Proton beam therapy for hepatocellular carcinoma patients with severe cirrhosis
Proton beam therapy for hepatocellular carcinoma patients with severe cirrhosis
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DOI：
10.1007/s00066-006-1564-2
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发表时间：
2006-12-01
影响因子：
3.1
通讯作者：
Akine, Yasuyuki
中科院分区：
文献类型：
--
作者：
Hata, Masaharu;Tokuuye, Koichi;Akine, Yasuyuki
背景与目的：肝细胞癌（HCC）合并严重肝硬化患者由于预后较差，通常采用支持性治疗。然而，由于先进的治疗方法，严重肝硬化患者的生存率最近有所提高。本研究的目的是确定质子束治疗在HCC合并严重肝硬化患者中的作用。患者与方法：19例HCC合并Child-Pugh C级肝硬化患者接受质子束治疗。肝肿瘤14例单发，5例多发，肿瘤最大直径25 ~ 80mm（中位40mm）。无局部淋巴结或远处转移。总剂量为50-84戈瑞（中位72戈瑞），分10至24份（中位16份）递送至肿瘤。结果：在治疗后3 ~ 63个月（中位17个月）的随访期间，19例患者中分别有6例、8例和4例死于癌症、肝衰竭和合并疾病。另一名患者在治疗33个月后存活，无疾病迹象。在随访期间，除1例肿瘤外，其余肿瘤均得到控制。10例患者在放疗区外出现新的肝内肿瘤。1年的总生存率和无进展生存率分别为53%和47%，2年生存率分别为42%。运动状态和Child-Pugh评分是影响患者生存的重要因素。未观察到治疗相关的3级或以上毒性。结论：质子束治疗HCC合并严重肝硬化患者是可以耐受的。对于一般情况和肝功能较好的患者，可提高生存率。
Background and Purpose: Hepatocellular carcinoma (HCC) patients with severe cirrhosis are usually treated with supportive care because of their poor prognosis. However, the survival of severe cirrhotic patients has recently improved due to advanced treatments. The aim of this study was to define the role of proton beam therapy for HCC patients with severe cirrhosis.Patients and Methods: 19 HCC patients with Child-Pugh class C cirrhosis received proton beam therapy. The hepatic tumors were solitary in 14 patients and multiple in five, and the tumor size was 25-80 mm (median 40 mm) in maximum diameter. No patient had regional Lymph node or distant metastasis. Total doses of 50-84 Gy (median 72 Gy) in ten to 24 fractions (median 16) were delivered to the tumors.Results: Of the 19 patients, six, eight and four died of cancer, Liver failure and intercurrent diseases, respectively, during the follow-up period of 3-63 months (median 17 months) after treatment. A remaining patient was alive with no evidence of disease 33 months after treatment. ALL but one of irradiated tumors were controlled during the follow-up period. Ten patients had new intrahepatic tumors outside the irradiated volume. The overall and progression-free survival rates were 53% and 47% at 1 year, respectively, and 42% each at 2 years. Performance status and Child-Pugh score were significant prognostic factors for survival. Therapy-related toxicity of grade 3 or more was not observed.Conclusion: Proton beam therapy for HCC patients with severe cirrhosis was tolerable. It may improve survival for patients with relatively good general condition and liver function.