Progressive hypofractionated carbon‐ion radiotherapy for hepatocellular carcinoma: Combined analyses of 2 prospective trials

Kasuya, Goro; Kato, Hirotoshi; Yasuda, Shigeo; Tsuji, Hiroshi; Yamada, Shigeru; Haruyama, Yasuo; Kobashi, Gén; Ebner, Daniel K.; Okada, Naohisa; Makishima, Hirokazu; Miyazaki, Masaru; Kamada, Tadashi; Tsujii, Hirohiko

doi:10.1002/cncr.30816

Cited by 71 publications

(62 citation statements)

References 38 publications

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“…15,27 Given these advantages, we have successfully treated hepatocellular carcinomas with minimal toxicity. 30 In addition, we used extreme hypofractionation of 2 fractions with successful outcomes. 16 CIRT is also a high-LET beam and generally has a stronger biological effect compared to low-LET beams as in X-ray/γ-ray.…”

Section: Discussionmentioning

confidence: 99%

Single fraction carbon ion radiotherapy for colorectal cancer liver metastasis: A dose escalation study

et al. 2018

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Prognosis is usually grim for those with liver metastasis from colorectal cancer (CRC) who cannot receive resection. Radiation therapy can be an option for those unsuitable for resection, with carbon ion radiotherapy (CIRT) being more effective and less toxic than X‐ray due to its physio‐biological characteristics. The objective of this study is to identify the optimal dose of single fraction CIRT for colorectal cancer liver metastasis. Thirty‐one patients with liver metastasis from CRC were enrolled in the present study. Twenty‐nine patients received a single‐fraction CIRT, escalating the dose from 36 Gy (RBE) in 5% to 10% increments until unacceptable incidence of dose‐limiting toxicity was observed. Dose‐limiting toxicity was defined as grade ≥3 acute toxicity attributed to radiotherapy. The prescribed doses were as follows: 36 Gy (RBE) (3 cases), 40 Gy (2 cases), 44 Gy (4 cases), 46 Gy (6 cases), 48 Gy (3 cases), 53 Gy (8 cases) and 58 Gy (3 cases). Dose‐limiting toxicity was not observed, but late grade 3 liver toxicity due to biliary obstruction was observed in 2 patients at 53 Gy (RBE). Both cases had lesions close to the hepatic portal region, and, therefore, the dose was escalated to 58 Gy (RBE), limited to peripheral lesions. The 3‐year actuarial overall survival rate of all 29 patients was 78%, and the median survival time was 65 months. Local control improved significantly at ≥53 Gy (RBE), with a 3‐year actuarial local control rate of 82%, compared to 28% in lower doses. Treatment for CRC liver metastasis with single‐fraction CIRT appeared to be safe up to 58 Gy (RBE) as long as the central hepatic portal region was avoided.

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Section: Discussionmentioning

confidence: 99%

Single fraction carbon ion radiotherapy for colorectal cancer liver metastasis: A dose escalation study

et al. 2018

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“…Collectively, these prospective studies (encompassing results from more than 350 patients with HCC) demonstrate that, for a well selected group of patients, HIGRT with photon-based therapy is an appropriate treatment option. Three prospective proton-based treatment studies [49][50][51] and 1 combined analysis of 2 prospective, carbon ion-based studies 52 also have produced similar rates of tumor control and patient survival.…”

Section: Prospective Modern Trialsmentioning

confidence: 96%

“…Several prospective, nonrandomized studies have evaluated the use of HIGRT for treatment of HCC (Table 1). [43][44][45][46][47][48][49][50][51][52] These experiences suggest that HIGRT is well tolerated, with acceptable toxicities and excellent local control (LC) rates. However, follow-up is relatively short, and many trials have not reached a median survival endpoint.…”

Section: Prospective Modern Trialsmentioning

confidence: 99%

The role of external beam radiotherapy in the treatment of hepatocellular cancer

Chino

Stephens

Marin

et al. 2018

Cancer

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Hepatocellular carcinoma (HCC) is increasing in incidence and mortality. Although the prognosis remains poor, long-term survival has improved from 3% in 1970 to an 18% 5-year survival rate today. This is likely because of the introduction of well tolerated, oral antiviral therapies for hepatitis C. Curative options for patients with HCC are often limited by underlying liver dysfunction/cirrhosis and medical comorbidities. Less than one-third of patients are candidates for surgery, which is the current gold standard for cure. Nonsurgical treatments include embolotherapies, percutaneous ablation, and ablative radiation. Technological advances in radiation delivery in the past several decades now allow for safe and effective ablative doses to the liver. Conformal techniques allow for both dose escalation to target volumes and normal tissue sparing. Multiple retrospective and prospective studies have demonstrated that hypofractionated image-guided radiation therapy, used as monotherapy or in combination with other liver-directed therapies, can provide excellent local control that is cost effective. Therefore, as the HCC treatment paradigm continues to evolve, ablative radiation treatment has moved from a palliative treatment to both a "bridge to transplant" and a definitive treatment.

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“…Such treatment courses may still make use of the technologies that are used in more extreme hypofractionated SABR. Also, some centers use particle therapies, including protons and heavier particles such as carbon ions, in hypofractionated treatment courses with the same goals as seen with X‐ray–based SABR . Heavy particles exhibit the Bragg peak phenomenon in their interactions with tissue.…”

Section: Physical Principles Of Sabrmentioning

confidence: 99%

“…Also, some centers use particle therapies, including protons and heavier particles such as carbon ions, in hypofractionated treatment courses with the same goals as seen with X-ray-based SABR. (21,22) Heavy particles exhibit the Bragg peak phenomenon in their interactions with tissue. This leads to reduced energy/dose to the patient outside of the tumor relative to what is seen with X-ray treatments.…”

Section: Physical Principles Of Sabrmentioning

confidence: 99%

Stereotactic ablative radiotherapy for hepatocellular carcinoma: History, current status, and opportunities

Meyer¹,

Singal

2018

Liver Transpl

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A variety of surgical and other local-regional approaches to the management of hepatocellular carcinoma (HCC) are in clinical use. External beam radiation therapy is a relative newcomer to the portfolio of treatment options. Advances in planning and delivery of radiation therapy, developing in parallel with and inspiring changing paradigms of tumor management in the field of radiation oncology, have led to growing interest in radiation therapy as a viable treatment option for HCC as well as other liver tumors. In this review, we discuss these advances, current trends in liver radiotherapy, as well as avenues of future clinical and basic research. Liver Transplantation 24 420-427 2018 AASLD.

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Progressive hypofractionated carbon‐ion radiotherapy for hepatocellular carcinoma: Combined analyses of 2 prospective trials

Cited by 71 publications

References 38 publications

Single fraction carbon ion radiotherapy for colorectal cancer liver metastasis: A dose escalation study

Single fraction carbon ion radiotherapy for colorectal cancer liver metastasis: A dose escalation study

The role of external beam radiotherapy in the treatment of hepatocellular cancer

Stereotactic ablative radiotherapy for hepatocellular carcinoma: History, current status, and opportunities

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