How small is TOO small? New liver constraint is needed— Proton therapy of hepatocellular carcinoma patients with small normal liver

Lee, Ching-Hsin; Hung, Sheng-Ping; Hong, Ji-Hong; Chang, Joseph Tung-Chieh; Tsang, Ngan‐Ming; Chan, Kun‐Ming; Tseng, Jeng‐Hwei; Huang, Shih‐Chiang; Lin, Shi‐Ming; Lien, Jau Min; Liu, Nai‐Jen; Lin, Chen‐Chun; Chen, Wei‐Ting; Chen, Wan‐Yu; Chen, Po-Jui; Huang, Bing‐Shen

doi:10.1371/journal.pone.0203854

Cited by 10 publications

(12 citation statements)

References 40 publications

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“…Lee et al analyzed 22 HCC patients with a small normal liver volume (< 800 cm 3 ) who were treated with proton radiotherapy. The oncological results were a 1-year infield local control rate of 95.5% and a 1-year OS rate of 81.8%; there were no cases of liver failure, and only one case of nonclassic RILD could be identified [18]. In the present study, 83.4% (n = 92) of the patients included in the PSM series had multiple tumors or a largest tumor size > 5 cm, and the risk of RILD would therefore be high with photon radiotherapy.…”

Section: Discussionmentioning

confidence: 95%

Proton versus photon radiotherapy for primary hepatocellular carcinoma: a propensity-matched analysis

et al. 2020

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Background: Proton radiotherapy has a dosimetric advantage over photon radiotherapy. Many retrospective studies have shown promising results with proton radiotherapy in treating hepatocellular carcinoma (HCC). However, clinical evidence demonstrating the benefit of protons over photons is still limited. We therefore compared the clinical outcomes of the two modalities using medical research databases from our medical foundation. Methods: We conducted a propensity score-matched cohort study based on our multi-institution medical organization research database. From January 2007 to January 2018, a total of 413 patients (photon: 349; proton: 64) who were diagnosed with HCC and primarily treated with radiotherapy with curative intent were enrolled. Overall survival (OS) and radiation-induced liver disease (RILD) were assessed. Stratified analysis was also performed to evaluate the heterogeneous effects of the two arms. Results: A total of 110 patients (photon: 55; proton: 55) were analyzed in the propensity-matched series. The matched groups were balanced for baseline tumor risk factors. Cox regression analysis revealed a significant survival benefit in the proton group (p = 0.032, HR 0.56, 95% CI 0.33-0.96). The median overall survival in the proton group was not reached and that in the photon group was 17.4 months. The biological equivalent dose of radiotherapy was significantly higher in the proton group than in the photon group (median, 96.56 Gray [relative biological effectiveness] vs. 62.5 Gray, p < 0.001). The risk of RILD was significantly lower in the proton group (11.8% vs. 36%, p = 0.004). Conclusions: Proton radiotherapy could deliver a higher radiation dose than photon radiotherapy without increasing the risk of RILD and result in a better overall survival rate for those diagnosed with HCC and treated with radiotherapy with curative intent.

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Section: Discussionmentioning

confidence: 95%

Proton versus photon radiotherapy for primary hepatocellular carcinoma: a propensity-matched analysis

et al. 2020

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“…Lee et al analyzed 22 HCC patients with a small normal liver volume (< 800 cm 3 ) who were treated with proton radiotherapy. The oncological results were a 1-year in-field local control rate of 95.5% and a 1-year OS rate of 81.8%; there were no cases of liver failure, and only one case of nonclassic RILD could be identified [18]. In the present study, 83.4% (n = 92) of the patients included in the PSM series had multiple tumors or a largest tumor size > 5 cm, and the risk of RILD would therefore be high with photon radiotherapy.…”

Section: Discussionmentioning

confidence: 95%

Proton versus photon radiotherapy for primary hepatocellular carcinoma: A propensity-matched analysis

