Rath Satyajeet
All India Institute of Medical Sciences, Rajkot, India.
Acta Med Litu. 2025;32(1):36-51. doi: 10.15388/Amed.2025.32.1.25. Epub 2025 Feb 18.
Hepatic oligometastasis (hOMC) incidence varies from 10-40% in the literature. While the old standard for local treatment was surgical resection, options like TACE, TARE, SBRT with photons and off late protons have come to the fore. The proton beam therapy (PBT) use has gradually started to get adopted in all regions worldwide with increasingly better availability and ever-reducing costs. The role of PBT in hOMC has been studied in many retrospective cohort studies. Although there is a plethora of evidence on photon-SBRT, there are very few analyses on the role of PBT in hOMC. The author intends to analyse the efficacy in terms of the local control (LC) and the overall survival (OS) for PBT and its toxicity profile in this systematic review. LC remains persistently high (76-89% at 1-2 years) across breast, colo-rectum, stomach, and esophagus. Sites like colo-rectum and breast show relatively better survival outcomes, with progression free survival (35-52% at 1-2 years) and OS (33-78% at 1-2 years) than other sites, likely due to disease biology. Breast primary derived hOMCs had the best 3-year OS of 67.6%. Toxicities remain remarkably low with grade 3 plus toxicities ranging from 0-3%, which reflects the ability of proton therapy to deliver beams with precision.
肝寡转移（hOMC）的发生率在文献中为10%-40%。虽然局部治疗的旧标准是手术切除，但诸如经动脉化疗栓塞（TACE）、钇90微球选择性体内放射治疗（TARE）、光子立体定向体部放疗（SBRT）以及最近的质子治疗等方法已崭露头角。质子束治疗（PBT）的应用已逐渐在全球所有地区开始采用，其可用性日益提高，成本也不断降低。PBT在hOMC中的作用已在许多回顾性队列研究中得到探讨。尽管有大量关于光子SBRT的证据，但关于PBT在hOMC中作用的分析却很少。作者打算在本系统评价中分析PBT在局部控制（LC）和总生存期（OS）方面的疗效及其毒性特征。在乳腺癌、结直肠癌、胃癌和食管癌中，LC在1-2年时一直保持较高水平（76%-89%）。结直肠癌和乳腺癌等部位的生存结果相对较好，其无进展生存期（1-2年时为35%-52%）和OS（1-2年时为%33-78%）优于其他部位，这可能归因于疾病生物学特性。源自乳腺癌的hOMC的3年OS最佳，为67.6%。3级及以上毒性的发生率极低，为0%-3%，这反映了质子治疗精确输送射线的能力。
