국립암센터 / 김태현*, 박중원, 김보현
Background: Proton beam has an excellent depth dose distribution due to its unique physical properties, and thus proton beam therapy (PBT) has been tried and showed promising outcomes in hepatocellular carcinoma (HCC). The purpose of this phase II study is to evaluate the efficacy of hypofractionated PBT in HCC. Methods: The eligibility criteria for this study were as follows: patients with HCC lesion(s) who were failed after, were difficult to treat with, or refused to other local treatments; tumor size and number of ≤7 and ≤2 cm, respectively, and HCC lesion(s) of ≥2 cm from gastrointestinal organs; Child-Pugh score of ≤7; Eastern Cooperative Oncology Group performance status ≤1; and age ≥18 years. The prescribed dose of PBT was 70 Gy equivalent in 10 fractions. The primary endpoint was 3-year local progression-free survival (LPFS) rate. Results: Forty-five patients were prospectively enrolled, and there were 35 men and 10 women with a median age of 63 years (range, 46-78 years). Thirty-seven patients had recurrent and/or residual disease, and eight patients had treatment-naive disease. All patients received the planned treatments without treatment interruption, and grade ≥3 acute toxicity did not occur. The median follow-up duration was 35.1 months (range, 11.2-56.3 months) and local progression occurred in two patients (8.7%). The 3-year rates of LPFS and overall survival (OS) were 95.2% (95% confidence interval [CI], 89.1%-100%) and 86.4% (95% CI, 72.9-99.9%), respectively. Conclusion: Hypofractionated PBT showed promising LPFS and OS, and further studies are warranted to compare PBT with other local modalities.
그림1.양성자치료 이후 종양 반응 (A) 양성자차료 이전 CT영상 소견 (종양, 화살표). (B) 양성자치료 전산화 계획 (C,D) 양성자치료후 4개월 후 CT 영상사진, 종양이 부분관해 보임 (종양, 화살표). (E) 양성자치료 이후 14개월 후 CT영상에서 종양이 완전관해 보임(종양부위, 화살표). (F) 양성자치료 이후 완전관해율（중앙값, 5.1개월 (95% Confidence interval[CI], 4.3 – 6.3개월)(범위, 1 – 19.6개월)
그림2.양성자치료를 받은 전체 대상환자에서 국소무진행생존율 (A), 무진행생존율 (B), 전체생존율 그래프. 3년 국소무진행생존율은 95.2% (95% CI, 89.1-100%), 3년 무진행생존율은 45.2% (95% CI, 39.9% - 60.5%), 3년 전체생존율은 86.4% (95% CI, 72.9- 99.9%).
Tae Hyun Kim 1 2 , Joong-Won Park 1 , Bo Hyun Kim 1 , Eun Sang Oh 2 , Sang Hee Youn 2 , Sung Ho Moon 2 , Sang Soo Kim 2 , Sang Myung Woo 1 , Young-Hwan Koh 1 , Woo Jin Lee 1 , Dae Yong Kim 2
1 Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang, South Korea.
2 Center for Proton Therapy, Research Institute and Hospital, National Cancer Center, Goyang, South Korea.