Carbon ion radiotherapy for 80 years or older patients with hepatocellular carcinoma

Abstract

BackgroundTo evaluate the safety and efficacy of carbon ion radiotherapy (C-ion RT) for 80 years or older patients with hepatocellular carcinoma (HCC).MethodsEligibility criteria of this retrospective study were: 1) HCC confirmed by histology or typical hallmarks of HCC by imaging techniques of four-phase multidetector-row computed tomography or dynamic contrast-enhanced magnetic resonance imaging; 2) no intrahepatic metastasis or distant metastasis; 3) no findings suggesting direct infiltration of the gastrointestinal tract; 4) performance status ≤2 by Eastern Cooperative Oncology Group classification; and 5) Child-Pugh classification A or B. Patients received C-ion RT with 52.8 Gy (RBE) or 60.0 Gy (RBE) in four fractions for usual cases and 60.0 Gy (RBE) in 12 fractions for close-to-gastrointestinal tract cases. Toxicities were classified using the National Cancer Institute’s Common Terminology Criteria for Adverse Events (Version 4.0).ResultsBetween March 2011 and November 2015, 31 patients were treated. The median follow-up period of all patients was 23.2 months (range: 8.4–55.3 months). Median age at the time of registration of C-ion RT was 83 years (range: 80–95 years). Child-Pugh grade A and B were 27 patients and 4 patients, respectively.The 2-year estimated overall survival, local control, and progression-free survival rates were 82.3%, 89.2%, and 51.3%, respectively. No patients had Grade 2 or higher acute toxicities (within 3 months after C-ion RT). One patient experienced progression in Child-Pugh classification from A to B within 3 months after C-ion RT. In late toxicities, Grade 3 encephalopathy was observed in 3 patients, and 2 improved with medication.ConclusionsC-ion RT was effective with minimal toxicities for 80 years or older patients with hepatocellular carcinoma.Trial registration UMIN000020571: date of registration, 14 January 2016, retrospectively registered.

No Deterioration in Clinical Outcomes of Carbon Ion Radiotherapy for Sarcopenia Patients with Hepatocellular Carcinoma

“…Dose constraints were as follows: (1) D 1cc <40 Gy (RBE) administered to the gastrointestinal tract and (2) V 20 <35% administered to the liver. Dose to the portal vein and bile duct was reduced as much as was possible (8). Figure 1 shows a typical radiation field with dose distribution.…”

“…Numerous local treatment options can be employed for treating HCC, with particle therapy, such as proton beam therapy and carbon ion radiotherapy (C-ion RT), being one of the less-invasive options (7,8). Most patients with HCC have a history of chronic liver disease resulting from alcohol abuse, or infection with hepatitis C or B virus, so that patients with HCC already are in a state of secondary sarcopenia caused by cirrhosis or chronic hepatitis.…”

“…The clinical target volume (CTV) was defined as a GTV plus 5 mm in all directions, including microscopic disease progression, and the internal margin (IM) was added as the extent of tumor motion displayed in 4D-CT images. The planning target volume (PTV) was defined as a summation of CTV, IM, and setup margin (8). Radiation dose measurements for the target volume and surrounding normal structures were expressed in Gy (relative biologic effectiveness [RBE]), which was defined as the physical dose multiplied by the RBE of carbon ions (10).…”

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].…”