Charged-particle therapy for hepatocellular carcinoma.

Charged-particle therapy for hepatocellular carcinoma.
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DOI:
10.1016/j.semradonc.2011.05.007
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发表时间:
2011-10
影响因子:
3.5
通讯作者:
Krishnan, Sunil
Krishnan, Sunil
中科院分区:
医学2区
文献类型:
--
作者:
Skinner, Heath D.;Hong, Theodore S.;Krishnan, Sunil

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从历史上看,外照射治疗肝细胞癌(HCC)一直受到未受累肝脏和周围结构毒性的限制。光子放射治疗的进展改善了肿瘤的剂量一致性,并促进了剂量升级,这是改善肝癌放射治疗结果的关键因素。然而,尽管光子放射治疗取得了这些进展,大量肝脏仍然接受低剂量的辐射,可以防止剂量上升,特别是在肝脏储备功能有限的患者。通过利用肿瘤外射束路径缺乏出口剂量和更高的生物有效性,带电粒子治疗提供了通过剂量递增最大限度地控制肿瘤的前景,而不会产生过多的肝脏毒性。在这篇综述中,我们讨论了质子和碳离子放射治疗的独特的生物物理属性,特别是当它们与肝癌的治疗有关时。我们还回顾了有关使用带电粒子治疗肝癌的临床结果和毒性的现有文献。
Historically, the use of external beam radiotherapy for hepatocellular carcinoma (HCC) has been limited by toxicity to the uninvolved liver and surrounding structures. Advances in photon radiotherapy have improved dose conformality to the tumor and facilitated dose escalation, a key contributor to improved HCC radiation treatment outcomes. However, despite these advances in photon radiotherapy, significant volumes of liver still receive low doses of radiation that can preclude dose escalation, particularly in patients with limited functional liver reserves. By capitalizing on the lack of exit dose along the beam path beyond the tumor and higher biological effectiveness, charged particle therapy offers the promise of maximizing tumor control via dose escalation without excessive liver toxicity. In this review we discuss the distinctive biophysical attributes of both proton and carbon ion radiotherapy, particularly as they pertain to treatment of HCC. We also review the available literature regarding clinical outcomes and toxicity of using charged particles for the treatment of HCC.
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