肝癌之質子治療

Proton Therapy in Hepatocellular Carcinoma

傳統光子治療因劑量分佈不均，常難以避免傷害正常肝臟及鄰近器官，對晚期、多顆或大體積肝癌副作用明顯，常僅作後線或姑息性治療。質子治療利用布拉格峰效應，能將高劑量精準聚焦於腫瘤，降低正常組織放射線傷害，從而提高局部控制率、延長存活並減少副作用。臨床上，質子治療適用於早期肝癌、肝臟移植橋接治療、嚴重肝癌及血管侵犯的治療，也可作為降期治療，使部分病人質子後獲得手術或肝臟移植的機會。新技術如呼吸調控、多葉準直儀、強度調控質子治療（intensity modulated proton therapy, IMPT）及錐狀射束電腦斷層掃描（cone beam computed tomography, CBCT）適應性計畫，進一步提升了治療精準度與安全性。長庚質子中心的經驗顯示，此治療為肝癌病人提供了一個安全有效的新選擇。

Photon therapy, due to its uneven dose distribution, often results in damage to normal liver tissue and adjacent organs. This is especially problematic for advanced, multiple, or large liver cancers, where significant side effects limit photon therapy to later-line or palliative treatments. In contrast, proton therapy utilizes the Bragg peak effect to precisely focus high doses on the tumor while sparing healthy tissue. This allows for dose escalation within safe limits, thereby improving local control, prolonging survival, and reducing side effects. Clinically, proton therapy is applicable to early hepatoma, bridging treatment before liver transplantation, and the management of severe hepatoma with vascular invasion. It can also be used as a downstaging strategy, enabling some patients to eventually qualify for surgery or liver transplantation. Furthermore, new technologies such as respiratory gating, multileaf collimators, intensity-modulated proton therapy (IMPT), and Cone-beam computed tomogeaphy (CBCT) adaptive planning have further enhanced treatment precision and safety. Experience at the Chang Gung Proton Center demonstrates that this approach offers a safe and effective new option for hepatoma patients.