Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Department of Radiology, Hyogo Ion Beam Medical Center, Tatsuno, Japan.
Dig Surg. 2022;39(2-3):99-108. doi: 10.1159/000524582. Epub 2022 Apr 22.
Although the primary treatment option for hilar cholangiocarcinoma (HC) has been surgical resection, most patients present with unresectable advanced tumors at the time of diagnosis. Particle therapy (PT) holds great potential for HC, even though the anatomical proximity to the gastrointestinal tract prevents delivering a radical dose to the tumor. Space-making PT (SMPT), consisting of spacer placement surgery and subsequent PT, has been developed to minimize complications and maximize the therapeutic benefit of dose escalation for HC. This study aimed to conduct a dosimetric evaluation and examine the effectiveness of SMPT for the treatment of HC.
Between 2007 and 2018, 12 patients with unresectable HC treated with SMPT were enrolled. The treatment outcomes and effectiveness of spacer placement surgery were evaluated through analyses of pre- and post-surgical parameters of dose-volume histograms.
All patients completed the planned SMPT protocol. The median survival time was 29.6 months, and the 1- and 3-year overall survival rates were 82.5% and 45.8%, respectively. The mean V95% value (volume irradiated with 95% of the planned treatment dose) of the gross tumor volume and clinical target volume after spacer placement surgery improved to 98.5% and 96.6% from preoperative values of 85.6% and 78.1%, respectively (p = 0.0196 and p = 0.0053, respectively). Grade 3 or higher adverse events after SMPT were seen in 6 patients.
DISCUSSION/CONCLUSION: SMPT led to improvements in dosimetric parameters and showed good feasibility and excellent outcomes. SMPT can be a promising novel alternative for unresectable HC.
尽管肝门部胆管癌（HC）的主要治疗选择是手术切除，但大多数患者在诊断时已患有不可切除的晚期肿瘤。粒子治疗（PT）对 HC 具有很大的潜力，尽管解剖位置接近胃肠道，但无法向肿瘤提供根治性剂量。为了最大程度地减少并发症并提高 HC 剂量递增的治疗效果，开发了空间形成 PT（SMPT），包括间隔器放置手术和随后的 PT。本研究旨在对 SMPT 治疗 HC 的剂量学评估和疗效进行研究。
2007 年至 2018 年间，共纳入 12 例接受 SMPT 治疗的不可切除 HC 患者。通过分析剂量-体积直方图的术前和术后参数，评估治疗结果和间隔器放置手术的疗效。
所有患者均完成了计划的 SMPT 方案。中位总生存期为 29.6 个月，1 年和 3 年总生存率分别为 82.5%和 45.8%。与术前的 85.6%和 78.1%相比，放置间隔器后，大体肿瘤体积和临床靶区的平均 V95%值（接受 95%计划治疗剂量照射的体积）分别改善至 98.5%和 96.6%（p = 0.0196 和 p = 0.0053）。SMPT 后有 6 例出现 3 级或更高级别的不良事件。
讨论/结论：SMPT 可改善剂量学参数，且具有良好的可行性和优异的结果。SMPT 可能是一种有前途的不可切除 HC 的新型治疗选择。