Cheng

Liu

Wang

et al. 2020

Preprint

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Abstract Background Proton radiotherapy has a dosimetric advantage over photon radiotherapy. Many retrospective studies have shown promising results with proton radiotherapy for treating hepatocellular carcinoma (HCC). However, clinical evidence demonstrating the benefit of protons over photons is still limited. We therefore compared clinical outcomes for the two modalities using medical research databases from our medical foundation.Methods We conducted a propensity score-matched cohort study based on our multi-institution medical organization research database. From January 2007 to January 2018, a total of 413 patients (photon: 349; proton: 64) who were diagnosed with HCC and primarily treated with radiotherapy with curative intent were enrolled. Overall survival (OS) and radiation-induced liver disease (RILD) were assessed. Stratified analysis was also performed to evaluate the heterogeneous effects of the two arms.Results A total of 110 patients (photon: 55; proton: 55) were analyzed in the propensity-matched series. The matched groups were balanced for baseline tumor risk factors. Cox regression analysis revealed a significant survival benefit in the proton group (p = 0.032, HR 0.56, 95 CI 0.33–0.96). The median overall survival in the proton and photon group was not reached and 17.4 months, respectively. The biological equivalent dose for radiotherapy was significantly higher in the proton group than the photon group (median, 96.56 Gray vs. 62.5 Gray, p < 0.001). The risk of RILD was significantly lower in the proton group (11.8% vs. 36%, p = 0.004).Conclusions Proton radiotherapy could deliver a higher radiation dose without increasing the risk of RILD and result in a better overall survival rate for those diagnosed with HCC and treated with radiotherapy with curative intent.

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“…Lee et al analyzed 22 HCC patients with a small normal liver volume (< 800 cm 3 ) who were treated with proton radiotherapy. The oncological results were a 1-year in-eld local control rate of 95.5% and a 1-year OS rate of 81.8%; there were no cases of liver failure, and only one case of nonclassic RILD could be identi ed [18]. In the present study, 83.4% (n=92) of the patients included in the PSM series had multiple tumors or a largest tumor size >5 cm, and the risk of RILD would therefore be high with photon radiotherapy.…”

Section: Discussionmentioning

confidence: 96%

Proton versus photon radiotherapy for primary hepatocellular carcinoma: A propensity-matched analysis

Cheng

Liu

Wang

et al. 2020

Preprint

Self Cite

View full text Add to dashboard Cite

Abstract Background Proton radiotherapy has a dosimetric advantage over photon radiotherapy. Many retrospective studies have shown promising results with proton radiotherapy in treating hepatocellular carcinoma (HCC). However, clinical evidence demonstrating the benefit of protons over photons is still limited. We therefore compared the clinical outcomes of the two modalities using medical research databases from our medical foundation.Methods We conducted a propensity score-matched cohort study based on our multi-institution medical organization research database. From January 2007 to January 2018, a total of 413 patients (photon: 349; proton: 64) who were diagnosed with HCC and primarily treated with radiotherapy with curative intent were enrolled. Overall survival (OS) and radiation-induced liver disease (RILD) were assessed. Stratified analysis was also performed to evaluate the heterogeneous effects of the two arms.Results A total of 110 patients (photon: 55; proton: 55) were analyzed in the propensity-matched series. The matched groups were balanced for baseline tumor risk factors. Cox regression analysis revealed a significant survival benefit in the proton group (p=0.032, HR 0.56, 95% CI 0.33-0.96). The median overall survival in the proton group was not reached and that in the photon group was 17.4 months. The biological equivalent dose of radiotherapy was significantly higher in the proton group than in the photon group (median, 96.56 Gray [relative biological effectiveness] vs. 62.5 Gray, p<0.001). The risk of RILD was significantly lower in the proton group (11.8% vs. 36%, p=0.004).Conclusions Proton radiotherapy could deliver a higher radiation dose than photon radiotherapy without increasing the risk of RILD and result in a better overall survival rate for those diagnosed with HCC and treated with radiotherapy with curative intent.

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How small is TOO small? New liver constraint is needed— Proton therapy of hepatocellular carcinoma patients with small normal liver

Cited by 10 publications

References 40 publications

Proton versus photon radiotherapy for primary hepatocellular carcinoma: a propensity-matched analysis

Proton versus photon radiotherapy for primary hepatocellular carcinoma: a propensity-matched analysis

Proton versus photon radiotherapy for primary hepatocellular carcinoma: A propensity-matched analysis

Proton versus photon radiotherapy for primary hepatocellular carcinoma: A propensity-matched analysis

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