 19 to 70 years, were randomly assigned in to eitherneoadjuvanct RT group(n=82) or control group (n=82, Fig.1). Neoadjuvant RT group received Three-dimensional conformal RT (3DCRT) within 5 days ofrandom assignment. While the control group only underwent surgical resectionwithin 5 days after random assignment. Patientsassigned to the neoadjuvant RT group were re-evaluated in 4 weeks aftercomplement of RT, and surgery was planned immediately and carried out within 5days if the patients did not develop a contraindication to surgery.
19～70岁的肝癌患者随机分为新辅助放疗组（n=82）和对照组（n=82, Fig. 1）。新辅助放疗组在随机分配后的5天内接受三维适形放疗（3DCRT）。而对照组仅在随机分配后的5天内进行手术切除。在新辅助放疗后4周内对新辅助放疗组的患者进行重新评估，若患者未出现手术禁忌症，则立即计划在5天内进行手术.
Fig.1: CONSORT diagram of the randomizedclinical trial. HBV, hepatitis B virus; HCC, hepatocellular carcinoma; HCV, hepatitisC virus; PVTT, portal vein tumor thrombus; RT, radiotherapy.
Results:The overall survival rate of neoaduvanct RT group at 6 , 12 and 18 monthswere 89.0%, 75.2%, 43.9%, and 27.4%, respectively, compared with 81.7%, 43.1%,16.7%, and 9.4% in the surgery-alone group (P<0.001). While at the same time disease-free survival rates were 56.9%, 33.0%,20.3%, and 13.3% versus 42.1%, 14.9%, 5.0%, and 3.3% (P< 0.001, Fig. 2).
结果：新辅助放疗组6个月、12个月和18个月的总体生存率分别为89.0%、75.2%、43.9%和27.4%，而单独手术组分别为81.7%、43.1%、16.7%和9.4%（P＜0.001）。同时，新辅助放疗组的无病生存率分别为56.9%、33.0%、20.3%和13.3%，而单独手术组仅为42.1%、14.9%、5.0%和3.3%（P＜0.001，Fig.2）。
Fig.2:(A) Overall survival (OS) and (B) disease-free survival (DFS) curves forthe neoadjuvant three-dimensional conformal radiotherapy (RT) plus surgery andsurgery-alone groups.
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启发思考
Tumor recurrence after successful hepatectomy is a common issue inHCC patients. Neoadjuvant radiotherapy before hepatectomy in HCC patients withresectable carcinoma, significantly enhances the clinical outcome, improveoverall survival and disease-free survival, as compared to the patients whoundergo local resection alone. Neoadjuvant radiotherapy plus hepatectomy is anexciting approach which may become the main treatment approach for allresectable HCC in the future.肝细胞癌成功切除后肿瘤复发是一个常见问题。在可切除的HCC患者中，肝切除术前进行新辅助放疗相比单独进行手术的患者，能显着改善患者预后，提高总体生存率和无病生存率。新辅助放射治疗+肝切除是一种值得期待的治疗方法，有望成为今后治疗可切除性肝癌的主要手段。
