A phase I trial of Proton stereotactic body radiation therapy for liver metastases

Kang, Joseph I.; Sufficool, Daniel; Hsueh, Chung-Tsen; Wroe, Andrew; Patyal, B; Reeves, Mark E.; Slater, Jerry D.; Yang, Gary

doi:10.21037/jgo.2018.08.17

Cited by 21 publications

(14 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…To date, SBPT has primarily been studied in the setting of hepatic metastases and seems to be a safe treatment technique. 25,26 The use of SBPT for HCC is intriguing, as proton therapy was an independent predictor of better OS in an National Cancer Database (NCDB) analysis comparing proton therapy to photon SBRT. 27 The current study is limited by its retrospective nature.…”

Section: Discussionmentioning

confidence: 99%

Intensity Modulated Proton Therapy for Hepatocellular Carcinoma: Initial Clinical Experience

Bhangoo

Mullikin

Ashman

et al. 2021

Advances in Radiation Oncology

View full text Add to dashboard Cite

Our purpose was to assess the safety and efficacy of intensity modulated proton therapy (IMPT) for the treatment of hepatocellular carcinoma (HCC). Methods and Materials: A retrospective review was conducted on all patients who were treated with IMPT for HCC with curative intent from June 2015 to December 2018. All patients had fiducials placed before treatment. Inverse treatment planning used robust optimization with 2 to 3 beams. The majority of patients were treated in 15 fractions (n Z 30, 81%, 52.5-67.5 Gy, relative biological effectiveness), whereas the remainder were treated in 5 fractions (n Z 7, 19%, 37.5-50 Gy, relative biological effectiveness). Daily image guidance consisted of orthogonal kilovoltage x-rays and use of a 6 of freedom robotic couch. Outcomes (local control, progression free survival, and overall survival) were determined using Kaplan-Meier methods. Results: Thirty-seven patients were included. The median follow-up for living patients was 21 months (Q1-Q3, 17-30 months). Pretreatment Child-Pugh score was A5-6 in 70% of patients and B7-9 in 30% of patients. Nineteen patients had prior liver directed therapy for HCC before IMPT. Eight patients (22%) required a replan during treatment, most commonly due to inadequate clinical target volume coverage. One patient (3%) experienced a grade 3 acute toxicity (pain) with no recorded grade 4 or 5 toxicities. An increase in Child-Pugh score by ! 2 within 3 months of treatment was observed in 6 patients (16%). At 1 year, local control was 94%, intrahepatic control was 54%, progression free survival was 35%, and overall survival was 78%.Sources of support: This work had no specific funding. Disclosures: S.K. reports grants from NIH, DoD, CPRIT, Celgene, and Elekta outside the submitted work. In addition, S.K. has issued patents on gold nanoparticles and radiation minibeams. W.L. reports grants from Arizona Biomedical Research Commissioning, grants from the National Cancer Institute (NCI) Career Developmental Award K25CA168984, grants from the Lawrence W. and Marilyn W. Matteson Fund for Cancer Research, and grants from the Kemper Marley Foundation outside the submitted work. In addition, W.L. has a patent, "An Accurate and Efficient Hybrid Method Based on Ray Casting to Calculate Physical Dose and Linear Energy Transfer (LET) Distribution for Intensity Modulated Proton Therapy" with royalties paid to.Decimal LLC. T.T.S. provides strategic and scientific recommendations as a member of the advisory board and a speaker for Novocure, Inc.All data generated and analyzed during this study are included in this published article. Research data are stored in an institutional repository and will be shared upon request to the corresponding author.

show abstract

Section: Discussionmentioning

confidence: 99%

Intensity Modulated Proton Therapy for Hepatocellular Carcinoma: Initial Clinical Experience

Bhangoo

Mullikin

Ashman

et al. 2021

Advances in Radiation Oncology

View full text Add to dashboard Cite

show abstract

“…The Karolinksa Institute was the first to report the efficacy and safety of high dose focal liver irradiation using a stereotactic technique in the 1990’s [ 41 ]. Additional centers have prospectively reported on the efficacy and safety of liver SABR, Table 1 [ 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 ]. Our prior review provides more depth on the background and history of the liver SABR [ 3 ].…”

Section: The Evolution Of External Beam Radiation Therapy For Livementioning

confidence: 99%

“…This survival benefit was attributed to a significantly lower mean liver dose, which decreased the risk of non-classic RILD in proton patients [ 73 ]. Additional prospective clinical trials have demonstrated the efficacy and safety of proton liver SABR [ 51 , 53 ]. Just as with photon based therapy, considerations need to be taken for motion management and image guidance with proton radiotherapy.…”

