Long-term outcomes of proton beam therapy in patients with previously untreated hepatocellular carcinoma.
Long-term outcomes of proton beam therapy in patients with previously untreated hepatocellular carcinoma.
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DOI：
10.1111/cas.13145
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发表时间：
2017-03
期刊：
影响因子：
5.7
通讯作者：
Hyodo I
中科院分区：
文献类型：
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作者：
Fukuda K;Okumura T;Abei M;Fukumitsu N;Ishige K;Mizumoto M;Hasegawa N;Numajiri H;Ohnishi K;Ishikawa H;Tsuboi K;Sakurai H;Hyodo I
质子束疗法(PBT)对未经治疗的肝细胞癌(HCC)患者的长期疗效尚不清楚。我们的目标是研究根据巴塞罗那临床肝癌(BCLC)分期对既往未经治疗的肝癌患者进行PBT的长期结果。这项观察性研究的主要资格标准是东部合作肿瘤组表现状态(PS)0-2，Child-Pugh A级或B级，以前未治疗的肝癌覆盖在照射野内，以及没有大量腹水。总量为66.0~77.0Gye，分10~35次给药。根据BCLC分期评估局部肿瘤控制(LTC)、无进展生存期(PFS)和总生存期(OS)。从2002年到2009年，在我们机构，129名患者符合条件。0/A期患者5年LTC、PFS和OS率分别为94%、28%和69%，B期患者分别为87%、23%和66%，C期患者分别为75%、9%和25%。15例大血管癌栓患者的5年LTC和OS率分别为90%和34%。多因素分析显示PS(0比1-2)是影响OS预后的重要因素。未观察到3级或更高的不良反应。PBT治疗0~C期BCLC远期疗效好，不良反应轻微，可作为治疗局限性肝细胞癌的一种替代治疗方法，尤其是合并癌栓的患者。这项研究已在UMIN临床试验注册中心(UMIN000025342)注册。
Long‐term efficacy of proton beam therapy (PBT) remains unclear for patients with previously untreated hepatocellular carcinoma (HCC). We aimed to study the long‐term outcomes of PBT according to Barcelona Clinic Liver Cancer (BCLC) staging classifications in patients with previously untreated HCC. The major eligibility criteria of this observational study were an Eastern Cooperative Oncology Group performance status (PS) 0–2, Child–Pugh grade A or B, previously untreated HCC covered within an irradiation field, and no massive ascites. A total of 66.0–77.0 GyE was administered in 10–35 fractions. Local tumor control (LTC), defined as no progression in the irradiated field, progression‐free survival (PFS), and overall survival (OS) were assessed according to BCLC staging. From 2002 to 2009 at our institution, 129 patients were eligible. The 5‐year LTC, PFS, and OS rates were 94%, 28%, and 69% for patients with 0/A stage disease (n = 9/21), 87%, 23%, and 66% for patients with B stage disease (n = 34), and 75%, 9%, and 25% for patients with C stage disease (n = 65), respectively. The 5‐year LTC and OS rates of 15 patients with tumor thrombi in major vessels were 90% and 34%, respectively. Multivariate analyses revealed that PS (0 versus 1–2) was a significant prognostic factor for OS. No grade 3 or higher adverse effects were observed. PBT showed favorable long‐term efficacies with mild adverse effects in BCLC stage 0 to C, and can be an alternative treatment for localized HCC especially when accompanied with tumor thrombi. This study was registered with UMIN Clinical Trials Registry (UMIN000025342).