글로벌 연구동향
방사선종양학
- 2017년 03월호
[Radiother Oncol. ] Risk-adapted simultaneous integrated boost-proton beam therapy (SIB-PBT) for advanced hepatocellular carcinoma with tumour vascular thrombosis.국립암센터 / 김대용, 박중원, 김태현*
- 출처
- Radiother Oncol.
- 등재일
- 2017 Jan
- 저널이슈번호
- 122(1):122-129. doi: 10.1016/j.radonc.2016.12.014. Epub 2016 Dec 26.
- 내용
Abstract
PURPOSE:
To evaluate clinical effectiveness and safety of simultaneous integrated boost-proton beam therapy (SIB-PBT) in hepatocellular carcinoma (HCC) patients with tumour vascular thrombosis (TVT).
MATERIAL AND METHODS:
Forty-one HCC patients with TVT underwent SIB-PBT using three dose-fractionation schemes: if gross tumour volume <1cm (n=27), 1-1.9cm (n=7), and ⩾2cm (n=7) from gastrointestinal structures, 50GyE (EQD2, 62.5GyE10), 60Gy (EQD2, 80GyE10), 66Gy (EQD2, 91.3GyE10), respectively, in 10 fractions was prescribed to planning target volume 1 (PTV1), and 30GyE (EQD2, 32.5GyE10) in 10 fractions was prescribed to PTV2.
RESULTS:
Overall, treatment was well tolerated, with no grade toxicity ⩾3. Median overall survival (OS) was 34.4months and 2-year local progression-free survival (LPFS), relapse free survival (RFS), and OS rates were 88.1%, 25%, and 51.1%, respectively. Patients treated with EQD2 of ⩾80GyE10 tended to show better TVT response (92.8% vs. 55.5%, p=0.002) 2-year LPFS (92.9% vs. 82.5%, p=0.463), RFS (28.8% vs. 19%, p=0.545), and OS (58.4% vs. 46.8%, p=0.428) rates than those with EQD2 of <80GyE10. Multivariate analysis showed that TVT response and Child Pugh classification were independent prognostic factors for OS.
CONCLUSIONS:
SIB-PBT is feasible and promising for HCC patients with TVT.
Fig. 1.Definition of target volumes according to the closeness of gastrointestinal structures: (A) in the patients with gross tumour volume (GTV) <1 cm from gastrointestinal (GI) structures; (B) in the patients with GTV within 1–1.9 cm from GI structures; and (C) in the patients with GTV ⩾2 cm from GI structures, and partial response of a primary tumour and tumour vascular thrombosis (TVT) to simultaneous integrated boost-proton beam therapy (SIB-PBT). D, E, and F: Pretreatment CT scans showing the primary tumour and TVT (arrow). G, H, and I: The patient underwent SIB-PBT (50 GyE/10Fx to PTV1 and 30 GyE/10Fx to PTV2, respectively; 60 GyE/10Fx to PTV1 and 30 GyE/10Fx to PTV1; and 66 GyE/10Fx to PTV1, respectively). J, K, and L: CT scans 3 months after SIB-PBT. Note shrinkage of both the primary tumour and TVT (arrow). Abbreviations: ITV, internal target volume; and PTV, planning target volume.
Author information
Kim DY1, Park JW1, Kim TH2, Kim BH1, Moon SH1, Kim SS1, Woo SM1, Koh YH1, Lee WJ1, Kim CM1.
1 Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea.2 Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea. Electronic address: k2onco@naver.com.
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