Department of Surgery, Division of Hepato-Biliary-Pancreatic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Cancer. 2011 Nov 1;117(21):4890-904. doi: 10.1002/cncr.26134. Epub 2011 Apr 14.
The objective of this study was to evaluate the clinical outcome of proton and carbon ion therapy for hepatocellular carcinoma (HCC).
In total, 343 consecutive patients with 386 tumors, including 242 patients (with 278 tumors) who received proton therapy and 101 patients (with 108 tumors) who received carbon ion therapy, were treated on 8 different protocols of proton therapy (52.8-84.0 gray equivalents [GyE] in 4-38 fractions) and on 4 different protocols of carbon ion therapy (52.8-76.0 GyE in 4-20 fractions).
The 5-year local control and overall survival rates for all patients were 90.8% and 38.2%, respectively. Regarding proton and carbon ion therapy, the 5-year local control rates were 90.2% and 93%, respectively, and the 5-year overall survival rates were 38% and 36.3%, respectively. These rates did not differ significantly between the 2 therapies. Univariate analysis identified tumor size as an independent risk factor for local recurrence in proton therapy, carbon ion therapy, and in all patients. Multivariate analysis identified tumor size as the only independent risk factor for local recurrence in proton therapy and in all patients. Child-Pugh classification was the only independent risk factor for overall survival in proton therapy, in carbon ion therapy, and in all patients according to both univariate and multivariate analyses. No patients died of treatment-related toxicities.
Proton and carbon ion therapies for HCC were comparable in terms of local control and overall survival rates. These therapies may represent innovative alternatives to conventional local therapies for HCC.
本研究旨在评估质子和碳离子治疗肝细胞癌（HCC）的临床疗效。
共纳入 343 例 386 个病灶的连续患者，其中 242 例（278 个病灶）接受质子治疗，101 例（108 个病灶）接受碳离子治疗。患者接受了 8 种不同质子治疗方案（4-38 分次，52.8-84.0 格雷等效剂量[GyE]）和 4 种不同碳离子治疗方案（4-20 分次，52.8-76.0 GyE）。
所有患者的 5 年局部控制率和总生存率分别为 90.8%和 38.2%。质子和碳离子治疗的 5 年局部控制率分别为 90.2%和 93%，5 年总生存率分别为 38%和 36.3%。两种治疗方法之间的这些比率没有显著差异。单因素分析发现，肿瘤大小是质子治疗、碳离子治疗和所有患者局部复发的独立危险因素。多因素分析发现，肿瘤大小是质子治疗和所有患者局部复发的唯一独立危险因素。Child-Pugh 分级是质子治疗、碳离子治疗和所有患者总生存率的唯一独立危险因素，无论是单因素分析还是多因素分析。没有患者因治疗相关毒性而死亡。
质子和碳离子治疗 HCC 的局部控制率和总生存率相当。这些治疗方法可能是 HCC 常规局部治疗的创新替代方法。
