Clinical results of fractionated proton therapy

Tsujii, Hirohiko; Tsuji, Hiroshi; Inada, Tomohiro; Maruhashi, Akira; Hayakawa, Yoshinori; Takada, Yoshihisa; Tada, Junichiro; Fukumoto, S.; Tatuzaki, Hideo; Ohara, Kiyoshi; Kitagawa, Toshio

doi:10.1016/0360-3016(93)90144-k

Cited by 87 publications

(41 citation statements)

References 34 publications

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“…Procedures for proton beam therapy at the University of Tsukuba were reported previously (28,35). Briefly, proton beams were provided with a booster synchrotron of the High Energy and Accelerator Research Organization.…”

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confidence: 99%

Proton Beam Therapy for Hepatocellular Carcinoma: A Retrospective Review of 162 Patients

Chiba

Tokuuye

Matsuzaki

et al. 2005

Clinical Cancer Research

227

141

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Purpose: We present results of patients with hepatocellular carcinoma (HCC) treated with proton beam therapy. Experimental Design: We reviewed 162 patients having 192 HCCs treated from November 1985 to July 1998 by proton beam therapy with or without transarterial embolization and percutaneous ethanol injection.The patients in the present series were considered unsuitable for surgery for various reasons, including hepatic dysfunction, multiple tumors, recurrence after surgical resection, and concomitant illnesses. The median total dose of proton irradiation was 72 Gy in 16 fractions over 29 days. Results: The overall survival rate for all of the162 patients was 23.5% at 5 years.The local control rate at 5 years was 86.9% for all 192 tumors among the 162 patients.The degree of impairment of hepatic functions attributable to coexisting liver cirrhosis and the number of tumors in the liver significantly affected patient survival. For 50 patients having least impaired hepatic functions and a solitary tumor, the survival rate at 5 years was 53.5%.The patients had very few acute reactions to treatments and a few late sequelae during and after the treatments. Conclusions: Proton beam therapy for patients with HCC is effective, safe, well tolerable, and repeatable. It is the useful treatment mode for either cure or palliation for patients with HCC irrespective of tumor size, tumor location in the liver, insufficient feeding of the tumor with arteries, presence of vascular invasion, impaired hepatic functions, and coexisting intercurrent diseases.

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mentioning

confidence: 99%

Proton Beam Therapy for Hepatocellular Carcinoma: A Retrospective Review of 162 Patients

Chiba

Tokuuye

Matsuzaki

et al. 2005

Clinical Cancer Research

227

141

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“…[15][16][17] It should be noted that many of these results were obtained from proton treatments carried out in research-based facilities with horizontal, passively scattered beams, limited energies, and restricted flexibility in the complexity and types of treatments that could be carried out. Further, the number of patients treated in a given disease site was relatively small and, thus, the analysis of these studies often did not produce statistically significant results.…”

Section: Iiib Clinical Resultsmentioning

confidence: 99%

Vision : Proton therapy

2009

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The first patients were treated with proton beams in 1955 at the Lawrence Berkeley Laboratory in California. In 1970, proton beams began to be used in research facilities to treat cancer patients using fractionated treatment regimens. It was not until 1990 that proton treatments were carried out in hospital-based facilities using technology and techniques that were comparable to those for modern photon therapy. Clinical data strongly support the conclusion that proton therapy is superior to conventional radiation therapy in a number of disease sites. Treatment planning studies have shown that proton dose distributions are superior to those for photons in a wide range of disease sites indicating that additional clinical gains can be achieved if these treatment plans can be reliably delivered to patients. Optimum proton dose distributions can be achieved with intensity modulated protons ͑IMPT͒, but very few patients have received this advanced form of treatment. It is anticipated widespread implementation of IMPT would provide additional improvements in clinical outcomes. Advances in the last decade have led to an increased interest in proton therapy. Currently, proton therapy is undergoing transitions that will move it into the mainstream of cancer treatment. For example, proton therapy is now reimbursed, there has been rapid development in proton therapy technology, and many new options are available for equipment, facility configuration, and financing. During the next decade, new developments will increase the efficiency and accuracy of proton therapy and enhance our ability to verify treatment planning calculations and perform quality assurance for proton therapy delivery. With the implementation of new multi-institution clinical studies and the routine availability of IMPT, it may be possible, within the next decade, to quantify the clinical gains obtained from optimized proton therapy. During this same period several new proton therapy facilities will be built and the cost of proton therapy is expected to decrease, making proton therapy routinely available to a larger population of cancer patients.

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“…A recent study showed that low-dose radiotherapy and whole-liver irradiation were ineffective, as they led to severe hepatic failure [9]. One study suggested that localized high-dose radiation therapy can improve the efficacy of radiation therapy [8], and ion beams can provide a better dose concentration then can photon beams [10,11]. Indeed, ion beams are considered a highly effective treatment for cancer due to their higher relative biological effectiveness (RBE) [12,13].…”

Section: Introductionmentioning

confidence: 99%

Preliminary study of apparent diffusion coefficient assessment after ion beam therapy for hepatocellular carcinoma

Kanamoto

Miyati

Terashima

et al. 2016

Radiol Phys Technol

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We evaluated the state of hepatocellular carcinoma (HCC) and the liver after ion beam therapy by analyzing the apparent diffusion coefficient (ADC). In this retrospective study, we evaluated 13 HCC lesions in 10 patients who underwent magnetic resonance imaging before and after therapy. Diffusion-weighted imaging was performed with use of b values of 0, 150, and 800 s/mm 2 . The ADC was determined for the tumor, irradiated liver, and normal liver. The maximum size of the tumor was measured, and reduction in tumor size was determined as a ratio of the maximum size of the diameter of the tumor. We compared the ADC before and after the therapy with the reduction in tumor size ratio. The reduction in tumor size ratio was compared with the ADCs of the tumors. The ADC of the tumor and the irradiated liver were significantly higher after therapy than before therapy. The ADC of the normal liver was not significantly different before and after therapy. The reduction ratio increased significantly (R = 0.73, P = 0.006) after therapy at the second follow-up when compared with after therapy at the first follow-up. No correlation was found between the reduction ratio and the ADC of the tumor in each follow-up. Inflammation of the liver occurs after treatment as a result of radiation doses from the ion beam, and the tumor reaches a state of necrosis. ADC value analysis provides a non-invasive assessment and yields focal information regarding the tumor and liver before and after ion beam therapy.

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Clinical results of fractionated proton therapy

Cited by 87 publications

References 34 publications

Proton Beam Therapy for Hepatocellular Carcinoma: A Retrospective Review of 162 Patients

Proton Beam Therapy for Hepatocellular Carcinoma: A Retrospective Review of 162 Patients

Vision : Proton therapy

Preliminary study of apparent diffusion coefficient assessment after ion beam therapy for hepatocellular carcinoma

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