局部不可切除肝细胞癌的质子束治疗结果。
Proton beam therapy outcomes for localized unresectable hepatocellular carcinoma.
机构信息
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States.
Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, United States; Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan.
出版信息
Radiother Oncol. 2019 Apr;133:54-61. doi: 10.1016/j.radonc.2018.10.041. Epub 2019 Jan 16.
BACKGROUND AND PURPOSE
This study documents the utilization and efficacy of proton beam therapy (PBT) in western patients with localized unresectable hepatocellular carcinoma (HCC).
METHODS AND METHODS
Forty-six patients with HCC, Child-Pugh class of A or B, no prior radiotherapy history, and ECOG performance status 0-2 received PBT at our institution from 2007 to 2016. Radiographic control within the PBT field (local control, LC) and overall survival (OS) were calculated from the start of PBT.
RESULTS
Most (83%) patients had Child-Pugh class A. Median tumor size was 6 cm (range, 1.5-21.0 cm); 22% of patients had multiple tumors and 28% had tumor vascular thrombosis. Twenty-five (54%) patients received prior treatment. Median biologically effective dose (BED) was 97.7 GyE (range, 33.6-144 GyE) administered in 15 fractions. Actuarial 2-year LC and OS rates were 81% and 62% respectively; median OS was 30.7 months. Out-of-field intrahepatic failure was the most common site of disease progression. Patients receiving BED ≥90 GyE had a significantly better OS than those receiving BED <90 GyE (49.9 vs. 15.8 months, p = 0.037). A trend toward 2-year LC improvement was observed in patients receiving BED ≥90 GyE compared with those receiving BED <90 GyE (92% vs. 63%, p = 0.096). On multivariate analysis, higher BED (p = 0.023; hazard ratio = 0.308) significantly predicted improved OS. Six (13%) patients experienced acute grade 3 toxicity.
CONCLUSIONS
High-dose PBT is associated with high rates of LC and OS for unresectable HCC. Dose escalation may further improve outcomes.
背景与目的
本研究记录了质子束治疗（PBT）在西方局部不可切除肝细胞癌（HCC）患者中的应用和疗效。
方法和方法
2007 年至 2016 年，46 例 HCC 患者，Child-Pugh 分级为 A 或 B，无既往放疗史，ECOG 体能状态为 0-2，在我院接受 PBT。从 PBT 开始计算 PBT 区域内的影像学控制（局部控制，LC）和总生存期（OS）。
结果
大多数（83%）患者为 Child-Pugh 分级 A。中位肿瘤大小为 6cm（范围，1.5-21.0cm）；22%的患者有多个肿瘤，28%的患者有肿瘤血管血栓形成。25 例（54%）患者接受了前期治疗。中位生物有效剂量（BED）为 97.7GyE（范围，33.6-144GyE），共 15 个分次。2 年 LC 和 OS 率分别为 81%和 62%；中位 OS 为 30.7 个月。肝外肿瘤进展最常见的部位是肿瘤进展。接受 BED≥90GyE 的患者 OS 明显优于接受 BED＜90GyE 的患者（49.9 与 15.8 个月，p=0.037）。与接受 BED＜90GyE 的患者相比，接受 BED≥90GyE 的患者 2 年 LC 改善趋势明显（92%与 63%，p=0.096）。多因素分析显示，较高的 BED（p=0.023；危险比=0.308）显著预测 OS 改善。6 例（13%）患者发生急性 3 级毒性。
结论
高剂量 PBT 治疗局部不可切除 HCC 患者的 LC 和 OS 率较高。剂量升级可能进一步改善结果。
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