Background: This study aimed to analyse treatment outcomes, determine prognostic factors and assess the toxicity of reirradiation using high-dose-rate (HDR) brachytherapy for liver metastases in the oligometastatic stage of disease.Materials and Methods: The study included 59 patients who had previously undergone SBRT (stereotactic body radiation therapy) or HDR brachytherapy and experienced progression within (type 1) or outside (type 2) the irradiated area, but in a different location within the liver. Patients were divided according to the type of reirradiation and the reason for treatment. Local control (LC), progression-free survival (PFS) and overall survival (OS) were analysed in relation to the following factors: age; gender; performance status; tumour type; line of systemic treatment; location of extrahepatic metastases; type of reirradiation; time since previous irradiation; indication for treatment; size and number of metastases; dose; and degree of response to treatment. Treatment toxicity and the influence of dose, irradiation volume, number of metastases, time since previous radiotherapy and dose to the non-irradiated part of the liver on hepatic toxicity were also assessed.Results: With a median follow-up period of 13 months, the median LC, PFS and OS were 9, 8 and 13 months, respectively. The respective rates of partial regression (PR), stable disease (SD) and progressive disease (PD) were 32%, 44% and 12%. The most significant factors influencing LC were the degree of tumour shrinkage, with PFS influenced by the degree of tumour shrinkage and a low number of metastases, and OS influenced by the degree of tumour shrinkage, a low number of metastases and one to two lines of systemic therapy. Treatment toxicity was low, and there was no strong correlation between the dosimetric parameters of the treatment plan and the biochemical parameters of liver function.Conclusions: Brachytherapy is a safe and effective method of re-irradiating liver metastases. However, due to the limitations of the study, further investigation is required.
背景：本研究旨在分析寡转移期肝转移瘤采用高剂量率（HDR）近距离放疗进行再照射的治疗效果，确定预后因素并评估其毒性。材料与方法：研究纳入59例既往接受过立体定向体部放疗（SBRT）或HDR近距离放疗后，在照射区域内（1型）或区域外（2型）出现进展但位于肝脏不同部位的患者。根据再照射类型和治疗原因对患者进行分组。分析局部控制率（LC）、无进展生存期（PFS）和总生存期（OS）与以下因素的关系：年龄、性别、体能状态、肿瘤类型、全身治疗方案线数、肝外转移部位、再照射类型、距前次放疗时间、治疗指征、转移灶大小与数量、照射剂量及治疗反应程度。同时评估治疗毒性，以及剂量、照射体积、转移灶数量、距前次放疗时间、肝脏非照射区受照剂量对肝毒性的影响。结果：中位随访13个月，中位LC、PFS和OS分别为9、8和13个月。部分缓解（PR）、疾病稳定（SD）和疾病进展（PD）的发生率分别为32%、44%和12%。影响LC的最显著因素是肿瘤退缩程度，PFS受肿瘤退缩程度和转移灶数量少的影响，OS则受肿瘤退缩程度、转移灶数量少以及接受1-2线全身治疗的影响。治疗毒性较低，且治疗计划的剂量学参数与肝功能生化指标间无显著相关性。结论：近距离放疗是肝转移瘤再照射安全有效的方法，但受研究局限性影响，仍需进一步深入探讨。
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