Ohkawa Ayako, Mizumoto Masashi, Ishikawa Hitoshi, Abei Masato, Fukuda Kuniaki, Hashimoto Takayuki, Sakae Takeji, Tsuboi Koji, Okumura Toshiyuki, Sakurai Hideyuki
Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki, Japan.
J Gastroenterol Hepatol. 2015 May;30(5):957-63. doi: 10.1111/jgh.12843.
Treatment for unresectable intrahepatic cholangiocarcinoma (ICC) has not been established. The aim of the study was to evaluate the outcome of proton beam therapy (PBT) for patients with unresectable ICC.
Up to 2010, 20 patients (11 males, 9 females, median age 63 years old) with unresectable ICC (two, seven, seven, and four in stages II, IIIA, IIIC, and IV, respectively) were treated with PBT. The largest dimensions of the tumors ranged from 15 to 140 mm (median: 50 mm). The intrahepatic region and lymph nodes received median total proton doses of 72.6 GyE in 22 fractions and 56.1 GyE in 17 fractions, respectively. Four patients received concurrent chemotherapy (tegafur, gimeracil, and oteracil; TS-1) during PBT. Twelve patients were treated curatively, and eight were treated palliatively because tumors were present outside the irradiation field.
In the curative group, nine tumors within the irradiated field were controlled in follow-up of 8.6-62.6 months (median: 20.8 months). Median survival rates in the curative and palliative groups were 27.5 and 9.6 months, respectively, and overall 1- and 3-year survival rates were 82% and 38%, and 50% and 0%, respectively. Eight patients survived for > 2 years, and there was no distant metastasis in five of these patients after 2 years. No severe side-effects occurred.
The results suggest that long-term survival can be achieved using PBT for patients with unresectable ICC without distant metastasis. Further studies are required to determine the optimal treatment schedule and best combination of PBT and chemotherapy.
不可切除性肝内胆管癌（ICC）的治疗方法尚未确立。本研究旨在评估质子束治疗（PBT）对不可切除性ICC患者的疗效。
截至2010年，20例不可切除性ICC患者（男性11例，女性9例，中位年龄63岁）接受了PBT治疗（II期、IIIA期、IIIC期和IV期分别为2例、7例、7例和4例）。肿瘤最大直径为15至140毫米（中位值：50毫米）。肝内区域和淋巴结接受的质子总剂量中位数分别为22次分割的72.6 GyE和17次分割的56.1 GyE。4例患者在PBT期间接受了同步化疗（替吉奥；TS-1）。12例患者接受了根治性治疗，8例因肿瘤位于照射野之外而接受了姑息性治疗。
在根治性治疗组中，照射野内的9个肿瘤在8.6至62.6个月（中位值：20.8个月）的随访中得到控制。根治性治疗组和姑息性治疗组的中位生存率分别为27.5个月和9.6个月，总体1年和3年生存率分别为82%和38%，以及50%和0%。8例患者存活超过2年，其中5例患者在2年后无远处转移。未发生严重副作用。
结果表明，对于无远处转移的不可切除性ICC患者，使用PBT可实现长期生存。需要进一步研究以确定最佳治疗方案以及PBT与化疗的最佳联合方式。
