Clinical results and risk factors of proton and carbon ion therapy for hepatocellular carcinoma

Abstract

BACKGROUND:The objective of this study was to evaluate the clinical outcome of proton and carbon ion therapy for hepatocellular carcinoma (HCC). METHODS: In total, 343 consecutive patients with 386 tumors, including 242 patients (with 278 tumors) who received proton therapy and 101 patients (with 108 tumors) who received carbon ion therapy, were treated on 8 different protocols of proton therapy (52.8-84.0 gray equivalents [GyE] in 4-38 fractions) and on 4 different protocols of carbon ion therapy (52.8-76.0 GyE in 4-20 fractions). RESULTS: The 5-year local control and overall survival rates for all patients were 90.8% and 38.2%, respectively. Regarding proton and carbon ion therapy, the 5-year local control rates were 90.2% and 93%, respectively, and the 5-year overall survival rates were 38% and 36.3%, respectively. These rates did not differ significantly between the 2 therapies. Univariate analysis identified tumor size as an independent risk factor for local recurrence in proton therapy, carbon ion therapy, and in all patients. Multivariate analysis identified tumor size as the only independent risk factor for local recurrence in proton therapy and in all patients. Child-Pugh classification was the only independent risk factor for overall survival in proton therapy, in carbon ion therapy, and in all patients according to both univariate and multivariate analyses. No patients died of treatment-related toxicities. CONCLUSIONS: Proton and carbon ion therapies for HCC were comparable in terms of local control and overall survival rates. These therapies may represent innovative alternatives to conventional local therapies for HCC. Cancer 2011;117:4890-

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

“…In addition, the incidence rates of RILD at 3 and 6 months after CIRT were considered to be low in the current study. In a study comparing CIRT and proton therapy for HCC, Komatsu et al29 observed no severe adverse effects, including effects in the liver for patients treated with CIRT. These results suggest that the high dose‐concentrating ability of the carbon‐ion beam offsets the higher biological effect of high linear energy transfer radiation on healthy tissue damage, and this allows the benefits of high linear energy transfer radiation to affect primarily the target.…”

Proton therapy for hepatocellular carcinoma

“…More recently, Komatsu et al reported on the retrospective review of 343 consecutive patients with HCC treated at the Hyogo Ion Beam Medical Center with proton or carbon ion therapies (35). For the 285 patients for which both proton and carbon ion beams were available, treatment planning with both modalities were performed and the better treatment plan was selected based on dosimetric criteria.…”

Metabolic liver function after stereotactic body radiation therapy for hepatocellular carcinoma

“…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].…”