质子束放射治疗作为一种新诊断的肝细胞癌的有治愈选择的替代方案，可替代射频消融术。

Proton Beam Radiotherapy as a Curative Alternative to Radiofrequency Ablation for Newly Diagnosed Hepatocellular Carcinoma.

机构信息

Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea;

出版信息

Anticancer Res. 2024 May;44(5):2219-2230. doi: 10.21873/anticanres.17029.

DOI:10.21873/anticanres.17029

PMID:38677752

Abstract

BACKGROUND/AIM: This study aimed to compare the oncological outcomes of proton beam radiotherapy (PBT) with those of radiofrequency ablation (RFA) for newly diagnosed hepatocellular carcinoma (HCC).

PATIENTS AND METHODS

This study included 323 patients who underwent PBT (n=40) or RFA (n=283) as a curative treatment for previously untreated HCC between October 2016 and June 2021. The primary endpoints were local progression and toxicity.

RESULTS

The median follow-up was 3.4 years (range=1.1-5.7 years). In terms of portal vein tumor thrombosis, tumor size, alpha-fetoprotein, and prothrombin-induced by vitamin K absence-II, the PBT group had significantly more severe tumor burdens than those of the RFA group (p<0.0001, p<0.0001, p=0.0004, and p<0.0001, respectively). No significant difference was observed in cumulative local progression rate (10.4% in PBT vs. 7.8% in RFA at 3-years, p=0.895). Grade 3 or higher toxicity was reported in only one patient (0.4%) after RFA. Multivariable analysis demonstrated that treatment modality was not a significant prognostic factor for local progression (hazard ratio=1.05; 95% confidence interval=0.32-3.48; p=0.934).

CONCLUSION

PBT demonstrated comparable local control with acceptable toxicity to RFA in newly diagnosed HCC. Therefore, PBT may be a valid alternative.

摘要

背景/目的：本研究旨在比较质子束放疗（PBT）与射频消融（RFA）治疗初诊肝细胞癌（HCC）的肿瘤学结果。

患者与方法

本研究纳入了 2016 年 10 月至 2021 年 6 月期间接受根治性治疗的 323 例初诊 HCC 患者，包括接受 PBT（n=40）或 RFA（n=283）治疗的患者。主要终点为局部进展和毒性。

结果

中位随访时间为 3.4 年（范围 1.1-5.7 年）。在门静脉癌栓、肿瘤大小、甲胎蛋白和维生素 K 缺乏诱导蛋白 II 方面，PBT 组的肿瘤负荷显著高于 RFA 组（p<0.0001、p<0.0001、p=0.0004 和 p<0.0001）。3 年时，PBT 组和 RFA 组的累积局部进展率无显著差异（分别为 10.4%和 7.8%，p=0.895）。RFA 后仅 1 例（0.4%）患者报告出现 3 级或更高级别的毒性。多变量分析表明，治疗方式不是局部进展的显著预后因素（风险比=1.05；95%置信区间 0.32-3.48；p=0.934）。