A preliminary study of hepatocellular carcinoma post proton beam therapy using MRI as an early prediction of treatment effectiveness

Abstract

Purpose To demonstrate the feasibility of magnetic resonance imaging (MRI) for early prediction of proton beam therapy (PBT) effectiveness in hepatocellular carcinoma (HCC). Methods Clinical data of the HCC patients without regional lymph node involvement or distant metastasis who received PBT at this institution between 2014 and 2017 were reviewed. A total of 43 patients were included. Tumor regression pattern after PBT were examined on the basis of follow-up duration. The variables were compared between patients with and without early tumor regression (ETR). Results The median follow-up duration was 40 months (range, 9–62 months). The cumulative overall survival rate at 6 months, 1 years and 5 years was 100%, 88.4%, 63.4%, respectively. Child-Pugh class A, local tumor control (LTC), complete response (CR), and ETR were significantly associated with overall survival (p < 0.05 each). Of 43 patients, 25 patients (58.1%) reached CR in the PBT-irradiated region. Twelve patients (27.9%) had a partial response and 3 patients (7.0%) had a stationary disease. Three patients (7.0%) developed in-field progression. The LTC rate at 5 years was 93.0%. Of the 25 patients who achieved a CR in the PBT-irradiated region, the median time to CR was 5 months (range, 1–19 months). Twenty-two patients (51.2%) showed ETR of the HCC, while 21 patients (48.8%) showed non-ETR. A significant association was observed between ETR and CR of the HCC after PBT (p < 0.001). Conclusion The post-PBT MRI follow-up at 3 months is helpful for monitoring therapeutic response. ETR of the HCC predicted a higher rate of CR and was associated with overall survival, which provides more accurate clinical management.

Tumor Response on Diagnostic Imaging after Proton Beam Therapy for Hepatocellular Carcinoma

“…Cases that reached CR/PR at 6 and 12 months had significantly better OS compared to non-CR/non-PR cases. Lin et al also found that HCC treated with PBT reached had better OS in CR cases at 3 months in MRI follow-up [23]. Intrahepatic recurrence outside the irradiated field is a common cause of death after PBT for HCC; thus, non-CR cases may be at high risk for this recurrence.…”

“…Takahashi et al reported that a difference in CT values between post-treatment lesions and liver parenchyma in the portal phase at 1-2 years after PBT is a predictor of local recurrence [22]. Lin et al found a median time to resolution of early enhancement on MRI of 5 months after PBT [23]. In this study, the presence of early enhancement at 6 months after PBT was not related to MST (presence vs. absence: 38.4 vs. 41.9 months, p = 0.147), but was significant at 12 and 24 months.…”