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      저자 : ( Hideyuki Sakurai ) (검색결과 1 건)
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      • Selection of Particle Beam vs. Photon Beam Radiation Therapy for HCC: Japanese Experience

        ( Hideyuki Sakurai ),( M Iizumi ),( S Shimizu ),( H. Numajiri ),( M. Mizumoto ),( K. Nakai ),( T. Okumura ) 대한간학회 2020 춘·추계 학술대회 (KASL) Vol.2020 No.1

        Radiation therapy (RT) using conventional fractionation has not been thought to be curative enough for hepatocellular carcinoma (HCC) and it has not been performed as a high priority in comparison to other standard treatments, such as surgery, percutaneous ablation and transcatheter approach. Because the liver is high sensitive to radiation, especially for patients with liver cirrhosis, non-irradiated normal liver volume must be preserved as much as possible when curative radiation is given for HCC. Since many technological progress has been made in radiation oncology in recent years, RTs are used as an important curative treatment option for liver cancer. Stereotactic body radiotherapy (SBRT), which is included in Japanese national health insurance system, is a technique to accurately concentrate doses three-dimensionally on the target with short-term irradiation of 1-2 weeks. This technique can be used for relatively small tumors less than 5 cm with about 90% local control. Recently, Hara K. et al. reported survival result of SBRT comparing radiofrequency ablation using propensity score analysis, and they concluded that SBRT appears to be an acceptable alternative treatment option for patients who are not candidates for RFA. In addition, in Japan, muticenter prospective study of SBRT for untreated solitary primary HCC, so called STRSPH study, is ongoing. Eligible patients are untreated solitary, Child-Pugh score ≦7, Diameter: 1-5cm, UICC 7th. T1, T2, T3bN0M0, performance status score of 0-2, and 20-85 year-old. The primary endpoint / number of cases of this study are 3-year overall survival / 60 cases. Particle beam therapy (PBT: proton beam therapy, heavy ion beam therapy) has unique character of radiation dose distribution, which is called Bragg peak. PBT can accumulate more dose to the target with minimizing normal liver dose. Primary liver tumor is an important indication that has been specified to be of the highest priority by the American Society for Radiology and Oncology (ASTRO). In fact, most of the studies on PBT for HCC are published by Japan, and rather highly evaluated abroad. Eighteen proton facilities and 6 heavy ion facilities are working now in Japan. The local control rate was approximately 90% and the 5-year survival rate was reported to be approximately 50%. According to the results of our hospital, PBT can control 90% of a large tumor of 10 cm or more. Clinical studies of PBT report favorable therapeutic effects, even for not only large tumors but also tumors in elderly patient. In addition, PBT has been clearly shown to play an important role in the treatment of HCC-related portal vein tumor thrombosis (PVTT). When applied as a curative treatment for bulky tumors with portal vein embolism, median survival time of 27 months has been obtained in our study. The clinical study comparing proton vs surgery, which is non-randomized trial using propensity score, is ongoing in Japan (JCOG1315C). Japanese Society for Radiation Oncology (JASTRO) defined identical rule for indication and treatment method in PBT for HCC, and the all data should be registered in the data-base since 2016. We are facing an aging society, although there are indications of surgery and other local treatment, the number of patients who choose curative radiation therapy due to aging and co-existing disease is increasing. But, the history of radical RT for HCC is still short, and sufficient consensus has not been obtained regarding the criteria for its therapeutic indication. RT may become an option for curative local treatment of HCC, but no specific role for RT has been described in the Japanese treatment guidelines. In the future, it is important to proceed with research to clarify the indication of curative radiation therapy, keeping in mind the comparison with other therapies.

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