台灣碳離子治療胰臟癌的臨床結果

Clinical Outcomes of Carbon Ion Radiotherapy for Pancreatic Cancer in Taiwan

胰臟癌預後極差，局部晚期或不可切除病人治療選擇有限。碳離子放射治療（carbon ion radiotherapy, CIRT）因其優異的物理與生物特性，可能提供突破性療效。本研究為台灣首度報告碳離子放射治療（CIRT）治療胰臟癌的臨床成果，探討其安全性、療效及預後因子。回溯分析84位接受碳離子放射治療（CIRT）的胰臟癌病人，收案條件包括局部晚期、邊緣可切除或寡轉移個案。所有病人皆接受12次分次治療，處方劑量為60-66Gy相對生物效應（relative biological effective, RBE）。治療計畫依四維電腦斷層掃描（4-dimensional computed tomography, 4DCT）設計，搭配呼吸門控系統與筆尖束掃描技術。以Kaplan-Meier法分析整體存活率（overall survival, OS）、局部失敗無復發率（local failure free survival, LFFS）、遠端轉移無復發率（distant metastasis free survival, DMFS）與無疾病惡化存活率（progression free survival, PFS），並以Cox模型進行預後因子分析。並分析新輔助化療（neoadjuvant chemotherapy, NAC）時間與CA19-9變化對預後之影響。中位追蹤期為12.7個月，整體1年局部無失敗存活率（LFFS）為94.72%、整體存活率（OS）為75.26%。在M0病人中，1年整體存活率（OS）為85.27%，無惡化存活率（PFS）為50.55%，中位無疾病存活期（median PFS）為13.36個月。遠端轉移（metastatic, M1）病人之整體存活率（OS）、遠端轉移無病存活率（DMFS）、無惡化存活率（PFS）明顯較差，但局部無失敗存活率（LFFS）差異不顯著。新輔助化療時間超過9個月與較差之整體存活率（OS）、遠端轉移無病存活率（DMFS）、無惡化存活率（PFS）顯著相關。治療前CA19-9>120U/mL為不良遠端控制預後因子。整體毒性多為Grade1-2，Grade3以上者極少見。碳離子放射治療（CIRT）在胰臟癌病人中展現出優異的局部控制與良好短期存活率，且副作用輕微，顯示其在未來胰臟癌治療中具高度應用潛力。

Pancreatic cancer has a dismal prognosis, and treatment options for patients with locally advanced or unresectable disease remain limited. Carbon ion radiotherapy (CIRT), due to its superior physical and biological properties, may offer a breakthrough therapeutic approach. This study is the first to report clinical outcomes of CIRT for pancreatic cancer in Taiwan, evaluating its safety, efficacy, and prognostic factors. We retrospectively analyzed 84 pancreatic cancer patients who received CIRT, including those with locally advanced, borderline resectable, or oligometastatic disease. All patients underwent 12-fraction treatment with a prescribed dose of 60–66 Gy (RBE). Treatment planning was based on 4DCT, using respiratory gating system and pencil beam scanning technology. Kaplan-Meier analysis was used to evaluate overall survival (OS), local failure-free survival (LFFS), distant metastasis-free survival (DMFS), and progression-free survival (PFS), while Cox proportional hazards modeling identified prognostic factors. We further examined the impact of neoadjuvant chemotherapy (NAC) duration and CA19-9 dynamics on outcomes. With a median follow-up of 12.7 months, the 1-year LFFS and OS were 94.72% and 75.26%, respectively. Among M0 patients, the 1-year OS and PFS were 85.27% and 50.55%, respectively, with a median PFS of 13.36 months. Patients with M1 disease had significantly worse OS, DMFS, and PFS, though LFFS was not significantly different. NAC duration >9 months was associated with significantly worse OS, DMFS, and PFS. A pre-treatment CA19-9 level >120 U/mL predicted poorer distant control. Most toxicities were Grade 1–2, with Grade≥3 events being rare. CIRT demonstrated excellent local control, favorable short-term survival, and minimal toxicity in pancreatic cancer patients, highlighting its high potential for future therapeutic applications.