肝癌質子治療新進展

New Advances in Proton Therapy for Hepatocellular Carcinoma

黃炳勝(Bing-Shen Huang) ； 賴家玄(Chia-Hsuan Lai) ； 鄭任祐(Jen-Yu Cheng) ； 劉介民(Chieh-Min Liu)

《內科學誌》 36卷1期 (2025/02) Pp. 15-20

https://doi.org/10.6314/JIMT.202502_36(1).03

摘要

肝癌質子治療的進展顯示出放射治療在肝癌治療中的重要性。過去由於放療技術的限制，醫師對肝臟腫瘤的放射治療充滿疑慮。隨著強度調控放射治療和立體定位放射治療等技術的發展，放射治療在早期肝癌、肝臟移植前的橋接治療及晚期肝癌等不同情況中扮演了重要的角色。質子治療因其獨特的「布拉格峰」特性，能在特定深度釋放能量，最大程度保護正常肝臟組織，尤其在大型或無法手術的肝癌患者中顯示出良好的局部控制率和存活率，因此成為肝癌治療的重要治療選擇。此外，新技術如呼吸調控、多葉準質儀、強度調控質子和錐狀射束電腦斷層掃描等，進一步提高了治療的精確性和正常肝臟組織的保護。展望未來，質子治療與藥物治療的結合有望提升療效，為更多肝癌患者帶來治療希望。

關鍵字

質子（Proton beam therapy） ； 布拉格峰（Bragg peak） ； 巨大肝癌（Giant hepatoma） ； 降期治療（downstaging conversion therapy）

並列摘要

The progress of proton therapy for hepatocellular carcinoma(HCC) highlights the importance of radiotherapy in the treatment of HCC. In the past, physicians had reservations about radiotherapy for HCC due to limitations in radiotherapy techniques. However, with the development of technologies such as intensity-modulated radiotherapy and stereotactic radiotherapy, radiotherapy has played a crucial role in various scenarios, including early-stage HCC, bridging treatment before liver transplantation, and advanced HCC. Proton therapy, with its unique "Bragg peak" characteristic, releases energy at specific depths, maximizing the protection of normal liver tissue. It has shown good local control rates and survival rates, particularly in patients with huge or inoperable liver tumors, making it an important treatment option for HCC. Additionally, new technologies such as respiratory gating, multi-leaf collimators, intensity-modulated proton therapy, and cone-beam computed tomography have further enhanced the precision of treatment and the protection of normal liver tissue. Looking ahead, the combination of proton therapy with systemic therapies is expected to improve therapeutic efficacy, bringing hope for treatment to more HCC patients.