Introduction: The aim of the study was to analyse the results and potential complications of local treatment with HDR (high dose-rate) brachytherapy of liver metastases from colorectal cancer, depending on the targeted therapy used and consideringRASgene mutation and chemotherapy in individual treatment lines. Material and methods: The study included 142 patients with oligoprogressive liver metastases who underwent HDR brachytherapy without changing the line of treatment, based on a retrospective analysis of 270 patients treated between 2015 and 2022. The impact ofRASgene mutations, lines of chemotherapy depending on the treatment regimens used, PFS (progression free survival), OS (overall survival), LC (local control) and the degree of radiological response were analysed. The impact of these drugs on hepatotoxicity and the risk of haemorrhagic complications was also analysed. Results: The presence of mutations inKRAS/NRASgenes (exons 2, 3, 4) had a statistically significant impact on PFS in the first, third and fourth lines of treatment, and on OS and LC in the third and fourth lines of treatment. In the third and fourth lines of treatment, patients with a mutation in theRASgene had a poorer radiological response to treatment regardless of the chemotherapy used. PFS, OS and LC differed depending on the line of treatment and amounted to 17.5, 11, 8.5, 6 and 4 months, 27, 19, 13, 11 and 11 months, and 27, 19, 11, 6 and 6 months, respectively. The greatest benefit in terms of PFS was achieved by patients treated with first-line chemotherapy combined with epidermal growth factor receptor (EGFR) inhibitors, in the absence ofRASgene mutations. In the third line, the greatest benefit was achieved by patients treated with trifluridine/tipiracil in the absence ofRASgene mutations. The greatest percentage reduction in the volume of treated lesions and the highest percentage of control were observed in the first three lines of treatment. The toxicity of the treatment was low; only in the third and fourth lines of treatment were differences in the decrease in albumin levels found depending on the type of treatment used. Conclusions: A mutation in theRASgenes worsens the prognosis, regardless of the line of treatment and the systemic treatment used. The greatest benefit from brachytherapy is seen in patients in the first three lines of treatment withoutRASmutations, treated with anti-EGFR chemotherapy in the first line and trifluridine/tipiracil in the third line. Combining brachytherapy of liver metastases with systemic treatment is safe, regardless of the systemic treatment used.
引言：本研究旨在分析结直肠癌肝转移灶高剂量率近距离放射治疗的疗效及潜在并发症，其分析依据包括所采用的靶向治疗方案，并综合考虑个体化治疗中RAS基因突变状态及各线化疗方案的影响。材料与方法：本研究基于2015年至2022年间接受治疗的270例患者进行回顾性分析，最终纳入142例发生寡进展性肝转移的患者，这些患者在未更改全身治疗方案的前提下接受了高剂量率近距离放射治疗。研究重点分析了RAS基因突变状态、基于不同化疗方案的治疗线数对无进展生存期、总生存期、局部控制率及影像学缓解程度的影响，同时评估了这些药物对肝毒性及出血并发症风险的影响。结果：KRAS/NRAS基因（第2、3、4外显子）突变状态对第一、三、四线治疗的无进展生存期，以及第三、四线治疗的总生存期和局部控制率均产生统计学显著影响。在第三、四线治疗中，无论采用何种化疗方案，携带RAS基因突变患者的影像学治疗反应均较差。无进展生存期、总生存期和局部控制率随治疗线数增加而递减，具体数值分别为17.5、11、8.5、6、4个月，27、19、13、11、11个月，以及27、19、11、6、6个月。在无RAS基因突变的情况下，接受一线化疗联合表皮生长因子受体抑制剂治疗的患者获得最大的无进展生存期获益；在第三线治疗中，无RAS基因突变患者接受曲氟尿苷/替匹嘧啶治疗获益最大。治疗病灶体积缩小比例最高及控制率最佳的疗效出现在前三线治疗中。治疗总体毒性较低，仅在第三、四线治疗中发现白蛋白水平下降程度因治疗方案不同存在差异。结论：无论治疗线数或全身治疗方案如何，RAS基因突变均会恶化患者预后。近距离放射治疗的最大获益人群为无RAS突变的前三线治疗患者，其中一线使用抗表皮生长因子受体化疗、三线使用曲氟尿苷/替匹嘧啶方案者获益尤为显著。肝转移灶近距离放射治疗联合全身治疗方案安全性良好，且该安全性不受具体全身治疗方案的影响。
肿瘤(癌症)患者之家