Iwata Hiromitsu, Ogino Hiroyuki, Hattori Yukiko, Nakajima Koichiro, Nomura Kento, Hayashi Kensuke, Toshito Toshiyuki, Sasaki Shigeru, Hashimoto Shingo, Mizoe Jun-Etsu, Shibamoto Yuta
Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Nagoya 462-8508, Japan.
Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya 467-8601, Japan.
Cancers (Basel). 2021 Jan 9;13(2):219. doi: 10.3390/cancers13020219.
This study retrospectively investigated the efficacy and safety of image-guided proton therapy (IGPT) for elderly (≥80 years old) hepatocellular carcinoma (HCC) patients. Proton therapy was performed using respiratory-gated and image-guided techniques. Seventy-one elderly HCC patients were treated using IGPT. The Child-Pugh score was A5 in 49 patients, A6 in 15, and B7-9 in 7. Forty-seven patients with a peripherally located tumor were administered 66 gray relative biological effectiveness (GyRBE) in 10 fractions, whereas 24 with a centrally located tumor received 72.6 GyRBE in 22 fractions. The median follow-up period of surviving patients was 33 months (range: 9-68). Two-year overall survival (OS) and local control (LC) rates estimated by the Kaplan-Meier method were 76% (95% confidence interval: 66-87%) and 88% (80-97%), respectively. According to the Common Terminology Criteria for Adverse Events version 4.0, no grade 2 or higher radiation-induced liver disease was observed, and only 1 patient developed grade 3 dermatitis. The quality of life score (European Organization for Research and Treatment of Cancer (EORTC) QLQ-C30 version 3.0, QLQ-HCC18, and SF-36) did not change after 1 year, except for the three-mental component summary (SF-36, improvement). IGPT is a safe and effective treatment for HCC in elderly patients.
本研究回顾性调查了图像引导质子治疗（IGPT）对老年（≥80岁）肝细胞癌（HCC）患者的疗效和安全性。质子治疗采用呼吸门控和图像引导技术进行。71例老年HCC患者接受了IGPT治疗。Child-Pugh评分A5的患者有49例，A6的有15例，B7 - 9的有7例。47例肿瘤位于周边的患者分10次给予66 Gy的相对生物效应剂量（GyRBE），而24例肿瘤位于中央的患者分22次给予72.6 GyRBE。存活患者的中位随访期为33个月（范围：9 - 68个月）。采用Kaplan-Meier法估计的2年总生存率（OS）和局部控制率（LC）分别为76%（95%置信区间：66 - 87%）和88%（80 - 97%）。根据《不良事件通用术语标准》第4.0版，未观察到2级或更高等级的放射性肝病，仅1例患者发生3级皮炎。生活质量评分（欧洲癌症研究与治疗组织（EORTC）QLQ-C30第3.0版、QLQ-HCC18和SF-36）在1年后除了精神成分总结（SF-36，有所改善）外均未改变。IGPT是老年HCC患者一种安全有效的治疗方法。
