PROTON BEAM THERAPY FOR LARGE HEPATOCELLULAR CARCINOMA
PROTON BEAM THERAPY FOR LARGE HEPATOCELLULAR CARCINOMA
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DOI：
10.1016/j.ijrobp.2009.02.030
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发表时间：
2010-02-01
影响因子：
7
通讯作者：
Tokuuye, Koichi
中科院分区：
文献类型：
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作者：
Sugahara, Shinji;Oshiro, Yoshiko;Tokuuye, Koichi
目的：探讨质子束治疗（PBT）治疗大型肝细胞癌（HCC）患者的安全性和有效性。方法和材料：1985年至2006年间，22名大于10 cm的HCC患者在我院接受了质子束治疗。这22名患者中有21名因晚期HCC、并发疾病或高龄而不适合手术。中位肿瘤大小为 11 cm（范围，10-14 cm），中位临床靶体积为 567 cm(3)（范围，335-1,398 cm(3)）。 18 例患者为单发性肝细胞癌，4 例为多灶性肝细胞癌。 18 名患者的肿瘤类型为结节性肿瘤，4 名患者的肿瘤类型为弥漫性肿瘤。 11 名患者存在门静脉肿瘤血栓。中位总剂量为 72.6 GyE，分 22 次（范围：47.3-89.1 GyE，分 10-35 次）。结果：中位随访时间为 13.4 个月（范围：1.5-85 个月）。 2年肿瘤控制率为87%。一年总生存率和无进展生存率分别为 64% 和 62%。两年总体生存率和无进展生存率分别为 36% 和 24%。主要的肿瘤进展模式是在照射野外出现新的肝肿瘤。未观察到 3 级或更高级别的晚期治疗相关毒性。结论：PBT 的布拉格峰特性可改善治疗区域的保形性。因此，可以对大肿瘤体积进行高剂量照射，而不会显着剂量暴露于周围正常组织。因此，质子束治疗代表了治疗大体积 HCC 的一种有前途的方法。我们的研究表明，PBT 是治疗大型 HCC 患者的有效且安全的方法。 (C) 2010 爱思唯尔公司。
Purpose: To investigate the safety and efficacy of proton beam therapy (PBT) in patients with large hepatocellular carcinoma (HCC).Methods and Materials: Twenty-two patients with HCC larger than 10 cm were treated with proton beam therapy at our institution between 1985 and 2006. Twenty-one of the 22 patients were not surgical candidates because of advanced HCC, intercurrent disease, or old age. Median tumor size was 11 cm (range, 10-14cm), and median clinical target volume was 567 cm(3) (range, 335-1,398 cm(3)). Hepatocellular carcinoma was solitary in 18 patients and multifocal in 4 patients. Tumor types were nodular and diffuse in 18 and 4 patients, respectively. Portal vein tumor thrombosis was present in 11 patients. Median total dose delivered was 72.6 GyE in 22 fractions (range, 47.3-89.1 GyE in 10-35 fractions).Results: The median follow-up period was 13.4 months (range, 1.5-85 months). Tumor control rate at 2 years was 87%. One-year overall and progression-free survival rates were 64% and 62%, respectively. Two-year overall and progression-free survival rates were 36% and 24%, respectively. The predominant tumor progression pattern was new hepatic tumor development outside the irradiated field. No late treatment-related toxicity of Grade 3 or higher was observed.Conclusions: The Bragg peak properties of PBT allow for improved conformality of the treatment field. As such, large tumor volumes can be irradiated to high doses without significant dose exposure to surrounding normal tissue. Proton beam therapy therefore represents a promising modality for the treatment of large-volume HCC. Our study shows that PBT is an effective and safe method for the treatment of patients with large HCC. (C) 2010 Elsevier Inc.