Space-Making Particle Therapy for Unresectable Hilar Cholangiocarcinoma
Space-Making Particle Therapy for Unresectable Hilar Cholangiocarcinoma
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DOI：
10.1159/000524582
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发表时间：
2022-06-01
影响因子：
2.7
通讯作者：
Fukumoto, Takumi
中科院分区：
文献类型：
--
作者：
Hashimoto, Yu;Komatsu, Shohei;Fukumoto, Takumi
虽然肝门胆管癌（HC）的主要治疗选择是手术切除，但大多数患者在诊断时出现不可切除的晚期肿瘤。颗粒疗法（PT）在HC治疗中具有巨大的潜力，尽管其解剖学上与胃肠道的接近阻止了向肿瘤输送根治剂量。空间制造PT (SMPT)，包括垫片放置手术和随后的PT，已经发展到最大限度地减少并发症和最大限度地提高剂量递增治疗HC的疗效。本研究旨在进行剂量学评价，并检查SMPT治疗HC的有效性。方法：在2007年至2018年期间，纳入了12例接受SMPT治疗的不可切除HC患者。通过分析术前和术后剂量-体积直方图参数，评价间隔剂置入手术的治疗效果和有效性。结果：所有患者均完成了计划的SMPT方案。中位生存时间为29.6个月，1年和3年总生存率分别为82.5%和45.8%。间隔片置入术后肿瘤总体积和临床靶体积的平均V95%值（按计划治疗剂量的95%照射体积）分别由术前的85.6%和78.1%提高到98.5%和96.6% （p = 0.0196和p = 0.0053）。6例患者在SMPT后出现3级或以上不良事件。讨论/结论：SMPT可改善剂量学参数，具有良好的可行性和良好的效果。SMPT是一种很有前途的治疗不可切除HC的新方法。(C) 2022 S. Karger AG，巴塞尔
Introduction: Although the primary treatment option for hilar cholangiocarcinoma (HC) has been surgical resection, most patients present with unresectable advanced tumors at the time of diagnosis. Particle therapy (PT) holds great potential for HC, even though the anatomical proximity to the gastrointestinal tract prevents delivering a radical dose to the tumor. Space-making PT (SMPT), consisting of spacer placement surgery and subsequent PT, has been developed to minimize complications and maximize the therapeutic benefit of dose escalation for HC. This study aimed to conduct a dosimetric evaluation and examine the effectiveness of SMPT for the treatment of HC. Methods: Between 2007 and 2018, 12 patients with unresectable HC treated with SMPT were enrolled. The treatment outcomes and effectiveness of spacer placement surgery were evaluated through analyses of pre- and post-surgical parameters of dose-volume histograms. Results: All patients completed the planned SMPT protocol. The median survival time was 29.6 months, and the 1- and 3-year overall survival rates were 82.5% and 45.8%, respectively. The mean V95% value (volume irradiated with 95% of the planned treatment dose) of the gross tumor volume and clinical target volume after spacer placement surgery improved to 98.5% and 96.6% from preoperative values of 85.6% and 78.1%, respectively (p = 0.0196 and p = 0.0053, respectively). Grade 3 or higher adverse events after SMPT were seen in 6 patients. Discussion/Conclusion: SMPT led to improvements in dosimetric parameters and showed good feasibility and excellent outcomes. SMPT can be a promising novel alternative for unresectable HC. (C) 2022 S. Karger AG, Basel