Hypofractionated Carbon Ion Therapy delivered with Scanned Ion Beams for Patients with Hepatocellular Carcinoma – Feasibility and Clinical Response

Abstract

Purpose: Photon-based radiation therapy does currently not play a major role as local ablative treatment for hepatocellular carcinoma (HCC). Carbon ions offer distinct physical and biological advantages. Due to their inverted dose profile and the high local dose deposition within the Bragg peak, precise dose application and sparing of normal tissue is possible. Furthermore, carbon ions have an increased relative biological effectiveness (RBE) compared to photons. Methods and materials:A total of six patients with one or more HCC-lesions were treated with carbon ions delivered by the raster-scanning technique according to our clinical trial protocol. Diagnosis of HCC was confirmed by histology or two different imaging modalities (CT and MRI) according to the AASLD-guidelines. Applied fractionation scheme was 4 × 10 Gy(RBE). Correct dose application was controlled by in-vivo PET measurement of β + −activity in the irradiated tissue shortly after treatment.

In silico comparison of photons versus carbon ions in single fraction therapy of lung cancer

“…Tumors in the abdomen region (liver and pancreas tumors) with were already successfully treated scanned ion beams at HIT, Heidelberg (Germany) and CNAO, Pavia (Italy) [Habermehl et al, 2013, Rossi, 2016 and first lung cancer patients are being treated at NIRS, Chiba (Japan) [Mori et al, 2016]. Studies on impact of scanned ion beams on lung cancer treatment are thus warranted, so that eligible patients can be identified.…”

Comparing the Use of Protons and Carbon Ions for Treatment

“…Univariate analysis revealed only tumor size as a risk factor for local recurrence. 59 Prostate Radiation therapy of the prostate using protons had been performed for a long time outside clinical trials. 53 Median progression-free survival was 36 months after 15 Â 4.2-Gy (RBE) fractions for a 3-week period.…”

Metabolic liver function after stereotactic body radiation therapy for hepatocellular carcinoma

“…Due to the sparing of the low and intermediate dose wash, particle therapy may be ideal for treatment of HCC [20]. We need to establish methods for selection of the proper patients for particle therapy.…”

“…NTCP modeling may have great potential in risk adapted dose prescription of SBRT of liver tumors. It may be employed in comparative treatment planning studies between particle-and photon-based SBRT for optimal selection of candidates for particle beam therapy, that may offer ideal dose distribution and favorable relative biological efficacy [20,[22][23][24].…”