■尽管质子束治疗(PBT)在全球范围内受到限制,随着新设施的扩展,其用于治疗肝细胞癌(HCC)的用途逐渐增加。因此,我们进行了系统评价和荟萃分析,以调查PBT治疗HCC的最新证据.
■MEDLINE,EMBASE,科克伦图书馆,和WebofScience数据库进行了系统搜索,以招募接受PBT治疗的肝局限性HCC患者,直至2024年2月。
■从2004年至2023年的22项研究中选择了1858名接受PBT的HCC患者进行这项荟萃分析。Child-PughA级的中位数比例为86%(范围:41-100%),中位肿瘤大小为3.6cm(范围:1.2-9cm)。中位总剂量范围为55GyE至76GyE(中位数,69GyE)。PBT后3年和5年局部无进展生存期的合并率为88%(95%置信区间[CI],85-91%)和86%(95%CI,82-90%),分别。合并的3年和5年总体比率分别为60%(95%CI,54-66%)和46%(95%CI,38-54%),分别。合并的3级肝毒性率,经典放射性肝病(RILD),非经典RILD为1%,2%,1%,分别。
■目前的研究支持PBT用于HCC,并证明与其他已发表的其他放射治疗方式的研究相比,有利的长期生存率和低肝毒性。然而,需要进一步的研究来确定将受益于PBT的亚组.
UNASSIGNED: Although access to proton beam therapy (PBT) is limited worldwide, its use for the treatment of hepatocellular carcinoma (HCC) is gradually increasing with the expansion of new facilities. Therefore, we conducted a systematic review and meta-analysis to investigate the updated evidence of PBT for HCC.
UNASSIGNED: The MEDLINE, EMBASE, Cochrane Library, and Web of Science databases were systematically searched for studies that enrolled patients with liver-confined HCC that were treated with PBT for a cure up to February 2024.
UNASSIGNED: A total of 1858 HCC patients receiving PBT from 22 studies between 2004 and 2023 were selected for this meta-analysis. The median proportion of Child-Pugh class A was 86% (range: 41-100%), and the median tumor size was 3.6 cm (range: 1.2-9 cm). The median total dose ranged from 55 GyE to 76 GyE (median, 69 GyE). The pooled rates of 3- and 5-year local progression-free survival after PBT were 88% (95% confidence interval [CI], 85-91%) and 86% (95% CI, 82-90%), respectively. The pooled 3- and 5-year overall rates were 60% (95% CI, 54-66%) and 46% (95% CI, 38-54%), respectively. The pooled rates of grade 3 hepatic toxicity, classic radiation-induced liver disease (RILD), and non-classic RILD were 1%, 2%, and 1%, respectively.
UNASSIGNED: The current study supports PBT for HCC and demonstrates favorable long-term survival and low hepatic toxicities compared with other published studies on other radiotherapy modalities. However, further studies are needed to identify the subgroups that will benefit from PBT.