Lin Dao-Chen, Hou Jen-Yin, Tseng Chen-Kan, Tsai Pei-Shan
Department of Radiology, Taipei Veterans General Hospital, Taipei City, Taiwan.
Division of Endocrine and Metabolism, Department of Medicine, Taipei Veterans General Hospital, Taipei City, Taiwan.
Eur J Pediatr. 2025 Sep 19;184(10):626. doi: 10.1007/s00431-025-06471-4.
Surgical resection or liver transplantation is the cornerstone of curative treatment for hepatoblastoma (HBL). For unresectable HBL, liver transplantation has proven to be a definitive curative option, with long-term survival rates ranging from 30 to 95% in previous studies. However, some patients may not meet the surgical or medical criteria for transplantation. Traditionally, radiotherapy (RT) has not been a standard treatment for HBL due to the risk of high-dose radiation damage to normal liver tissue. Proton beam therapy (PBT), a type of RT, leverages the Bragg peak phenomenon, concentrating the majority of its energy within the last few millimeters of its range. This results in a significantly reduced radiation dose beyond this point, thereby minimizing potential harm to distal radiosensitive structures. PBT has emerged as an alternative treatment option for hepatocellular carcinoma in non-surgical adult patients, but its effects and post-treatment changes in HBL remain under-documented. In this preliminary investigation, we aimed to examine the post-PBT following imaging changes in both HBL and the surrounding liver parenchyma in pediatric patients. What Is Known: • HBL is the most common primary malignancy of liver in children. • In HBL, liver transplantation is indicated for patients with tumors that cannot be managed by surgical resection. What Is New: • PBT may prove to be a promising treatment option for unresectable HBL, with the potential to preserve normal liver tissue. • Understanding the imaging changes in post-PBT tumors and the associated focal liver reaction at various time points is crucial for accurately assessing treatment response and guiding appropriate alternative treatment options.
手术切除或肝移植是肝母细胞瘤（HBL）根治性治疗的基石。对于无法切除的HBL，肝移植已被证明是一种确定性的根治性选择，在以往的研究中，长期生存率在30%至95%之间。然而，一些患者可能不符合手术或移植的医学标准。传统上，由于高剂量辐射对正常肝组织造成损伤的风险，放射治疗（RT）并非HBL的标准治疗方法。质子束治疗（PBT）作为一种放射治疗，利用布拉格峰现象，将其大部分能量集中在射程的最后几毫米内。这导致在此点之后的辐射剂量显著降低，从而将对远端放射敏感结构的潜在危害降至最低。PBT已成为非手术成年患者肝细胞癌的替代治疗选择，但其在HBL中的效果和治疗后变化仍记录不足。在这项初步研究中，我们旨在研究儿童患者接受PBT后HBL及其周围肝实质的影像学变化。已知信息：•HBL是儿童最常见的肝脏原发性恶性肿瘤。•在HBL中，对于无法通过手术切除治疗的肿瘤患者，建议进行肝移植。新发现：•PBT可能被证明是无法切除的HBL的一种有前景的治疗选择，具有保留正常肝组织的潜力。•了解PBT后肿瘤的影像学变化以及不同时间点相关的局部肝反应，对于准确评估治疗反应和指导适当的替代治疗选择至关重要。