Section: Strategies To Overcome Limitations To Sabrmentioning

confidence: 99%

Magnetic Resonance Imaging-Guided Adaptive Radiotherapy for Colorectal Liver Metastases

Romesser

Tyagi

Crane

2021

Cancers

View full text Add to dashboard Cite

Technological advances have enabled well tolerated and effective radiation treatment for small liver metastases. Stereotactic ablative radiation therapy (SABR) refers to ablative dose delivery (>100 Gy BED) in five fractions or fewer. For larger tumors, the safe delivery of SABR can be challenging due to a more limited volume of healthy normal liver parenchyma and the proximity of the tumor to radiosensitive organs such as the stomach, duodenum, and large intestine. In addition to stereotactic treatment delivery, controlling respiratory motion, the use of image guidance, adaptive planning and increasing the number of radiation fractions are sometimes necessary for the safe delivery of SABR in these situations. Magnetic Resonance (MR) image-guided adaptive radiation therapy (MRgART) is a new and rapidly evolving treatment paradigm. MR imaging before, during and after treatment delivery facilitates direct visualization of both the tumor target and the adjacent normal healthy organs as well as potential intrafraction motion. Real time MR imaging facilitates non-invasive tumor tracking and treatment gating. While daily adaptive re-planning permits treatment plans to be adjusted based on the anatomy of the day. MRgART therapy is a promising radiation technology advance that can overcome many of the challenges of liver SABR and may facilitate the safe tumor dose escalation of colorectal liver metastases.

show abstract

“…However, the authors note that this is likely related to a lower BED. A phase I dose escalation trial showed Proton SBRT to be safe and well tolerated with the maximal tolerated dose not reached at a dose of 60 GyE (Gray equivalent) (28).…”

Section: Original Articlementioning

confidence: 99%

“…The dose in proton therapy is defined in terms of effective dose, which is the physical dose in Gray multiplied by a relative biological effectiveness (RBE) of 1.1, which has been validated in the clinic (29). The 60 GyE regimen had no dose limiting toxicity and is used for the phase II trial with dose constraints specified by protocol (28). Other patients who did not meet eligibility criteria for the phase II trial were treated in 3 or 5 fractions.…”

Section: Fractionation Schemes and Dose Constraintsmentioning

confidence: 99%

Proton stereotactic body radiation therapy for liver metastases—results of 5-year experience for 81 hepatic lesions

Coffman

Sufficool

Kang

et al. 2021

J Gastrointest Oncol

Self Cite

View full text Add to dashboard Cite

Background: To report on our institutional experience using Proton stereotactic body radiation therapy (SBRT) for patients with liver metastases.Methods: All patients with liver metastases treated with Proton SBRT between September 2012 and December 2017 were retrospectively analyzed. Local control (LC) and overall survival (OS) were estimated using the Kaplan-Meier method calculated from the time of completion of Proton SBRT. LC was defined according to Response Evaluation Criteria in Solid Tumors (RECIST) guidelines (version 1.1). Toxicity was graded according to Common Terminology Criteria for Adverse Events (CTCAE) version 4.0.Results: Forty-six patients with 81 lesions were treated with Proton SBRT. The median age was 65.5 years old (range, 33-86 years) and the median follow up was 15 months (range, 1-54 months). The median size of the gross tumor volume (GTV) was 2.5 cm (range, 0.7-8.9 cm). Two or more lesions were treated in 56.5% of patients, with one patient receiving treatment to a total of five lesions. There were 37 lesions treated with a biologically effective dose (BED) ≤60, 9 lesions with a BED of 61-80, 22 lesions with a BED of 81-100, and 13 lesions with a BED >100. The 1-year and 2-year LC for all lesions was 92.5% (95% CI, 82.7% to 96.8%). The grade 1 and grade 2 toxicity rates were 37% and 6.5%, respectively. There were no grade 3 or higher toxicities and no cases of radiation-induced liver disease (RILD).Conclusions: Proton SBRT for the treatment of liver metastases has promising LC rates with the ability to safely treat multiple liver metastases. Accrual continues for our phase II trial treating liver metastases with Proton SBRT to 60 GyE (Gray equivalent) in 3 fractions.

show abstract

A phase I trial of Proton stereotactic body radiation therapy for liver metastases

Cited by 21 publications

References 14 publications

Intensity Modulated Proton Therapy for Hepatocellular Carcinoma: Initial Clinical Experience

Intensity Modulated Proton Therapy for Hepatocellular Carcinoma: Initial Clinical Experience

Magnetic Resonance Imaging-Guided Adaptive Radiotherapy for Colorectal Liver Metastases

Proton stereotactic body radiation therapy for liver metastases—results of 5-year experience for 81 hepatic lesions

Contact Info

Product

Resources

About