Effectiveness of Particle Radiotherapy in Various Stages of Hepatocellular Carcinoma: A Pilot Study

Abstract

Aim: We analyzed the effectiveness of external particle radiotherapy (PRT) as an alternative therapy for various stages of hepatocellular carcinoma (HCC). Methods: Eighty-three patients with HCC underwent PRT in our hospital from 2007 to 2015 (proton beam radiation in 58 patients and carbon ion radiation in 25 patients), including patients with early-stage HCC (single HCC measuring ≤3 cm, Barcelona Clinic Liver Cancer [BCLC] stage 0 or A) (group A, n = 30), those with intermediate-stage HCC (HCCs measuring ≥3 cm but inoperable or multinodular and transcatheter arterial embolization [TACE]-refractory, BCLC stage B) (group B, n = 31), and those with advanced-stage HCC (HCC with portal invasion or extrahepatic metastasis) (group C, n = 22). The median radiation dose was 72.6 GyE (range 50–74) for proton beam radiation and 45.0 GyE (range 45–52.8) for carbon beam radiation. Local control ability was defined as continuous shrinkage of the tumor size without development of new lesions for ≥6 months after PRT. Results: The rates of local control of the target tumor at 6 months, 1 year, and 2 years were 91.9, 86.3, and 84.8%, respectively. The overall survival rates at 1, 2, and 3 years were 83.0, 65.6, and 55.1%, respectively. Patients in group A showed the best survival rates (100.0% at 1 year and 85.9% at 2 years). The 1-year survival rate was poor in group C (63.6%) despite a good local tumor control rate of 74.7%. The overall survival rates were significantly better in groups A and B than in group C. Conclusions: The local control rates after PRT were sufficiently high compared to TACE or sorafenib. Thus, PRT should be adopted for patients with difficult-to-treat HCC in the early and intermediate stages.

Proton Therapy in the Management of Hepatocellular Carcinoma

“…Proton therapy for HCC remains a research topic of interest to this day in East Asia. In addition to further retrospective data [ 27 , 28 , 29 , 30 ], prospective evidence was also generated. An early phase II trial included 30 patients with HCC and liver cirrhosis who received 76 GyE of PBT in 20 fractions [ 31 ].…”

“…The analyses in the studies mentioned above found different combinations of variables to be correlated with survival. The risk factors that were consistently shown to be relevant include the Child–Pugh classification [ 26 , 27 , 34 ] and tumor stage [ 28 , 29 , 34 ]. Another factor is the indocyanine-green retention rate at 15 min (ICG R15).…”

Efficacy and Safety of 4 Fractions of Carbon-Ion Radiation Therapy for Hepatocellular Carcinoma: A Prospective Study

“…Although it requires acceleration with a large cyclotron, C-ion RT is theoretically an ideal radiotherapy technique [16][17][18]. Furthermore, some previous studies have shown that Cion RT could be performed with fewer fractions than proton beams [19,20]. A short treatment duration also has the advantage of maintaining the patient's quality of life.…”