Background: Proton beam therapy (PBT) provides excellent tumor control with minimal hepatic toxicity in patients with unresectable hepatocellular carcinoma (HCC), by minimizing radiation exposure to non-cancerous liver tissue. Progressive skeletal muscle loss, often seen in cirrhosis and HCC, can negatively impact treatment outcomes and survival. This study compared the efficacy and safety of PBT with transarterial chemoembolization (TACE) combined with radiofrequency ablation (RFA) in patients with unresectable HCC. Methods: A total of 91 patients (PBT/TACE+RFA,n= 41/50) ineligible for surgery or RFA alone were retrospectively analyzed, with propensity score matching applied to adjust for differences in baseline characteristics, resulting in matched groups of 33 patients each. The cross-sectional area of the psoas muscle at the third lumbar vertebra was assessed using computed tomography. Results: PBT resulted in longer overall survival (OS) and fewer hepatic and systemic adverse events compared to TACE+RFA, with no grade 3 or higher toxicities observed in the PBT group. Importantly, psoas muscle size remained stable after PBT, even in patients with tumors ≥ 3 cm, whereas TACE+RFA led to significant muscle loss regardless of tumor size, which was associated with poorer prognosis. These findings suggest that, for patients with unresectable HCC not adequately controlled by RFA alone, PBT may improve OS and help preserve muscle mass, while offering lower toxicity and more favorable clinical outcomes than TACE+RFA. Conclusions: Overall, PBT may represent an effective strategy for managing unresectable HCC.
背景：质子束治疗（PBT）通过最大限度地减少对非癌性肝组织的辐射暴露，为不可切除肝细胞癌（HCC）患者提供了优异的肿瘤控制效果，同时肝毒性最小。进行性骨骼肌流失常见于肝硬化和HCC患者，可能对治疗结果和生存产生负面影响。本研究比较了PBT与经动脉化疗栓塞（TACE）联合射频消融（RFA）在不可切除HCC患者中的疗效和安全性。方法：回顾性分析了91例不适合单独手术或RFA的患者（PBT/TACE+RFA，n=41/50），应用倾向评分匹配调整基线特征差异，最终获得各33例患者的匹配组。通过计算机断层扫描评估第三腰椎水平腰大肌的横截面积。结果：与TACE+RFA相比，PBT带来更长的总生存期（OS）和更少的肝脏及全身不良事件，且PBT组未观察到3级或以上毒性。重要的是，即使在肿瘤≥3 cm的患者中，PBT后腰大肌尺寸保持稳定，而TACE+RFA则导致显著的肌肉流失，且与肿瘤大小无关，这与较差的预后相关。这些发现表明，对于单独RFA无法充分控制的不可切除HCC患者，PBT可能改善OS并有助于维持肌肉质量，同时相比TACE+RFA具有更低的毒性和更有利的临床结果。结论：总体而言，PBT可能是治疗不可切除HCC的有效策略。
肿瘤(癌症)患者之家