Clinical results of active scanning proton therapy for primary liver tumors

Abstract

<jats:sec><jats:title>Background:</jats:title><jats:p> Evidence for the efficacy of radiation therapy for primary liver cancer is growing. In this context, proton therapy (PT) can potentially improve the therapeutic ratio, as demonstrated by recent clinical studies. Here we report the first European clinical experience on the use of PT for primary liver cancer. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> All patients treated for primary liver cancer in our center entered the analysis. Patients were simulated during deep expiration breath-hold. A 15-fraction treatment schedule was adopted using active scanning PT. Clinical outcome and toxicity were retrospectively analyzed. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> Between January 2018 and December 2019, 18 patients were treated. Fourteen patients had hepatocellular carcinoma (HCC), three patients had intrahepatic cholangiocarcinoma (ICC), and one patient had synchronous ICC-HCC. The Child-Pugh score was A5 in the majority of patients with HCC (71.4%). Median prescription dose was 58.05 Gy (range, 50.31–67.5). Median follow-up was 10 months (range, 1–19). The majority of deaths occurred from liver tumor progression. One-year overall survival (OS) was 63%. A significant correlation between worse OS and patient performance status, vascular invasion, and tumor stage was recorded. One-year local control was 90%. Toxicity was low, with a decrease in Child-Pugh score ⩾2 points detected in one patient. No cases of classic radiation-induced liver disease occurred. </jats:p></jats:sec><jats:sec><jats:title>Conclusions:</jats:title><jats:p> Our initial results of active scanning PT for primary liver cancer demonstrated the feasibility, safety, and effectiveness of this advanced technique in this setting. The potential of the combination of PT with other locoregional therapies is under evaluation. </jats:p></jats:sec>

Simultaneous Multiple Liver Metastasis Treated with Pencil Beam Proton Stereotactic Body Radiotherapy (SBRT)

“…Most PBS liver studies have involved fractionated proton therapy. Dionisi et al [ 7 ] reported on 18 patients with hepatobiliary tumors treated with 15 fraction PBS liver therapy with median dose 58 GyRBE. One-year local control was 90%, with excellent toxicity.…”

Chemoembolization with Degradable Starch Microspheres (DSM-TACE): expanding indications in HCC multidisciplinary tumor board

“…The adherence of MDTB treatment decisions to guidelines recommendations has been shown to be suboptimal mainly in the case of advanced age, severe comorbidities and strategic tumor localization [77] , but also in relation to differences in the availability of the therapeutic options in every center [78] . The overall rate of guidelines violations may reach 40% [77] and, interestingly, the adherence rate drops with the increasing disease stages to less than 50% in the intermediate and advanced stages, according to an Italian study [79] . Our MDTB, for example, is "non-compliant" with guidelines offering stereotactic body radiotherapy (SBRT) or proton beam therapy (PT) [80] for local HCC ablation in case of contraindications to surgical resection or thermal ablation.…”

Current evidence and the potential role of proton beam therapy for hepatocellular carcinoma

“…Recently, published retrospective series demonstrated the feasibility, safety, and efficacy of PBS-PBT for treating HCC. Although only small retrospective series have been reported, most studies achieved high local tumor control (around 95% at one year) and low toxicity profiles [ 16 , 17 ]. Yoo et al [ 18 ] compared the outcomes of HCC patients treated with either PS-PBT or PBS-PBT.…”

“…Although only small retrospective series have been reported, most studies achieved high local tumor control (around 95% at one year) and low toxicity profiles. 16,17 Yoo et al 18 compared the outcomes of HCC patients treated with either PS-PBT or PBS-PBT. After propensity score matching, they revealed no difference in toxicity, tumor control, or survival between patients treated with PS-PBT or PBS-PBT.…”