Proton beam therapy for hepatocellular carcinoma
Proton beam therapy for hepatocellular carcinoma
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DOI：
10.1080/14737140.2017.1368392
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发表时间：
2017-08
影响因子：
3.3
通讯作者：
R. Yeung;T. Chapman;S. Bowen;S. Apisarnthanarax
中科院分区：
文献类型：
--
作者：
R. Yeung;T. Chapman;S. Bowen;S. Apisarnthanarax
摘要引言：放射治疗是肝细胞癌（HCC）患者的有效治疗选择。然而，由于缺乏随机对照试验和肝毒性风险（主要由基线肝功能和递送至非肿瘤肝细胞的剂量介导），HCC的放射治疗作为标准治疗选择在国际共识指南中的认可度仍然有限。质子束治疗（PBT）可以通过其在低至中等剂量下保留更多肝脏体积的剂量测定特性提供优于基于光子的放射治疗的优势。PBT有可能减少辐射相关的肝毒性，并允许肿瘤剂量递增。涵盖的领域：本文回顾了PBT用于HCC患者的临床原理以及回顾性和前瞻性研究的临床结局和毒性数据。PBT特定的技术挑战，这些肿瘤和适当的选择患者与PBT治疗进行了讨论。专家评论：肝脏PBT的局部控制、总生存期和毒性结果是有希望的。未来的研究，包括正在进行的随机合作组试验，将旨在确定PBT相对于光子的增量益处以及哪些患者最适合PBT。
ABSTRACT Introduction: Radiation therapy is an effective treatment option for hepatocellular carcinoma (HCC) patients. However, radiotherapy for HCC still has limited recognition as a standard treatment option in international consensus guidelines due to a paucity of randomized controlled trials and the risk of hepatotoxicity, which is primarily mediated by baseline liver function and dose delivered to non-tumor liver cells. Proton beam therapy (PBT) may offer advantages over photon-based radiation treatments through its dosimetric characteristic of sparing more liver volume at low to moderate doses. PBT has the potential to reduce radiation-related hepatotoxicity and allow for tumor dose escalation. Areas covered: This article reviews the clinical rationale for using PBT for HCC patients and clinical outcome and toxicity data from retrospective and prospective studies. PBT-specific technical challenges for these tumors and appropriate selection of patients to be treated with PBT are discussed. Expert commentary: Local control, overall survival, and toxicity results are promising for liver PBT. Future studies, including ongoing randomized cooperative group trials, will aim to determine the incremental benefit of PBT over photons and which patients are most suitable for PBT.