proton therapy for hepatocellular carcinomalivercancer.or.kr/file/sympo/sympo_11_12.pdf ·...
TRANSCRIPT
Dae Yong Kim Tae Hyun KimNational Cancer Center
Proton Therapy for Hepatocellular Carcinoma
꿈의꿈의
방사선치료방사선치료
미래형미래형
방사선치료방사선치료
Proton Beam vs. X-ray
X-ray
Radiation Proton Beam Radiation
Electromagnetic wave Charged particle
Proton Beam vs. X-ray
Bragg peak
치료용
X선
Proton
조직내
깊이
(cm)
상
대
선
량
(%
)
Proton Beam vs. X-ray
Iiver
Proton Beam vs. X-ray
Iiver
bowel
Proton Beam vs. X-ray
•
1946 : Robert Wilson: 양성자로 환자치료 제안
•
1955 : Berkeley Radiation Lab에서 양성자 치료시작
•
1961 : MGH에서 양성자 치료시작
•
1983 : 일본 Tsukuba 대학병원에서 양성자 치료시작
•
1990 : LLUMC에서
환자전용
양성자
치료기
설치
•
1998 : 일본
암 센터 환자전용
양성자
치료기
설치
•
1999 : MGH 병원 환자전용 양성자 치료기 설치
•
2007 : 국립암센터 양성자치료 개시
Proton Beam Therapy, History
USA=6 Russia=3
Japan=6+2
Switzerland=1
Sweden=1
England=1
France=2 South Africa=1
Canada=1Germany=1+1
Italy=1
China=1
Total = 25 + 3White = Proton/Red = Particle
Proton Beam Therapy Facility, World wide (2006)
Proton Beam Therapy Facility, NCC
-빔
종류: 양성자
(수소이온)
-
빔 에너지: 230 MeV
(물
30 cm
투과)
-
빔
속도: 빛
속도의
약
60%,
178,700 km/초
-
자기장
강도: 2.3 Tesla
-
빔 전류: 1-300 nA
-
총 중량: 220 톤
-
빔 추출 반경: 1.02 m
NCC, Cyclotron
NCC, Gantry Treatment Room
NCC, Clinical Research with Proton Treatment
• Increase tumor control by dose-escalation
- Most solid tumors: H/N, Lung, Prostate,
Sarcoma, HCC, locally recurrent tumor
• Reduced treatment-related morbidity
- Pediatric tumors : medulloblastoma
Two Basic Aim of Proton Beam Therapy
Example of Proton Plan, NCC
Hepatocellular carcinoma
Example of Proton Plan, NCC
Hepatocellular carcinoma
Example of Proton Plan, NCC
Hepatocellular carcinoma
Pre-RT Post-RT 3 months
Example of Proton Plan, NCC
Hepatocellular carcinoma
Example of Proton Plan, NCC
Hepatocellular carcinoma
Author,Year
Patient s No
Child- Pugh score
Dose/FxScheme
Follow-up (median) Local Control Survival
Bush1,2004
34 A or B 63 GyE/15F All >6 mo 75% in-field35% recur out-field
OS2yr; 55%
Kawashima2, 2005
30 A; 67%B; 33%
50 GyE/10F~87.5GyE/30F
16~54 mo(31 mo)
97% in-field60% recur out-field
OS2yr; 66%
Chiba3, 2005 162 A; 50.6%B; 38.3%C; 6.2%
72 Gy/16F78 Gy/20F84 Gy/24F50 Gy/10F
3~133 mo(31.7 mo)
86.9% in-field85% recur in liver
OS5yr; 23.5%
Hata4, 2005
12 (All c PVT)A; 75%B; 25%
50~72 Gy/10~22F
0.3~7.3 yr(2.3 yr)
100% in-field83% recur out-field
PFS2yr; 67%5yr; 24%
Hata5,2006
19 C; 100% 50~84 Gy/10~24F
3~63 mo(17 mo)
94% in-field53% recur out-field
OS2yr; 42%
Hata6,2007
21 (All ≥80yr)A; 71%B; 24%C; 5%
60 Gy/10F66 Gy/22F70 Gy/35F
6~49 mo(16 mo)
100% in-field24% recur out-field
OS3yr; 62%
Clinical outcome of HCC treated by proton therpy
3D-CRT
Proton beam boost
Proton beam therapy
Example of Proton Plan, NCC
PAN recurrence
3D-CRT Proton beam therapy
Example of Proton Plan, NCC
Liver metastasis
3D-CRT Proton beam therapy
Example of Proton Plan, NCC
Lung metastasis
Thank you for your attention!