A feasibility study of high-dose hypofractionated carbon ion radiation therapy using four fractions for localized hepatocellular carcinoma measuring 3 cm or larger

Shibuya, Kazuhiko; Ohno, Tatsuya; Katoh, Hiroyuki; Okamoto, Masahiko; Shiba, Shintaro; Koyama, Yoshinori; Kakizaki, Satoru; Shirabe, Ken; Nakano, Takashi

doi:10.1016/j.radonc.2018.10.009

Cited by 36 publications

(42 citation statements)

References 31 publications

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“…Notably, 5.7% had grade 3-4 toxicity with 1.7% developing radiation induced liver disease (67). Given the safety of the four fraction regimens, these were applied to 21 patients with HCC lesions >3 cm, with similar LC and toxicity rates (68). Further, treatment with 15 fractions in patients with cirrhosis did not increase the Child-Pugh score by more than 2 points (69).…”

Section: Hepatocellular Carcinoma (Hcc)mentioning

confidence: 99%

Carbon Ion Therapy: A Modern Review of an Emerging Technology

et al. 2020

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Radiation therapy is one of the most widely used therapies for malignancies. The therapeutic use of heavy ions, such as carbon, has gained significant interest due to advantageous physical and radiobiologic properties compared to photon based therapy. By taking advantage of these unique properties, carbon ion radiotherapy may allow dose escalation to tumors while reducing radiation dose to adjacent normal tissues. There are currently 13 centers treating with carbon ion radiotherapy, with many of these centers publishing promising safety and efficacy data from the first cohorts of patients treated. To date, carbon ion radiotherapy has been studied for almost every type of malignancy, including intracranial malignancies, head and neck malignancies, primary and metastatic lung cancers, tumors of the gastrointestinal tract, prostate and genitourinary cancers, sarcomas, cutaneous malignancies, breast cancer, gynecologic malignancies, and pediatric cancers. Additionally, carbon ion radiotherapy has been studied extensively in the setting of recurrent disease. We aim to provide a comprehensive review of the studies of each of these disease sites, with a focus on the current trials using carbon ion radiotherapy.

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Section: Hepatocellular Carcinoma (Hcc)mentioning

confidence: 99%

Carbon Ion Therapy: A Modern Review of an Emerging Technology

et al. 2020

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“…The internal target volume (ITV) was de ned as the summation of CTV from four-dimensional CT images. The planning target volume (PTV) was de ned as the summation of CTV, ITV, and included margin of uncertainties in patient setup [8].…”

Section: Carbon Ion Radiotherapymentioning

confidence: 99%

“…The planning aim was to cover the PTV with at least 95% of the prescribed dose. Dose constraints were D 1cc < 40 Gy (RBE) administered to the gastrointestinal tract, V 20 < 35% administered to the liver, and D max < 52.8 Gy (RBE) administered outside of the PTV at the porta hepatis (including the rst branch of the portal vein and hepatic duct) [8]. Figure 1 shows a representative case of the dose distribution and diagnostic imaging in LAHCC before C-ion RT.…”

Section: Carbon Ion Radiotherapymentioning

confidence: 99%

Clinical Impact of Hypofractionated Carbon Ion Radiotherapy on Locally Advanced Hepatocellular Carcinoma

Shiba

Shibuya

Okamoto

et al. 2020

Preprint

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Background: Hepatocellular carcinoma (HCC) involving a major branch of the portal or hepatic vein is in a locally advanced stage and remains difficult to cure. This study aimed to evaluate the clinical effects of carbon ion radiotherapy (C-ion RT) in locally advanced HCC (LAHCC). Methods: The data of 11 consecutive patients with LAHCC who received C-ion RT were analyzed. The C-ion RT doses of 52.8 Gy (relative biological effectiveness [RBE]) and 60.0 Gy (RBE) were delivered in 4 fractions for standard cases, and the 60.0 Gy dose was delivered in 12 fractions for close-to-gastrointestinal-tract cases. Survival and local control probabilities were calculated using the Kaplan-Meier method. Results: The median follow-up duration after C-ion RT was 36.4 months. The median age at the time of registration for C-ion RT was 76 years. The median tumor size was 53 mm. The numbers of treatment-naive and recurrent HCC patients were 1 and 10, respectively. Direct invasion of the major branch of the portal vein, hepatic vein, or both portal and hepatic veins was observed in three, five, and three patients, respectively. The 3-year overall survival, local control, and progression-free survival rates were 64%, 78%, and 18%, respectively. No patient developed radiation-induced liver diseases or grade 3 or higher toxicities in the acute and late phases. Conclusions: C-ion RT showed favorable clinical outcomes with a high rate of local control and minimal toxicities in LAHCC. Our findings suggest that C-ion RT is a promising multidisciplinary treatment option in LAHCC.

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“…C-ion RT plans used two or three coplanar ports to avoid the gastrointestinal (GI) tract. The maximum dose to 1 mL (D 1cc ) was <40 Gy (RBE) administered to the GI tract [8]. Figure 1 shows the typical dose distribution of C-ion RT; all treatment plans were made by medical physicists.…”

Section: C-ion Rtmentioning

confidence: 99%

“…Particle therapy has since improved radiation dose distributions further still [5,6]. In particular, carbon ion RT (C-ion RT) has produced favorable clinical outcomes for patients with HCC [7][8][9][10][11], as this modality reduces the dose to the liver while ensuring good target coverage [12,13] owing to its physical characteristics that include distal tail-off because of a high and narrow Bragg Peak as well as a sharp lateral penumbra [14]. Abe et al's dosimetric comparison between C-ion RT and SBRT for HCC treatment found that the former has better sparing of the liver [5].…”

Section: Introductionmentioning

confidence: 99%

Comparison of dose distributions when using carbon ion radiotherapy versus intensity-modulated radiotherapy for hepatocellular carcinoma with macroscopic vascular invasion: A retrospective analysis

Shiba

Shibuya

Kawashima

et al. 2019

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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.

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A feasibility study of high-dose hypofractionated carbon ion radiation therapy using four fractions for localized hepatocellular carcinoma measuring 3 cm or larger

Cited by 36 publications

References 31 publications

Carbon Ion Therapy: A Modern Review of an Emerging Technology

Carbon Ion Therapy: A Modern Review of an Emerging Technology

Clinical Impact of Hypofractionated Carbon Ion Radiotherapy on Locally Advanced Hepatocellular Carcinoma

Comparison of dose distributions when using carbon ion radiotherapy versus intensity-modulated radiotherapy for hepatocellular carcinoma with macroscopic vascular invasion: A retrospective analysis

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A feasibility study of high-dose hypofractionated carbon ion radiation therapy using four fractions for localized hepatocellular carcinoma measuring 3 cm or larger

Cited by 36 publications

References 31 publications

Carbon Ion Therapy: A Modern Review of an Emerging Technology

Carbon Ion Therapy: A Modern Review of an Emerging Technology

Clinical Impact of Hypofractionated Carbon Ion Radiotherapy on Locally Advanced Hepatocellular Carcinoma

Comparison of dose distributions when using carbon ion radiotherapy versus intensity-modulated radiotherapy for hepatocellular carcinoma with macroscopic vascular invasion: A retrospective analysis

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A feasibility study of high-dose hypofractionated carbon ion radiation therapy using four fractions for localized hepatocellular carcinoma measuring 3 cm or larger