碳离子放射治疗不可切除的局部复发性结直肠癌：一种对放疗初治病例和再程放疗病例均有前景的根治性治疗方法

Carbon-Ion Radiation Therapy for Unresectable Locally Recurrent Colorectal Cancer: A Promising Curative Treatment for Both Radiation Therapy: Naïve Cases and Reirradiation Cases.

作者信息

Takiyama Hirotoshi, Yamada Shigeru, Isozaki Tetsuro, Ikawa Hiroaki, Shinoto Makoto, Imai Reiko, Koto Masashi

机构信息

QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Japan.

出版信息

Int J Radiat Oncol Biol Phys. 2024 Mar 1;118(3):734-742. doi: 10.1016/j.ijrobp.2023.09.036. Epub 2023 Sep 29.

DOI:10.1016/j.ijrobp.2023.09.036

PMID:37776980

Abstract

PURPOSE

It is difficult to effectively cure patients with unresectable locally recurrent colorectal cancers (LRCRCs) using conventional chemotherapy or chemoradiation therapy. Furthermore, treatment options vary depending on the patient's history of radiation therapy. Carbon-ion radiation therapy (CIRT) is a potentially curative treatment for these patients. Here, we compare the treatment outcomes of radiation therapy-naïve cases (nRT) and re-irradiation cases (reRT).

METHODS AND MATERIALS

Patients with LRCRC treated with CIRT at QST Hospital between 2003 and 2019 were eligible. CIRT was administered daily 4 d/wk for 16 fractions. The total irradiated dose was set at 73.6 Gy (relative biologic effectiveness-weighted dose [RBE]) for nRT and 70.4 Gy (RBE) for reRT patients.

RESULTS

We included 390 nRT cases and 83 reRT cases. The median follow-up period from the initiation of CIRT was 48 (5-208) months. The 3-year overall survival (OS) rates for nRT and reRT were 73% (95% CI, 68%-77%) and 76% (65%-84%), respectively. The 5-year OS rates were 50% (45%-55%) and 50% (38%-61%), respectively. These rates did not differ significantly (P = .55). The 3-year local control (LC) rates for nRT (73.6 Gy) and reRT (70.4 Gy) cases were 80% (75%-84%) and 80% (68%-88%), respectively. The 5-year LC rates were 72% (67%-78%) and 69% (55%-81%), respectively, without a significant difference (P = .56).

CONCLUSIONS

Our results suggest that CIRT for LRCRC is a very effective and promising treatment for both nRT and reRT cases.

摘要

目的

使用传统化疗或放化疗难以有效治愈无法切除的局部复发性结直肠癌（LRCRC）患者。此外，治疗方案因患者的放疗史而异。碳离子放疗（CIRT）对这些患者是一种潜在的治愈性治疗方法。在此，我们比较了未接受过放疗的病例（nRT）和再程放疗的病例（reRT）的治疗结果。

方法和材料

2003年至2019年期间在QST医院接受CIRT治疗的LRCRC患者符合条件。CIRT每周4天，每天进行一次，共16次分割。nRT患者的总照射剂量设定为73.6 Gy（相对生物效应加权剂量[RBE]），reRT患者为70.4 Gy（RBE）。

结果

我们纳入了390例nRT病例和83例reRT病例。从开始CIRT起的中位随访期为48（5 - 208）个月。nRT和reRT的3年总生存率（OS）分别为73%（95%CI，68% - 77%）和76%（65% - 84%）。5年OS率分别为50%（45% - 55%）和50%（38% - 61%）。这些率无显著差异（P = 0.55）。nRT（73.6 Gy）和reRT（70.4 Gy）病例的3年局部控制率（LC）分别为80%（75% - 84%）和80%（68% - 88%）。5年LC率分别为72%（67% - 78%）和69%（55% - 81%），无显著差异（P = 0.56）。