Ukwelashwa kwe-Proton ngomdlavuza wesibindi, ukusinda isikhathi eside kweziguli ezine-hepatocellular carcinoma proton therapy
I-Hepatocellular carcinoma iwuhlobo oluvame kakhulu lomdlavuza wesibindi, nokufa kwabantu abangaphezu kuka-700,000 emhlabeni wonke unyaka ngamunye, futhi izigameko ziyanda. Izindlela zokwelapha i-hepatocellular carcinoma zihlanganisa ukufakelwa kwesibindi, ukuhlinzwa kabusha, izinqubo zokuqothula kanye ne-radiotherapy (i-photon radiotherapy noma ukwelashwa kweproton). Phakathi kwabo, ukuhlinzekwa kuseyindlela yokwelashwa ekhethwayo, kepha imithombo yesibindi engasetshenziselwa ukufakelwa kabusha iyindlala futhi iziguli eziningi azikwazi ukwamukela ukukhishwa kabusha kokuhlinzwa ngenxa yesibindi sokuqina kwesibindi nezinye izizathu.
Ukwelashwa kweProton kunganweba ukusinda okuphelele kwesiguli
IMassachusetts General Hospital uNina Sanford, MD kanye neqembu baphindisela emuva ngemiphumela yokwelashwa kweziguli eziyi-133 ezinomdlavuza wesibindi ongasebenzi owathola i-photon radiotherapy yendabuko noma ukwelashwa kweproton eMassachusetts General Hospital phakathi kuka-2008 no-2017, lapho amacala angama-49 (37%)) Athola ukwelashwa kwe-proton. Lesi yisifundo sokuqala sokuqhathanisa ukwelashwa kweproton kanye ne-photon radiotherapy ye-hepatocellular carcinoma.
Isikhathi sokulandelwa kwesilinganiso sesifundo kwakuyizinyanga eziyi-14, umthamo we-irradiation wawuyi-45 Gy / 15 noma i-30 Gy / 5 ~ 6, kanti iminyaka ephakathi yeziguli yayiyiminyaka engama-68. Ucwaningo lukhombisile ukuthi ukusinda okuphelele kweziguli eziseqenjini lokwelashwa kwe-proton kungcono kunaleso seqembu le-photon radiotherapy, nezikhathi zokuphila eziphakathi kwezinyanga ezingama-31 nezinyanga eziyi-14, ngokulandelana, kanye nezinyanga ezingama-24 zokuphila jikelele ezingama-59.1% no-28.6% , ngokulandelana. Ngasikhathi sinye, ukwelashwa kwe-proton kunganciphisa izehlakalo zesifo sesibindi esenziwe ngemisebe engajwayelekile (RILD) uma kuqhathaniswa ne-photon radiotherapy. Ezigulini ezingama-21 ezine-RILD engajwayelekile, ezi-4 zithole ukwelashwa kwe-proton kwathi eziyi-17 zathola i-photon radiotherapy; nangemva kokwelashwa Isigameko se-RILD ezinyangeni ezi-3 sasihambisana nokusinda okuphelele. Amanani wokulawulwa kwendawo weqembu lokwelashwa kwe-proton neqembu le-photon radiotherapy kwakungu-93% no-90%, ngokulandelana, futhi kwakungekho mehluko omkhulu phakathi kwala maqembu womabili.
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 isisu, 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.”
Khomba ukubikezela kokulimala kwesibindi ngemuva kokwelapha i-proton
I-Radiotherapy ye-hepatocellular carcinoma isaphikisana ngoba umthamo omkhulu we-irradiation yamathumba ungadala ezinye izifo zesibindi (RILD). Isikhungo Somdlavuza i-MD Anderson kanye nesazi somdlavuza wemisebe uCheng-En Hsieh, MD waseChang Gung Memorial Hospital eTaiwan nethimba lakhe bakhombe ababikezeli beRILD ngemuva kokwelapha i-proton.
Ivolumu yesibindi esingahlosiwe / isilinganiso sevolumu yesibindi evamile (i-ULV / SLV) ye-histogram
Lolu cwaningo lwezikhungo eziningi lubandakanya iziguli eziyi-136 ezine-hepatocellular carcinoma ezingazange zithuthukele kwizicubu ze-intrahepatic ngemuva kokwelapha i-proton. Ukwelashwa kwe-proton kwahlukaniswa kwaba yi-2 GyE. Ukuhlaziywa kwe-Multivariate regression kukhombisile ukuthi umthamo we-isibindi esingahlosiwe / isilinganiso sevolumu ejwayelekile yesibindi (i-ULV / SLV), ivolumu ebhekiswe ku-tumor, kanye nokuhlukaniswa kwe-Child-Pugh kwakuyizibikezelo ezizimele ze-RILD, kanti isilinganiso sesilinganiso sesibindi kanye nomthamo wokulethwa kwezinhloso awuhlobene RILD Ucansi. Abaphenyi bakholelwa ukuthi inani le-ULV / SLV liyisibikezelo esibaluleke kunazo zonke ze-RILD; ukuvezwa kwe- ≥1 GyE kungadala izinkinga zesibindi. Ngakho-ke, ekuvikeleni nasekwelapheni izifo zesibindi, ivolumu yesibindi engahlosiwe ibaluleke kakhulu kunomthamo wesibindi omaphakathi.
"Imininingwane yethu ibonisa ukuthi uma izibindi ezanele zingavikelwa, ukwelashwa kwe-proton kuphephe ngokwanele futhi ingozi ye-RILD ingancishiswa," kusho uDkt. Hsieh. “Kufana nokukhishwa kwesibindi, esigcina isibindi esanele Umthamo omkhulu wesibindi ungasuswa ngokuphepha ngezicubu. “
Ukubaluleka kokukhethwa kweziguli kanye nokwelashwa okuhlukile
U-Laura Dawson, MD, umongameli okhethiwe we-ASTRO, uthe ukucacisa izinto ezibikezelayo ezihambisana nengozi enkulu yokulimala kwesibindi kungasiza ama-oncologists emisebe ukulinganisa izinzuzo nezingozi zokwelashwa futhi athuthukise namasu okwelashwa ahlukile.
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. “
UDkt. Sanford uthe: “Njengamanje, ukwelashwa kwama-proton kusalokhu kuyindlela yokwelapha ebiza kakhulu futhi kunezinsiza ezilinganiselwe. Ngakho-ke, sidinga ukuqhubeka nokwenza ucwaningo ukuze sithuthukise ukukhethwa kweziguli zokwelashwa kwe-proton ngokuya ngezici zokwelashwa noma ama-tumor biomarkers. ”
