Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki, Japan.
Int J Radiat Oncol Biol Phys. 2012 Mar 1;82(3):e529-35. doi: 10.1016/j.ijrobp.2011.05.056.
Our previous results for treatment of hepatocellular carcinoma with proton beam therapy (PBT) revealed excellent local control. In this study, we focused on the impact of PBT on normal liver function.
The subjects were 259 patients treated with PBT at the University of Tsukuba between January 2001 and December 2007. We evaluated the Child-Pugh score pretreatment, on the final day of PBT, and 6, 12, and 24 months after treatment with PBT. Patients who had disease progression or who died with tumor progression at each evaluation point were excluded from the analysis to rule out an effect of tumor progression. An increase in the Child-Pugh score of 1 or more was defined as an adverse event.
Of the 259 patients, 241 had no disease progression on the final day of PBT, and 91 had no progression within 12 months after PBT. In univariate analysis, the percentage volumes of normal liver receiving at least 0, 10, 20, and 30 GyE in PBT (V0, 10, 20, and 30) were significantly associated with an increase of Child-Pugh score at 12 months after PBT. Of the 91 patients evaluated at 12 months, 66 had no increase of Child-Pugh score, 15 had a 1-point increase, and 10 had an increase of ≥2 points. For the Youden index, the optimal cut-offs for V0, V10, V20, and V30 were 30%, 20%, 26%, and 18%, respectively.
Our findings indicate that liver function after PBT is significantly related to the percentage volume of normal liver that is not irradiated. This suggests that further study of the relationship between liver function and PBT is required.
我们之前使用质子束疗法（PBT）治疗肝细胞癌的结果显示出优异的局部控制效果。在本研究中，我们专注于 PBT 对正常肝功能的影响。
本研究的对象是 2001 年 1 月至 2007 年 12 月在筑波大学接受 PBT 治疗的 259 名患者。我们评估了患者的 Child-Pugh 评分，分别在治疗前、PBT 治疗的最后一天以及治疗后 6、12 和 24 个月。在每个评估点，将患有疾病进展或因肿瘤进展而死亡的患者排除在分析之外，以排除肿瘤进展的影响。Child-Pugh 评分增加 1 分或以上定义为不良事件。
在 259 名患者中，有 241 名患者在 PBT 治疗的最后一天没有疾病进展，有 91 名患者在 PBT 治疗后 12 个月内没有进展。在单因素分析中，PBT 中接受至少 0、10、20 和 30 GyE 的正常肝脏的百分比体积（V0、10、20 和 30）与 PBT 后 12 个月时 Child-Pugh 评分的增加显著相关。在接受 12 个月评估的 91 名患者中，有 66 名患者的 Child-Pugh 评分没有增加，有 15 名患者增加了 1 分，有 10 名患者增加了≥2 分。对于 Youden 指数，V0、V10、V20 和 V30 的最佳截断值分别为 30%、20%、26%和 18%。
我们的研究结果表明，PBT 后的肝功能与未受照射的正常肝脏的百分比体积显著相关。这表明需要进一步研究肝功能与 PBT 之间的关系。
