Background. Studies comparing the dose distributions of carbon ion radiotherapy (C-ion RT) and intensity-modulated radiotherapy (IMRT) in patients with locally advanced hepatocellular carcinoma (LAHCC) are lacking. This study aimed to investigate the dose distributions of these modalities and identify any advantages to using C-ion RT.
Methods. Patients with LAHCC who had undergone C-ion RT between June 2010 and November 2018 were retrospectively analyzed. From among 210 patients with hepatocellular carcinoma who received C-ion RT, 10 consecutive patients with LAHCC were included. The dose-volume histogram parameters of clinical plans using C-ion RT at 60 Gy (relative biological effectiveness [RBE]) and simulated plans using IMRT at 60 Gy and 50 Gy were compared. We evaluated the three plans in terms of the following parameters: the percentage of the minimum dose that covered 95% of the target volume (D95); mean liver dose (MLD); and percentage of the normal liver volume that received at least 5 Gy (V5), 10 Gy (V10), 20 Gy (V20), 30 Gy (V30), 40 Gy, and 50 Gy. Patients at high risk of developing radiation-induced liver disease (RILD) were those with MLD and V30 of >23 Gy and >28%, respectively.
Results. The V5, V10, V20, and MLD were significantly lower in patients who received 60 Gy (RBE) of C-ion RT than in those who received 60 Gy of IMRT, although the D95 values were not significantly different. The V5, V10, and V20 were also significantly lower in patients who received 60 Gy (RBE) of C-ion RT than in those who received 50 Gy of IMRT; moreover the D95 was significantly superior in the former group. The numbers of high-risk patients who developed RILD when administered 60 Gy (RBE) of C-ion RT, 60 Gy of IMRT, and 50 Gy of IMRT were 1, 7, and 6, respectively.
Conclusions. C-ion RT exhibits a better dose distribution to the liver than does IMRT when treating patients with LAHCC. C-ion RT made it possible to treat patients with LAHCC who otherwise could not be treated using IMRT because of the high risk of RILD.
Systemic chemotherapy has significantly improved in recent years. In this study. the clinical impact of carbon-ion radiotherapy (CIRT) with concurrent chemotherapy for locally advanced unresectable pancreatic cancer (URPC) was evaluated. Methods: Patients with URPC who were treated with CIRT between January 2016 and December 2020 were prospectively registered and analyzed. The major criteria for registration were (1) diagnosed as URPC on imaging; (2) pathologically diagnosed adenocarcinoma; (3) no distant metastasis; (4) Eastern Cooperative Oncology Group performance status of 0–2; (5) tumors without gastrointestinal tract invasion; and (6) available for concurrent chemotherapy. Patients who received neoadjuvant chemotherapy (NAC) for more than one year prior to CIRT were excluded. Results: Forty-four patients met the inclusion criteria, and thirty-seven received NAC before CIRT. The median follow-up period of living patients was 26.0 (6.0–68.6) months after CIRT. The estimated two-year overall survival, local control, and progression-free survival rates after CIRT were 56.6%, 76.1%, and 29.0%, respectively. The median survival time of all patients was 29.6 months after CIRT and 34.5 months after the initial NAC. Conclusion: CIRT showed survival benefits for URPC even in the multiagent chemotherapy era.
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