Proton Beam Therapy for Large Hepatocellular Carcinoma

Sugahara, Shinji; Oshiro, Yoshiko; Nakayama, Hidetsugu; Fukuda, Komei; Mizumoto, Masashi; Abei, Masato; Shoda, Junichi; Matsuzaki, Yasushi; Thono, Eriko; Tokita, Mari; Tsuboi, Koji; Tokuuye, Koichi

doi:10.1016/j.ijrobp.2009.02.030

Cited by 122 publications

(93 citation statements)

References 50 publications

(42 reference statements)

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“…Only 3% of the patients experienced grade 2 or higher late toxicity. Several recent retrospective studies show similar overall survival and local control rates in a similar population (33,34).…”

Section: Clinical Outcomes Of Hcc Treated With Proton Radiotherapymentioning

confidence: 75%

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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Section: Clinical Outcomes Of Hcc Treated With Proton Radiotherapymentioning

confidence: 75%

Proton therapy for hepatocellular carcinoma

Ling

Kang

Bush

et al. 2012

Chin. J. Cancer Res.

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“…Although the tumor stages of the patients were diverse and TACE or PEI may have also been administered, the overall efficacy seems quite favorable. PBT showed a good response rate even for large tumors (> 10 cm) and HCCs with main portal tumor thrombosis [107,108] . Radioembolization: Radioembolization is a modality involving the use of a transarterial approach to the hepatic tumor and subsequent infusion of radioactive substances.…”

Section: Radiotherapies and Emerging Therapiesmentioning

confidence: 99%

Current management of hepatocellular carcinoma: An Eastern perspective

Yim¹

2015

WJG

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“…Along with these two high-volume studies, the group has also extensively published subgroup analyses on HCC associated with severe cirrhosis (42,43), severe ascites (30), portal vein tumor thrombosis (44,45), porta hepatis involvement (46), limited treatment options (47), elderly patients (48), LR (29,36), tumor adjacent to the GI tract (49), large-sized tumors (50), and altered fractionation (51,52).…”

Section: Livermentioning

confidence: 99%

Clinical outcomes and toxicities of proton radiotherapy for gastrointestinal neoplasms: a systematic review

Verma

Lin

Simone

et al. 2016

J. Gastrointest. Oncol.

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Background: Proton beam radiotherapy (PBT) is frequently shown to be dosimetrically superior to photon radiotherapy (RT), though supporting data for clinical benefit are severely limited. Because of the potential for toxicity reduction in gastrointestinal (GI) malignancies, we systematically reviewed the literature on clinical outcomes (survival/toxicity) of PBT. Methods: A systematic search of PubMed, EMBASE, abstracts from meetings of the American Society for Radiation Oncology, Particle Therapy Co-Operative Group, and American Society of Clinical Oncology was conducted for publications from 2000-2015. Thirty-eight original investigations were analyzed. Results: Although results of PBT are not directly comparable to historical data, outcomes roughly mirror previous data, generally with reduced toxicities for PBT in some neoplasms. For esophageal cancer, PBT is associated with reduced toxicities, postoperative complications, and hospital stay as compared to photon radiation, while achieving comparable local control (LC) and overall survival (OS). In pancreatic cancer, numerical survival for resected/unresected cases is also similar to existing photon data, whereas grade ≥3 nausea/emesis and post-operative complications are numerically lower than those reported with photon RT.The strongest data in support of PBT for HCC comes from phase II trials demonstrating very low toxicities, and a phase III trial of PBT versus transarterial chemoembolization demonstrating trends towards improved LC and progression-free survival (PFS) with PBT, along with fewer post-treatment hospitalizations. Survival and toxicity data for cholangiocarcinoma, liver metastases, and retroperitoneal sarcoma are also roughly equivalent to historical photon controls. There are two small reports for gastric cancer and three for anorectal cancer; these are not addressed further. Conclusions: Limited quality (and quantity) of data hamper direct comparisons and conclusions. However, the available data, despite the inherent caveats and limitations, suggest that PBT offers the potential to achieve significant reduction in treatment-related toxicities without compromising survival or LC for multiple GI malignancies. Several randomized comparative trials are underway that will provide more definitive answers.

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Proton Beam Therapy for Large Hepatocellular Carcinoma

Cited by 122 publications

References 50 publications

Proton therapy for hepatocellular carcinoma

Proton therapy for hepatocellular carcinoma

Current management of hepatocellular carcinoma: An Eastern perspective

Clinical outcomes and toxicities of proton radiotherapy for gastrointestinal neoplasms: a systematic review

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