Terapi proton for liver cancer, prolonged overall survival of patients with hepatocellular carcinoma proton therapy
Hepatocellular carcinoma is the most common type of liver cancer, with more than 700,000 deaths worldwide each year, and the incidence is increasing. Treatment methods for hepatocellular carcinoma include liver transplantation, surgical resection, ablative procedures and radiotherapy (photon radiotherapy or terapi proton). Diantarana, bedah masih mangrupikeun pangobatan anu dipikaresep, tapi sumber ati anu tiasa dianggo pikeun transplantasi jarang sareng seueur pasién anu henteu tiasa nampi reseksi bedah kusabab sirosis ati sareng alesan anu sanés.
Terapi proton tiasa manjangkeun salamet sacara sabar sacara umum
Rumah Sakit Umum Massachusetts Nina Sanford, MD sareng tim retrospectively ngabandingkeun épék terapi tina 133 penderita kanker haté anu teu tiasa dioperasikeun anu ngalaman radioterapi foton tradisional atanapi terapi proton di Rumah Sakit Umum Massachusetts antara taun 2008 sareng 2017, diantarana 49 kasus (37%)) Nampi terapi proton. Ieu mangrupikeun studi banding munggaran pikeun terapi proton jeung radioterapi foton pikeun carcinoma hépatocellular.
Periode susulan median pangajian nyaéta 14 bulan, dosis iradiasi nyaéta 45 Gy / 15 atanapi 30 Gy / 5 ~ 6, sareng umur médién pasien nyaéta 68 taun. Panilitian parantos nunjukkeun yén salamet sadaya pasien dina grup terapi proton langkung saé tibatan gugus radioterapi foton, kalayan waktos salamet rata-rata 31 bulan sareng 14 bulan masing-masing, sareng tingkat salamet 24-bulan sacara umum 59.1% sareng 28.6% , masing-masing. Dina waktos anu sasarengan, terapi proton tiasa ngirangan kajadian panyakit ati anu diinduksi tina radiasi non-klasik (RILD) dibandingkeun sareng radioterapi foton. Tina 21 pasién sareng RILD non-klasik, 4 nampi terapi proton sareng 17 nampi radioterapi foton; sareng saatos perlakuan Kajadian RILD dina 3 bulan aya hubunganana sareng salamet sacara umum. Tingkat kontrol lokal tina grup terapi proton sareng grup radioterapi foton masing-masing 93% sareng 90%, sareng teu aya bédana anu signifikan antara dua kelompok.
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 tumor, 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.”
Identipikasi prediktor tatu ati saatos terapi proton
Radioterapi pikeun karsinoma hepatosélular masih kontropérsial sabab penyinaran dosis tinggi tumor tiasa nyababkeun panyakit ati sanés (RILD). Pusat Kanker MD Anderson sareng ahli onkologi radiasi Cheng-En Hsieh, MD ti Rumah Sakit Peringatan Chang Gung di Taiwan sareng timnya ngaidéntifikasi prediktor RILD saatos terapi proton.
Volume-target ati ati-standar / standar volume volume ratio (ULV / SLV) histogram-efek histogram
Panilitian multi-pusat ieu kalebet 136 pasién sareng karsinoma hepatokellular anu henteu maju kana tumor intrahepatic saatos terapi proton. Terapi proton dibagi kana 2 GyE. Analisis régrési multivariat nunjukkeun yén volume ati sanés / rasio volume ati standar (ULV / SLV), volume target tumor, sareng klasifikasi Child-Pugh mangrupikeun prediktor bebas RILD, sareng dosis rata ati sareng dosis pangiriman target henteu aya hubunganana sareng Kelamin RILD. Panaliti yakin yén nilai ULV / SLV mangrupikeun prediktor anu paling penting pikeun RILD; paparan ≥1 GyE tiasa nyababkeun komplikasi ati. Ku alatan éta, pikeun pencegahan sareng pangobatan panyakit ati, volume ati anu henteu udagan langkung penting tibatan rata-rata dosis ati.
“Our data shows that if enough livers can be protected, proton therapy is safe enough and the risk of RILD can be minimized,” Dr. Hsieh said. “It’s like a liver resection, which retains enough liver The large volume of liver can be safely removed with tissue. “
Pentingna Pilihan sabar sareng perlakuan individual
Laura Dawson, MD, ASTRO's president-elect, nyatakeun yén netelakeun faktor prediktik anu aya hubunganana sareng résiko anu parah tina cilaka ati tiasa ngabantosan ahli onkologi radiasi nyaimbangkeun manpaat sareng résiko pangobatan sareng ngembangkeun stratégi perlakuan individual.
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. “
Sanford nyarios: "Ayeuna, terapi proton masih mangrupikeun pangobatan anu mahal sareng ngagaduhan sumber anu terbatas. Kituna, urang kedah ngalaksanakeun langkung seueur panilitian pikeun ngaoptimalkeun pilihan pasién terapi proton dumasar kana faktor klinis atanapi tumor biomarker. "
