A comparison of carbon ion radiotherapy and transarterial chemoembolization treatment outcomes for single hepatocellular carcinoma: a propensity score matching study

Abstract

Background We compared clinical outcomes of carbon ion radiotherapy and transarterial chemoembolization in the treatment of hepatocellular carcinoma. Methods Data of 477 patients with hepatocellular carcinoma who had undergone carbon ion radiotherapy or transarterial chemoembolization between April 2007 and September 2016 were retrospectively reviewed. Treatment naïve patients with single HCC, who underwent carbon ion radiotherapy or transarterial chemoembolization as a primary treatment were included. Clinical outcomes of the treatments were compared after utilizing propensity score matching. Results Of 124 patients who received carbon ion radiotherapy and 353 patients who received transarterial chemoembolization, 31 and 23 patients met our inclusion criteria, respectively. After utilizing propensity score matching, 17 matched pairs of patients from each treatment group were analyzed. The median follow-up durations after carbon ion radiotherapy and transarterial chemoembolization were 43 and 32 months, respectively. The 3-year overall survival, local control, and progression-free survival rates in the carbon ion radiotherapy versus transarterial chemoembolization groups were 88% versus 58% ( p < 0.05), 80% versus 26% ( p < 0.01), and 51% versus 15% ( p < 0.05), respectively. Conclusions Carbon ion radiotherapy showed more favorable clinical outcomes than did transarterial chemoembolization for patients with single hepatocellular carcinoma after matching patient characteristics utilizing propensity score matching. Further studies with larger patient numbers are required to confirm our results. Trial registration UMIN000036455 : date of registration 22 March 2019, retrospectively registered.

Carbon Ion Therapy: A Modern Review of an Emerging Technology

“…Doses of 52.8-60 Gy in 4 fractions were used, with 60.0 Gy in 12 fractions close to the GI tract. Treatment with CIRT showed improved OS (88% vs. 58%), LC (80% vs. 26%), and PFS (51% vs. 15%) compared to TACE for single tumor HCC (71).…”

Comparison of dose distributions when using carbon ion radiotherapy versus intensity-modulated radiotherapy for hepatocellular carcinoma with macroscopic vascular invasion: A retrospective analysis

“…Because Gy (RBE) is calculated based on the survival response of human salivary gland cells after C-ion beam irradiation, and not of liver cells, a direct comparison between Gy (RBE) and Gy for the liver can be problematic; moreover, the dose constraints of C-ion RT and those of IMRT for the liver might be different. However, the dose constraints of C-ion RT for the liver used in our study are considered safe, as previous clinical studies of C-ion RT used the same dose constraints, and no severe toxicities were observed [7][8][9][10][11].…”

“…Particle therapy has since improved radiation dose distributions further still [5,6]. In particular, carbon ion RT (C-ion RT) has produced favorable clinical outcomes for patients with HCC [7][8][9][10][11], as this modality reduces the dose to the liver while ensuring good target coverage [12,13] owing to its physical characteristics that include distal tail-off because of a high and narrow Bragg Peak as well as a sharp lateral penumbra [14]. Abe et al's dosimetric comparison between C-ion RT and SBRT for HCC treatment found that the former has better sparing of the liver [5].…”

Improved Clinical Outcome Using Transarterial Chemoembolization Combined with Radiofrequency Ablation for Patients in Barcelona Clinic Liver Cancer Stage A or B Hepatocellular Carcinoma Regardless of Tumor Size: Results of a Single-center Retrospective Case Control Study

“…One study [40] showed that for HCC patients receiving CIT or TACE, patients in the CIT group were significantly better than those in the TACE group in terms of 3-year OS, PFS and local control rates.…”