Hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) has a poor prognosis and is generally not indicated for surgery. Proton beam therapy (PBT) may offer an alternative treatment. In this study, long-term outcomes were examined in 116 patients (median age 66 years, 100 males) with HCC with advanced PVTT (Vp3 or Vp4) who received PBT from April 2008 to March 2018. Of these patients, 63 received PBT as definitive treatment and 53 as palliative treatment. The representative dose was 72.6 Gy (RBE) in 22 fractions. Eight patients died in follow-up, including 72 due to tumor progression. The 5-year overall survival (OS) rate was 18.0% (95% CI 9.8–26.2%) and the 5-year local control (LC) rate was 86.1% (74.9–97.3%). In multivariate analyses, performance status and treatment strategy were significantly associated with OS. The median follow-up period for survivors with definitive treatment was 33.5 (2–129) months, and the 5-year OS rate was 25.1% (12.9–37.3%) in these cases. The median survival time after definitive irradiation was >20 months. The 5-year OS rate was 9.1% (0–19.7%) for palliative irradiation. These results compare favorably with those of other therapies and suggest that PBT is a useful option for cases of HCC with advanced PVTT that cannot undergo surgery, with an expected survival benefit and good local control. Determining the optimal indication for this treatment is a future challenge.
肝细胞癌合并门静脉癌栓预后较差，通常不适宜手术治疗。质子束治疗可能提供替代治疗方案。本研究回顾性分析了2008年4月至2018年3月期间接受质子束治疗的116例晚期门静脉癌栓（Vp3或Vp4型）肝细胞癌患者（中位年龄66岁，男性100例）的长期疗效。其中63例接受根治性质子束治疗，53例接受姑息性治疗。标准照射方案为22次分割给予72.6 Gy（相对生物效应值）。随访期间108例患者死亡，其中72例死于肿瘤进展。5年总生存率为18.0%（95% CI 9.8–26.2%），5年局部控制率达86.1%（74.9–97.3%）。多因素分析显示体能状态和治疗策略与总生存率显著相关。根治治疗组存活患者中位随访时间为33.5（2–129）个月，该组5年总生存率为25.1%（12.9–37.3%）。根治性放疗后中位生存时间超过20个月，而姑息治疗组5年总生存率为9.1%（0–19.7%）。与其他治疗方案相比，本研究结果显示出质子束治疗对无法手术的晚期门静脉癌栓肝细胞癌具有临床应用价值，能提供预期生存获益和良好局部控制。未来需进一步明确该治疗的最佳适应症选择标准。
肿瘤(癌症)患者之家