방사선의학 웹진

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Abstract
Purpose: To assess the effectiveness of carbon-ion radiation therapy (CIRT) versus that of photon radiation therapy (RT) in patients with isolated paraortic lymph node metastasis from colorectal cancer postcurative surgery.

Methods and materials: A retrospective analysis was conducted on 116 patients, including 53 treated with CIRT and 63 with photon RT. The primary endpoint was local control (LC), with progression-free survival (PFS) and overall survival (OS) as secondary endpoints. Kaplan-Meier and Cox regression analyses were used to evaluate outcomes. A propensity score matching analysis was also performed to adjust for baseline imbalances.

Results: At a median follow-up of 54.8 months for surviving patients, CIRT was associated with higher 2-year LC than photon RT (78.9% vs 68.1%, P = .028). Cox regression analysis identified CIRT (hazard ratio, 2.152; 95% confidence interval, 1.082-4.279) and a smaller gross tumor volume at RT as significant independent predictors of improved LC. The difference in LC remained significant after propensity score matching (2-year 78.9% vs 63.3%, P = .036). No significant differences in PFS or OS were observed between the groups. Grade 2 or higher acute gastrointestinal toxicity occurred in 17.4% of the photon RT group but was absent in the CIRT group. Acute hematologic toxicity of grade 2 or higher occurred in 22.6% of the CIRT group and 17.5% of the photon RT group. Late toxicity, reported only in the photon RT group (11.1%), consisted of mild gastrointestinal symptoms.

Conclusions: CIRT demonstrated superior LC to photon RT in the treatment of isolated paraortic lymph node metastases, with a more favorable toxicity profile. Although no significant differences were observed in PFS or OS, careful patient selection and integration of systemic therapies may further optimize outcomes.

성향점수매칭을 이용하여 다른 변수의 영향을 최소화하고 중입자 치료와 광자 방사선 치료를 받은 환자들의 치료 방식에 따른 결과를 비교했을 때, 국소 조절에 있어서 중입자 치료가 통계적으로 유의미하게 우수함을 나타내는 사진.

Affiliations

Jason Joon Bock Lee 1, Tetsuro Isozaki 2, Seo Hee Choi 3, Hirotoshi Takiyama 2, Jeongshim Lee 4, Jee Suk Chang 3, Shigeru Yamada 5, Woong Sub Koom 6
1Department of Radiation Oncology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
2QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Japan.
3Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea.
4Department of Radiation Oncology, Inha University Hospital, Inha University School of Medicine, Incheon, Republic of Korea.
5QST Hospital, National Institutes for Quantum Science and Technology, Chiba, Japan. Electronic address: s_yamada@qst.go.jp.
6Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, Republic of Korea. Electronic address: mdgold@yuhs.ac.