Department of Radiation Oncology, Hokkaido University Faculty of Medicine, Hokkaido, Japan.
Department of Diagnostic and Interventional Radiology, Hokkaido University Hospital, Hokkaido, Japan.
Br J Radiol. 2023 Mar 1;96(1144):20220720. doi: 10.1259/bjr.20220720. Epub 2023 Jan 23.
In a previous study of hepatic toxicity, the following three factors were identified to predict the benefits of proton beam therapy (PBT) for hepatocellular carcinomas (HCCs) with a maximum diameter of ≤5 cm and Child-pugh grade A (CP-A): number of tumors (1 vs ≥2), the location of tumors (hepatic hilum or others), and the sum of the diameters of lesions. The aim of this study is to analyze the association between these three factors and hepatic toxicity.
We retrospectively reviewed patients of CP-A treated with PBT or photon stereotactic body radiotherapy (X-ray radiotherapy, XRT) for HCC ≤5 cm. For normal liver dose, the V5, V10, V20 (volumes receiving 5, 10, and 20 Gy at least), and the mean dose was evaluated. The albumin-bilirubin (ALBI) and CP score changes from the baseline were evaluated at 3 and 6 months after treatment.
In 89 patients (XRT: 48, PBT: 41), those with two or three (2-3) predictive factors were higher normal liver doses than with zero or one (0-1) factor. In the PBT group, the ALBI score worsened more in patients with 2-3 factors than those with 0-1 factor, at 3 months (median: 0.26 0.02, = 0.032) and at 6 months (median: 0.35 0.10, = 0.009). The ALBI score change in the XRT group and CP score change in either modality were not significantly different in the number of predictive factors.
The predictive factor numbers predicted the ALBI score change in PBT but not in XRT.
This study suggest that the number of predictive factors previously identified (0-1 vs 2-3) were significantly associated with dosimetric parameters of the normal liver in both modalities. In the proton group, the number of predictive factors was associated with a worsening ALBI score at 3 and 6 months, but these associations were not found in the photon SBRT group.
在之前的一项关于肝毒性的研究中，发现以下三个因素可预测最大直径≤5cm 且 Child-pugh 分级为 A（CP-A）的肝细胞癌（HCC）患者接受质子束治疗（PBT）的获益：肿瘤数量（1 个与≥2 个）、肿瘤位置（肝门或其他部位）以及病变直径之和。本研究旨在分析这三个因素与肝毒性之间的关系。
我们回顾性分析了接受 PBT 或光子立体定向体放射治疗（X 射线放疗，XRT）治疗的 CP-A 且 HCC 直径≤5cm 的患者。对于正常肝脏剂量，评估了 V5、V10、V20（至少接受 5、10 和 20Gy 的体积）和平均剂量。在治疗后 3 个月和 6 个月时评估白蛋白-胆红素（ALBI）和 CP 评分的变化。
在 89 例患者（XRT：48 例，PBT：41 例）中，有两个或三个（2-3）预测因素的患者正常肝脏剂量高于有零个或一个（0-1）预测因素的患者。在 PBT 组中，2-3 个预测因素的患者 ALBI 评分在 3 个月（中位数：0.26 0.02， = 0.032）和 6 个月（中位数：0.35 0.10， = 0.009）时比 0-1 个预测因素的患者恶化更明显。在 XRT 组中，两种模式下的 ALBI 评分变化和 CP 评分变化在预测因素数量上均无显著差异。
预测因素的数量预测了 PBT 而非 XRT 中 ALBI 评分的变化。
本研究表明，之前确定的预测因素数量（0-1 与 2-3）与两种模式下正常肝脏的剂量学参数显著相关。在质子组中，预测因素的数量与 3 个月和 6 个月时 ALBI 评分的恶化相关，但在光子 SBRT 组中未发现这些关联。
