A Prospective Study of Hypofractionated Proton Beam Therapy for Patients With Hepatocellular Carcinoma

Fukumitsu, Nobuyoshi; Sugahara, Shinji; Nakayama, Hidetsugu; Fukuda, Kuniaki; Mizumoto, Masashi; Abei, Masato; Shoda, Junichi; Thono, Eriko; Tsuboi, Koji; Tokuuye, Koichi

doi:10.1016/j.ijrobp.2008.10.073

Cited by 198 publications

(116 citation statements)

References 39 publications

(41 reference statements)

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“…A similar survival rate of 86.0% at 3 years was obtained in patients with hepatocellular carcinoma adjacent to the porta hepatis. 30 Kawashima et alalso reported that the local control rate at 2 years was 96.0% in patients treated with proton beam therapy to 76 GyE in 20 fractions. 31 Unfortunately, the excellent local control rates achieved in hepatocellular carcinoma have not translated into similarly high overall survival rates.…”

Section: 29mentioning

confidence: 98%

Proton beam therapy for hepatocellular carcinoma

Nakayama

Sugahara

Tokita

et al. 2009

Cancer

Self Cite

117

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BACKGROUND:The authors have published a series of studies evaluating the safety and efficacy of proton beam therapy for the treatment of hepatocellular carcinoma in a variety of clinical settings. In the current study, they retrospectively reviewed their entire experience treating hepatocellular carcinoma patients with proton beam therapy at their hospital-based facility at the University of Tsukuba. METHODS: From November 2001 to December 2007, 333 patients with hepatocellular carcinoma were treated with proton beam therapy at the University of Tsukuba. A total of 318 patients were included in this study. Total dose delivered and fractionation scheme were determined by protocols that varied based on location of tumor. Survival rates and prognostic factors were assessed. RESULTS: Overall actuarial survival rates at 1-year, 3-years, and 5-years were 89.5% (95% confidence interval [95% CI], 85.7-93.1%), 64.7% (95% CI, 56.6-72.9%), and 44.6% (95% CI, 29.7-59.5%), respectively. Child-Pugh liver function (hazards ratio [HR], 2.84; P < .01), T stage (HR, 1.94; P < .05), performance status (HR, 2.12; P < .01), and planning target volume (HR, 2.12; P < .05) significantly impacted survival. The 3-year and 5-year survival rates were 69.1% (95% CI, 59.9-78.3%) and 55.9% (95% CI, 41.5-70.3%), respectively, for patients with Child-Pugh A disease and 51.9% (95% CI, 32.3-71.5%) and 44.5% (95% CI, 23.1-65.8%), respectively, for patients with Child-Pugh B disease. The actuarial survival rates of patients with Child-Pugh class A were statistically different between groups of planned target volume 125 mL and >125 mL (P < .05). CONCLUSIONS: The authors have shown proton beam therapy to be both safe and effective for the treatment of patients with hepatocellular carcinoma. They strongly recommend the consideration of proton beam therapy in patients for whom other treatment options are risky or contraindicated.

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Section: 29mentioning

confidence: 98%

Proton beam therapy for hepatocellular carcinoma

Nakayama

Sugahara

Tokita

et al. 2009

Cancer

Self Cite

117

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“…This study included larger tumors as well as patients with symptomatic hepatitis C infections. Approximately two-thirds of the patients in this study had received prior local therapy as well (40).…”

Section: Clinical Outcomes Of Hcc Treated With Proton Radiotherapymentioning

confidence: 99%

Proton therapy for hepatocellular carcinoma

Ling

Kang

Bush

et al. 2012

Chin. J. Cancer Res.

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Proton radiotherapy has seen an increasing role in the treatment of hepatocellular carcinoma (HCC). Historically, external beam radiotherapy has played a very limited role in HCC due to a high incidence of toxicity to surrounding normal structures. The ability to deliver a high dose of radiation to the tumor is a key factor in improving outcomes in HCC. Advances in photon radiotherapy have improved dose conformity and allowed dose escalation to the tumor. However, despite these advances there is still a large volume of normal liver that receives a considerable radiation dose during treatment. Proton beams do not have an exit dose along the beam path once they enter the body. The inherent physical attributes of proton radiotherapy offer a way to maximize tumor control via dose escalation while avoiding excessive radiation to the remaining liver, thus increasing biological effectiveness. In this review we discuss the physical attributes and rationale for proton radiotherapy in HCC. We also review recent literature regarding clinical outcomes of using proton radiotherapy for the treatment of HCC.

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“…Proton therapy in particular, has clear dosimetric advantages, particularly when compared to the low-dose bath necessary for IMRT, VMAT, or SBRT, although whether this hypothetical advantage provides a clinical benefit for hepatobiliary malignancies is unclear. In 2009, Fukumitsu et al reported the results of a prospective study of patients with HCC treated with hypofractionated proton therapy (36). Fifty-one patients were treated to 66 GyE in ten fractions.…”

Section: Moderately Hypofractionated Proton Therapymentioning

confidence: 99%