Sorin Yushi, Ikeda Kenji, Kawamura Yusuke, Fujiyama Shunichiro, Kobayashi Masahiro, Hosaka Tetsuya, Sezaki Hitomi, Akuta Norio, Saitoh Satoshi, Suzuki Fumitaka, Suzuki Yoshiyuki, Arase Yasuji, Kumada Hiromitsu
Department of Hepatology, Toranomon Hospital, Tokyo, Japan.
Okinaka Memorial Institute for Medical Research, Tokyo, Japan.
Liver Cancer. 2018 Oct;7(4):323-334. doi: 10.1159/000487311. Epub 2018 Mar 14.
We analyzed the effectiveness of external particle radiotherapy (PRT) as an alternative therapy for various stages of hepatocellular carcinoma (HCC).
Eighty-three patients with HCC underwent PRT in our hospital from 2007 to 2015 (proton beam radiation in 58 patients and carbon ion radiation in 25 patients), including patients with early-stage HCC (single HCC measuring ≤3 cm, Barcelona Clinic Liver Cancer [BCLC] stage 0 or A) (group A, = 30), those with intermediate-stage HCC (HCCs measuring ≥3 cm but inoperable or multinodular and transcatheter arterial embolization [TACE]-refractory, BCLC stage B) (group B, = 31), and those with advanced-stage HCC (HCC with portal invasion or extrahepatic metastasis) (group C, = 22). The median radiation dose was 72.6 GyE (range 50-74) for proton beam radiation and 45.0 GyE (range 45-52.8) for carbon beam radiation. Local control ability was defined as continuous shrinkage of the tumor size without development of new lesions for ≥6 months after PRT.
The rates of local control of the target tumor at 6 months, 1 year, and 2 years were 91.9, 86.3, and 84.8%, respectively. The overall survival rates at 1, 2, and 3 years were 83.0, 65.6, and 55.1%, respectively. Patients in group A showed the best survival rates (100.0% at 1 year and 85.9% at 2 years). The 1-year survival rate was poor in group C (63.6%) despite a good local tumor control rate of 74.7%. The overall survival rates were significantly better in groups A and B than in group C.
The local control rates after PRT were sufficiently high compared to TACE or sorafenib. Thus, PRT should be adopted for patients with difficult-to-treat HCC in the early and intermediate stages.
我们分析了外照射粒子放疗（PRT）作为肝细胞癌（HCC）各阶段替代治疗方法的有效性。
2007年至2015年期间，我院83例HCC患者接受了PRT治疗（58例接受质子束放疗，25例接受碳离子放疗），包括早期HCC患者（单个HCC直径≤3 cm，巴塞罗那临床肝癌[BCLC]分期0期或A期）（A组，n = 30）、中期HCC患者（HCC直径≥3 cm但无法手术或为多结节且经动脉化疗栓塞术[TACE]难治性，BCLC分期B期）（B组，n = 31）以及晚期HCC患者（伴有门静脉侵犯或肝外转移的HCC）（C组，n = 22）。质子束放疗的中位辐射剂量为72.6 GyE（范围50 - 74），碳束放疗的中位辐射剂量为45.0 GyE（范围45 - 52.8）。局部控制能力定义为PRT后≥6个月肿瘤大小持续缩小且无新病灶出现。
目标肿瘤在6个月、1年和2年时的局部控制率分别为91.9%、86.3%和84.8%。1年、2年和3年的总生存率分别为83.0%、65.6%和55.1%。A组患者的生存率最佳（1年时为100.0%，2年时为85.9%）。C组尽管局部肿瘤控制率良好（74.7%），但其1年生存率较差（63.6%）。A组和B组的总生存率显著优于C组。
与TACE或索拉非尼相比，PRT后的局部控制率足够高。因此，对于早期和中期难以治疗的HCC患者应采用PRT治疗。
