Sugahara Shinji, Nakayama Hidetsugu, Fukuda Kuniaki, Mizumoto Masashi, Tokita Mari, Abei Masato, Shoda Junichi, Matsuzaki Yasushi, Thono Eriko, Tsuboi Koji, Tokuuye Koichi
Department of Radiation Oncology, Institute of Clinical Medicine, University of Tsukuba, Ibaraki, Japan.
Strahlenther Onkol. 2009 Dec;185(12):782-8. doi: 10.1007/s00066-009-2020-x.
The prognosis of patients with advanced hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) is extremely poor, as effective treatment options are limited. The authors performed a retrospective review to evaluate the efficacy of proton-beam therapy (PBT) for patients presenting with PVTT in the setting of HCC.
Between February 1991 and September 2005, 35 patients with HCC and tumor thrombi in the main trunk or major branches of the portal vein presented for consideration of PBT. Their tumor sizes ranged from 25 mm to 130 mm (median, 60 mm). A median total dose of 72.6 GyE in 22 fractions was delivered over 31 days to a target volume that encompassed both the primary hepatic lesion and the PVTT.
32 patients were progression-free during a median follow-up period of 21 months (range, 2-88 months) and three patients experienced disease progression. Local progression-free survival rates were 46% at 2 years and 20% at 5 years, and the median local progression-free survival was 21 months. Acute toxicity > or = grade 3 was observed in three patients, and no patient experienced late toxicity > or = grade 3. None of the patients had to discontinue treatment as a result of toxicity.
PBT improved local control and significantly prolonged survival in HCC patients with PVTT.
晚期肝细胞癌（HCC）合并门静脉癌栓（PVTT）患者的预后极差，因为有效的治疗选择有限。作者进行了一项回顾性研究，以评估质子束治疗（PBT）对HCC合并PVTT患者的疗效。
1991年2月至2005年9月期间，35例HCC合并门静脉主干或主要分支癌栓的患者接受了PBT治疗。他们的肿瘤大小从25毫米到130毫米不等（中位数为60毫米）。在31天内分22次给予中位总剂量72.6 GyE，照射靶体积包括原发性肝脏病变和PVTT。
32例患者在中位随访期21个月（范围2 - 88个月）内无疾病进展，3例患者出现疾病进展。2年局部无进展生存率为46%，5年为20%，中位局部无进展生存期为21个月。3例患者出现3级及以上急性毒性反应，无患者出现3级及以上晚期毒性反应。无一例患者因毒性反应而不得不中断治疗。
PBT改善了HCC合并PVTT患者的局部控制并显著延长了生存期。
