对未经治疗的肝细胞癌的质子束疗法不适合通过导管动脉化学栓塞
Hikaru Niitsu1, Hirokazu Makishima1,2, Naoyuki Hasegawa3
1Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan.
质子束疗法 (PBT) 为TACE不适合的肝细胞癌 (HCC) 提供了高局部控制. 需要进一步的研究来解决场外复发,以改善生存结果.
科学领域:
- 在瘤学瘤学.
- 辐射疗法 辐射疗法
- 肝胆道医学 肝胆道医学
背景情况:
- 中期肝细胞癌 (HCC) 显示了跨动脉化学栓塞 (TACE) 的有限益处.
- 不适合TACE的HCC需要替代治疗策略来改善肝脏内病变控制.
- 粒子疗法,特别是质子束疗法 (PBT),提供高局部控制与最小的毒性.
研究的目的:
- 追溯评估PBT在TACE不适合,以前未经治疗的HCC患者的疗效和安全性.
- 评估PBT后的整体存活率 (OS),局部控制 (LC),无进展率 (PFR) 和进展时间 (TTP).
- 在这个患者队列中确定与生存和进展相关的风险因素.
主要方法:
- 在2010年至2018年期间,202名先前未经治疗的HCC患者接受了最终的PBT.
- 不适合TACE的标准包括超过多达七个规则,ALBI等级2-3,非简单结节型或宏观血管入侵 (MVI).
- 卡普兰-梅尔分析用于OS,LC,PFR和TTP; 风险因素的考克斯回归; CTCAE v. 5.0用于不良事件.
主要成果:
- 在TACE不适合的HCC中,PBT显示3年的OS为62.9%,3年的PFR为42.4%,3年的LC为89.3%.
- 多变量分析确定了ECOG PS,ALBI和瘤大小作为OS的重要因素,以及TTP的性别和瘤大小.
- 一般来说,不良事件是可控的,有2例3级急性皮肤炎,4例3级慢性胃肠道出血.
结论:
- 当瘤负担有限时,PBT是TACE不适合HCC的可行的非劣质治疗选择.
- 抑制场外复发对于进一步增强PBT治疗患者的生存益处至关重要.
- 在TACE不适合的HCC中,PBT显示出有希望的疗效和安全性,因此需要进一步研究优化治疗策略.
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