Bhangoo Ronik S, Mullikin Trey C, Ashman Jonathan B, Cheng Tiffany W, Golafshar Michael A, DeWees Todd A, Johnson Jedediah E, Shiraishi Satomi, Liu Wei, Hu Yanle, Merrell Kenneth W, Haddock Michael G, Krishnan Sunil, Rule William G, Sio Terence T, Hallemeier Christopher L
Department of Radiation Oncology, Mayo Clinic, Phoenix, Arizona.
Department of Radiation Oncology, Mayo Clinic, Rochester, Minnesota.
Adv Radiat Oncol. 2021 Mar 2;6(4):100675. doi: 10.1016/j.adro.2021.100675. eCollection 2021 Jul-Aug.
Our purpose was to assess the safety and efficacy of intensity modulated proton therapy (IMPT) for the treatment of hepatocellular carcinoma (HCC).
A retrospective review was conducted on all patients who were treated with IMPT for HCC with curative intent from June 2015 to December 2018. All patients had fiducials placed before treatment. Inverse treatment planning used robust optimization with 2 to 3 beams. The majority of patients were treated in 15 fractions (n = 30, 81%, 52.5-67.5 Gy, relative biological effectiveness), whereas the remainder were treated in 5 fractions (n = 7, 19%, 37.5-50 Gy, relative biological effectiveness). Daily image guidance consisted of orthogonal kilovoltage x-rays and use of a 6° of freedom robotic couch. Outcomes (local control, progression free survival, and overall survival) were determined using Kaplan-Meier methods.
Thirty-seven patients were included. The median follow-up for living patients was 21 months (Q1-Q3, 17-30 months). Pretreatment Child-Pugh score was A5-6 in 70% of patients and B7-9 in 30% of patients. Nineteen patients had prior liver directed therapy for HCC before IMPT. Eight patients (22%) required a replan during treatment, most commonly due to inadequate clinical target volume coverage. One patient (3%) experienced a grade 3 acute toxicity (pain) with no recorded grade 4 or 5 toxicities. An increase in Child-Pugh score by ≥ 2 within 3 months of treatment was observed in 6 patients (16%). At 1 year, local control was 94%, intrahepatic control was 54%, progression free survival was 35%, and overall survival was 78%.
IMPT is safe and feasible for treatment of HCC.
我们的目的是评估调强质子治疗（IMPT）用于治疗肝细胞癌（HCC）的安全性和有效性。
对2015年6月至2018年12月期间接受IMPT治疗且有治愈意图的所有HCC患者进行回顾性研究。所有患者在治疗前均放置了基准标记。逆向治疗计划采用2至3束射束的稳健优化。大多数患者接受15次分割治疗（n = 30，81%，52.5 - 67.5 Gy，相对生物效应），其余患者接受5次分割治疗（n = 7，19%，37.5 - 50 Gy，相对生物效应）。每日图像引导包括正交千伏级x光和使用六自由度机器人治疗床。采用Kaplan - Meier方法确定结果（局部控制、无进展生存期和总生存期）。
共纳入37例患者。存活患者的中位随访时间为21个月（第一四分位数 - 第三四分位数，17 - 30个月）。70%的患者治疗前Child - Pugh评分为A5 - 6，30%的患者为B7 - 9。19例患者在接受IMPT之前曾接受过针对HCC的肝定向治疗。8例患者（22%）在治疗期间需要重新计划，最常见的原因是临床靶区覆盖不足。1例患者（3%）出现3级急性毒性反应（疼痛），无4级或5级毒性反应记录。6例患者（16%）在治疗后3个月内Child - Pugh评分升高≥2分。1年时，局部控制率为94%，肝内控制率为54%，无进展生存率为35%，总生存率为78%。
IMPT治疗HCC安全可行。
