Kurapa kweproton yekenza yechiropa, kurarama kwenguva refu kwevarwere vane hepatocellular carcinoma proton therapy
Hepatocellular carcinoma ndiyo yakajairika mhando yekenza yechiropa, ine vanopfuura 700,000 nzufu pasi rose gore rega rega, uye chiitiko chiri kuwedzera. Nzira dzekurapa hepatocellular carcinoma dzinosanganisira kuisirwa chiropa, kuvhiyazve, maablative maitiro uye radiotherapy (photon radiotherapy kana proton therapy). Pakati pavo, kuvhiyiwa kuchiri kurapwa kwakasarudzika, asi masosi echiropa anogona kushandiswa pakuisazve ari mashoma uye varwere vazhinji havagone kubvuma kuvhiyiwa nekuda kwechiropa cirrhosis uye zvimwe zvikonzero.
Kurapa kweproton kunogona kuwedzera kupona kwemurwere kwese
Massachusetts General Hospital Nina Sanford, MD uye timu retrospectively yakafananidza yekurapa mhedzisiro ye133 varwere vane isingashande kenza yechiropa avo vakaitwa echinyakare photon radiotherapy kana proton therapy kuMassachusetts General Hospital pakati pegore ra2008 na2017, makumi mashanu nematatu (49%)) Vanogamuchira kurapwa kweproton. Uku ndiko kuongorora kwekutanga kwekuenzanisa kwe proton therapy uye photon radiotherapy yehepatocellular carcinoma.
Iyo yepakati yekutevera nguva yekudzidza yaive mwedzi gumi nemana, iyo irradiation dose yaive 14 Gy / 45 kana 15 Gy / 30 ~ 5, uye yepakati zera yevarwere yaive makore 6. Zvidzidzo zvakaratidza kuti kupona kwevarwere muboka repronon Therapy kuri nani pane iro reboka reproton radiotherapy, ine nguva dzekupona dzepakati pemwedzi makumi matatu nemana nemwedzi gumi nemana, zvichiteerana, uye nemwedzi makumi maviri nemana ekupona kwehuwandu hwe68% uye 31% , zvichiteerana. Panguva imwecheteyo, kurapa kweproton kunogona kudzora kuitika kweasina-echinyakare radiation-inokonzerwa nechiropa chirwere (RILD) ichienzaniswa nefoton radiotherapy. Pakati pevarwere makumi maviri nevaviri vane R-non-classical RILD, 14 vakagamuchira proton therapy uye 24 vakagamuchira photon radiotherapy; uye mushure mekurapa Chiitiko cheRILD pamwedzi mitatu chakabatana pamwe nekupona kwese. Iwo emunharaunda ekudzora mwero weboka reproton Therapy uye iro photon radiotherapy boka raive 59.1% uye 28.6%, zvichiteerana, uye pakanga pasina mutsauko wakakura pakati pemapoka maviri aya.
The article indicates that the longer overall survival of patients in the proton therapy group may be due to the lower incidence of decompensated liver function after treatment. Dr. Sanford said that in the United States, patients with hepatocellular carcinoma are often accompanied by other liver diseases, making these patients unable to undergo surgery and making radiotherapy more difficult. The proton therapy has a lower radiation dose to normal tissues around the tumarara, so for patients with hepatocellular carcinoma, the non-target liver tissue receives less radiation dose. “We think this will reduce the incidence of liver injury. Because the cause of many hepatocellular carcinoma patients is other liver diseases, the lower liver injury rate in the proton therapy group can translate into better patient survival.”
Ziva kufungidzira kwekukuvara kwechiropa mushure mekurapwa kweproton
Radiotherapy yehepatocellular carcinoma ichiri kukakavara nekuti yakanyanya-mwero kufuridzirwa kwemamota kunogona kukonzera zvimwe zvirwere zveropa (RILD). MD Anderson Cancer Center uye radiation oncologist Cheng-En Hsieh, MD weChang Gung Memorial Hospital muTaiwan nechikwata chake vakaona vanofungidzira veRILD mushure mekurapa kweproton.
Isiri-yakatarwa chiropa vhoriyamu / yakaenzana chiropa vhoriyamu chiyero (ULV / SLV) vhoriyamu-mhedzisiro histogram
Iyi yakawanda-yepakati yekudzidza yaisanganisira varwere ve136 vane hepatocellular carcinoma vasina kufambira mberi kuenda kumatraepatic tumors mushure mekurapa kweproton. Iyo yekurapa kweproton yakakamurwa kuita 2 GyE. Multivariate kudzokorodza ongororo yakaratidza kuti iyo isiri-yakatarwa chiropa vhoriyamu / yakajairwa chiropa vhoriyamu chiyero (ULV / SLV), bundu rinotarisisa vhoriyamu, uye Mwana-Pugh kupatsanurwa vaive vakazvimiririra kufanotaura kweRILD, uye avhareji chiropa chipimo uye chipenga dhiraini yekuendesa yanga isina hukama ne RILD Bonde. Vatsvakurudzi vanotenda kuti iyo ULV / SLV kukosha ndiyo inonyanya kukosha kufanotaura kweRILD; kuratidzwa kwe -1 GyE kunogona kukonzera kusangana kwechiropa. Naizvozvo, pakudzivirira uye kurapwa kwezvirwere zvechiropa, iyo isiri-yakatarwa chiropa vhoriyamu yakakosha kupfuura avhareji yechiropa dose.
"Data redu rinoratidza kuti kana zviropa zvakakwana zvinogona kuchengetedzwa, proton therapy yakachengeteka zvakakwana uye njodzi yeRILD inogona kuderedzwa," Dr. Hsieh vakadaro. “Zvakafanana nekubviswa chiropa, chinochengeta chiropa chakakwana Huwandu hwechiropa hunogona kubviswa zvakachengeteka nenyama. “
Kukosha kwesarudzo yevarwere uye kurapwa kwakasarudzika
Laura Dawson, MD, purezidhendi-akasarudzwa weASTRO, akataura kuti kujekesa zvinhu zvekufungidzira zvine chekuita nenjodzi yakakura yekukuvara kwechiropa kunogona kubatsira radiation oncologists kuyera zvakanakira uye njodzi dzekurapa nekuvandudza nzira dzakasiyana dzekurapa.
Both studies have emphasized the need for individualized radiotherapy for liver cancer,” Dr. Dawson said. “Although there are currently suitable patient types for proton therapy, there is still insufficient clinical evidence to treat proton therapy as the liver prior to photon radiotherapy. The preferred treatment for cell cancer. We still need randomized trials (such as NRG-GI003) to guide clinical practice and make it clearer which patients can benefit from proton therapy. “
Dr. Sanford vakati: “Parizvino, kurapwa kweproton kuchiri kurapwa kunodhura uye kune mashoma zviwanikwa. Naizvozvo, tinofanirwa kuramba tichiita tsvagiridzo kuti tigadzirise kusarudzwa kweproton therapy varwere zvichibva pamakiriniki kana bundu biomarkers. "
