Hoffmeister-Wittmann Paula, Hoegen-Saßmannshausen Philipp, Wicklein Livia, Weykamp Fabian, Seidensaal Katharina, Springfeld Christoph, Dill Michael T, Longerich Thomas, Schirmacher Peter, Mehrabi Arianeb, Mathy René Michael, Köhler Bruno C, Debus Jürgen, Herfarth Klaus, Liermann Jakob
Department of Radiation Oncology, Heidelberg University Hospital, Heidelberg, Germany.
Heidelberg Institute of Radiation Oncology (HIRO) and National Center for Radiation Research in Oncology (NCRO), Heidelberg, Germany.
Radiat Oncol. 2025 Feb 18;20(1):23. doi: 10.1186/s13014-025-02594-y.
Liver cancer is the third leading cause of cancer related death due to treatment resistance and late onset of symptoms (Rumgay in J Hepatol 77: 1598-1606, 2022). The role of external beam radiotherapy (EBRT) in treatment of unresectable liver cancer needs to be defined. The use of particle therapy such as carbon ion radiation therapy (CIRT) with high linear energy transfer (LET) could increase efficacy of EBRT while limiting the toxic effects of radiation on non-cancerous liver tissue. Promising effects of CIRT have been described in several studies during the past decades, mostly in Japan. To date, no standardized treatment protocol has been established and European data on CIRT for liver cancer is lacking. This retrospective analysis aims to investigate efficacy and safety of hypofractionated CIRT compared to photon-based stereotactic body radiation (SBRT) in primary liver cancer.
Thirty-six (n = 36) and twenty (n = 20) patients with primary malignant liver tumors were treated with hypofractionated CIRT (4 fractions) and photon-based SBRT, respectively, between 2011 and 2022 and were retrospectively evaluated for survival, local control, and toxicity.
Two-year local control rate after CIRT was 92.3%. Compared to photon- based SBRT, CIRT scores with a significantly longer median distant progression free survival (3.1 versus 0.9 years). In a matched pair comparison of the two treatment regimens, the CIRT cohort demonstrated both longer 2-year overall survival (100% versus 59.6%) and longer 2-year distant PFS (75.7% versus 22.9%). No significant impairment of liver function was observed in either cohort.
In this retrospective analysis, patients who received CIRT presented excellent local tumor control and had better oncologic outcomes than patients who received photon-based SBRT. SBRT with carbon ions is a promising local ablative treatment option that needs further investigation in large prospective trials.
由于治疗耐药性和症状出现较晚，肝癌是癌症相关死亡的第三大主要原因（鲁姆盖伊，《肝脏病学杂志》77: 1598 - 1606, 2022）。外照射放疗（EBRT）在不可切除肝癌治疗中的作用有待明确。使用具有高线性能量传递（LET）的粒子疗法，如碳离子放射治疗（CIRT），可以提高EBRT的疗效，同时限制辐射对非癌性肝组织的毒性作用。在过去几十年里，多项研究描述了CIRT的显著效果，大多在日本。迄今为止，尚未建立标准化的治疗方案，且缺乏欧洲关于肝癌CIRT的数据。这项回顾性分析旨在研究与基于光子的立体定向体部放疗（SBRT）相比，低分割CIRT在原发性肝癌中的疗效和安全性。
2011年至2022年期间，分别对36例（n = 36）和20例（n = 20）原发性恶性肝肿瘤患者进行了低分割CIRT（4次分割）和基于光子的SBRT治疗，并对其生存、局部控制和毒性进行回顾性评估。
CIRT治疗后的两年局部控制率为92.3%。与基于光子的SBRT相比，CIRT的中位远处无进展生存期显著更长（3.1年对0.9年）。在两种治疗方案的配对比较中，CIRT队列的两年总生存率（100%对59.6%）和两年远处无进展生存期（75.7%对22.9%）均更长。两个队列均未观察到肝功能的显著损害。
在这项回顾性分析中，接受CIRT治疗的患者表现出优异的局部肿瘤控制，并且比接受基于光子的SBRT治疗的患者具有更好的肿瘤学结局。碳离子SBRT是一种有前景的局部消融治疗选择，需要在大型前瞻性试验中进一步研究。
