Protons versus Photons for Unresectable Hepatocellular Carcinoma: Liver Decompensation and Overall Survival
Protons versus Photons for Unresectable Hepatocellular Carcinoma: Liver Decompensation and Overall Survival
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DOI：
10.1016/j.ijrobp.2019.01.076
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发表时间：
2019-09-01
影响因子：
7
通讯作者：
Hong, Theodore S.
中科院分区：
文献类型：
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作者：
Sanford, Nina N.;Pursley, Jennifer;Hong, Theodore S.
目的：消融放射治疗越来越多地用于肝细胞癌（HCC），导致良好的局部控制率;然而，没有疾病进展证据的患者通常死于肝功能衰竭。质子相对于光子放射治疗的临床获益尚不清楚。因此，我们试图比较质子与光子消融放射治疗在不可切除的HCC患者中的临床结果。这是一项在2008年至2017年期间接受非转移性，既往未接受过肝脏定向放射治疗且未接受进一步肝脏-完成首次治疗后12个月内接受定向放射治疗。采用考克斯回归分析评估主要结局，即总生存期（OS）。次要终点包括非经典放射性肝病的发生率（定义为治疗后3个月基线Child-Pugh评分增加≥ 2分），使用logistic回归进行评估，以及局部复发，使用Fine-Gray回归进行竞争风险评估。结果：中位随访时间为14个月。在133例中位年龄为68岁且75%为男性的患者中，49例（37%）接受了质子放射治疗。质子放射治疗与OS改善相关（校正的风险比，0.47; P = 0.008; 95%置信区间[CI]，0.27-0.82）。质子和光子患者的中位OS分别为31个月和14个月，质子和光子患者的24个月OS分别为59.1%和28.6%。质子放射治疗也与非经典放射性肝病的风险降低相关（比值比，0.26; P = 0.03; 95%CI，0.08-0.86）。3个月时发生非典型RILD与OS恶化相关（校正风险比，3.83; P
Purpose: Ablative radiation therapy is increasingly being used for hepatocellular carcinoma (HCC) resulting in excellent local control rates; however, patients without evidence of disease progression often die from liver failure. The clinical benefit of proton-over photon-based radiation therapy is unclear. We therefore sought to compare clinical outcomes of proton versus photon ablative radiation therapy in patients with unresectable HCC.Methods and Materials: This is a single-institution retrospective study of patients treated during 2008 to 2017 with nonmetastatic, unresectable HCC not previously treated with liver-directed radiation therapy and who did not receive further liver-directed radiation therapy within 12 months after completion of index treatment. The primary outcome, overall survival (OS), was assessed using Cox regression. Secondary endpoints included incidence of noneclassic radiation-induced liver disease (defined as increase in baseline Child-Pugh score by >= 2 points at 3 months posttreatment), assessed using logistic regression, and locoregional recurrence, assessed using Fine-Gray regression for competing risks. All outcomes were measured from radiation start date.Results: The median follow-up was 14 months. Of 133 patients with median age 68 years and 75% male, 49 (37%) were treated with proton radiation therapy. Proton radiation therapy was associated with improved OS (adjusted hazard ratio, 0.47; P = .008; 95% confidence interval [CI], 0.27-0.82). The median OS for proton and photon patients was 31 and 14 months, respectively, and the 24-month OS for proton and photon patients was 59.1% and 28.6%, respectively. Proton radiation therapy was also associated with a decreased risk of noneclassic radiationeinduced liver disease (odds ratio, 0.26; P = .03; 95% CI, 0.08-0.86). Development of nonclassic RILD at 3 months was associated with worse OS (adjusted hazard ratio, 3.83; P