がん治療の中における放射線治療の確立に向けて

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Advanced hepatocellular carcinoma treated effectively with irinotecan via hepatic arterial infusion followed by proton beam therapy

金沢大学医学部附属病院がん高度先進治療センターWe report a 48-year-old man with hepatocellular carcinoma (HCC) treated with hepatic arterial infusion (HAI) chemotherapy followed by proton beam therapy. The HCC lesion in this patient was 88 mm in diameter, with portal vein tumor thrombosis in the right lobe of the liver. He was first treated with 5-fluorouracil, cisplatin, and isovorin, administered by HAI, combined with interferon-α, and he was subsequently treated with epirubicin and mitomycin-C administered by HAI. However, no definite efficacy of either of these treatments was observed. Then, after 3 weeks\u27 continuous administration of irinotecan by HAI, the tumor size decreased to 68 mm in diameter. However, 3 months after reduction of the tumor, the tumor had become enlarged to 100 mm in diameter and intrahepatic metastases were prominent. Angiographic findings indicated that the HCC was fed not only from the right hepatic artery but also from the left gastric and right and left subphrenic arteries. After rearrangement of the arteries, and 3 months\u27 continuous HAI chemotherapy with irinotecan, plus hyperthermia, the tumor size had decreased to 50 mm in diameter. The reduction rate of the main tumor according to the Response Evaluation Criteria in Solid Tumors was 43%; therefore, the efficacy of this treatment was judged as a partial response. Two months after reduction of the tumor, the patient\u27s serum alpha-fetoprotein (AFP) level was elevated, and so docetaxel was administered by HAI instead of irinotecan. The liver tumors showed gradual enlargement during the administration of docetaxel, although the AFP level was suppressed. Proton beam therapy was instituted and the liver tumors showed necrosis after this therapy. The patient died of hepatic failure and distant metastases 6 years after the onset of HCC. As far as we know, this is the first case report of HCC treated effectively with irinotecan administered by HAI followed by proton beam therapy in which tumor suppression and the long-term survival of the patient were observed. © 2009 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases

Proton Beam Therapy for Large Hepatocellular Carcinoma

PurposeTo investigate the safety and efficacy of proton beam therapy (PBT) in patients with large hepatocellular carcinoma (HCC).Methods and MaterialsTwenty-two patients with HCC larger than 10 cm were treated with proton beam therapy at our institution between 1985 and 2006. Twenty-one of the 22 patients were not surgical candidates because of advanced HCC, intercurrent disease, or old age. Median tumor size was 11 cm (range, 10–14cm), and median clinical target volume was 567 cm3 (range, 335–1,398 cm3). Hepatocellular carcinoma was solitary in 18 patients and multifocal in 4 patients. Tumor types were nodular and diffuse in 18 and 4 patients, respectively. Portal vein tumor thrombosis was present in 11 patients. Median total dose delivered was 72.6 GyE in 22 fractions (range, 47.3–89.1 GyE in 10–35 fractions).ResultsThe median follow-up period was 13.4 months (range, 1.5–85 months). Tumor control rate at 2 years was 87%. One-year overall and progression-free survival rates were 64% and 62%, respectively. Two-year overall and progression-free survival rates were 36% and 24%, respectively. The predominant tumor progression pattern was new hepatic tumor development outside the irradiated field. No late treatment-related toxicity of Grade 3 or higher was observed.ConclusionsThe Bragg peak properties of PBT allow for improved conformality of the treatment field. As such, large tumor volumes can be irradiated to high doses without significant dose exposure to surrounding normal tissue. Proton beam therapy therefore represents a promising modality for the treatment of large-volume HCC. Our study shows that PBT is an effective and safe method for the treatment of patients with large HCC

Cell Cycle Checkpoint and Apoptosis Induction in Glioblastoma Cells and Fibroblasts Irradiated with Carbon Beam

This study was conducted in order to evaluate the cytotoxicity of high linear-energy-transfer (LET) ionizing radiation (IR) on glioblastoma cells and fibroblasts using different modes of cell inactivation assays. Two human glioblastoma cell lines with or without p53-mutation, and fibroblasts were used as materials. Gamma rays and 290 MeV/u carbon beams with LET values of 20, 40, 80 keV/mum were used. To evaluate cell inactivation, we used colony formation assay, morphological detection of apoptosis, and flow-cytometry. Serial expressions of p53 and p21 were analyzed by immunoblotting. High-LET IR reduced the reproductive potency of these cells to identical levels in spite of differences in gamma-sensitivity, and yield of cell death correlated to LET values. A p53-wild-type glioblastoma cell line demonstrated a higher yield of apoptosis than other cell lines, whereas fibroblasts hardly displayed any cell death indicating senescence-like growth arrest even after high LET IR. A p53-mutant tumor cell line demonstrated very low yield of cell death with prominent G2/M arrest. Results of radiosensitivity differ according to what mode of cell inactivation is selected. While fibroblasts depend on G1 block after IR, G2/M blocks may play crucial roles in the radioresistance of p53-mutant glioblastoma cells