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;
Anticancer Res. 2024 May;44(5):2219-2230. doi: 10.21873/anticanres.17029.
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).
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.
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).
PBT demonstrated comparable local control with acceptable toxicity to RFA in newly diagnosed HCC. Therefore, PBT may be a valid alternative.
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。
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。
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）。
在初诊 HCC 中，PBT 显示出与 RFA 相当的局部控制效果和可接受的毒性，因此可能是一种有效的替代治疗方法。
