Proton-Beam Therapy for Hepatocellular Carcinoma Associated with Portal Vein Tumor Thrombosis*

Sugahara, Shinji; Nakayama, Hidetsugu; Fukuda, Kuniaki; Mizumoto, Masashi; Tokita, Mari; Abei, Masato; Shoda, Junichi; Matsuzaki, Yasushi; Thono, Eriko; Tsuboi, Koji; Tokuuye, Koichi

doi:10.1007/s00066-009-2020-x

Cited by 112 publications

(81 citation statements)

References 39 publications

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“…A series of 35 patients with HCC portal venous thrombosis received treatment of 50 to 72 CGE which resulted in local control rates of over 45% at 2 years. Only 3 of these patients developed severe acute toxicity (36). The excellent conformality of proton beams may open up the possibilities for retreatment in the case of HCC progression or for synchronous tumors arising elsewhere in the liver.…”

Section: Clinical Outcomes Of Hcc Treated With Proton Radiotherapymentioning

confidence: 99%

“…One of the larger prospective studies was a phase II trial examining outcomes of proton radiotherapy in HCC patients with cirrhosis demonstrated a 66% 2-year overall survival rate after delivering 76 CGE in 3.8 CGE daily fractions (36). Loma Linda University reported results of the largest prospective phase II trial describing the use of proton radiotherapy in patients with HCC.…”

Section: Clinical Outcomes Of Hcc Treated With Proton Radiotherapymentioning

confidence: 99%

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Proton therapy for hepatocellular carcinoma

Ling

Kang

Bush

et al. 2012

Chin. J. Cancer Res.

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Proton radiotherapy has seen an increasing role in the treatment of hepatocellular carcinoma (HCC). Historically, external beam radiotherapy has played a very limited role in HCC due to a high incidence of toxicity to surrounding normal structures. The ability to deliver a high dose of radiation to the tumor is a key factor in improving outcomes in HCC. Advances in photon radiotherapy have improved dose conformity and allowed dose escalation to the tumor. However, despite these advances there is still a large volume of normal liver that receives a considerable radiation dose during treatment. Proton beams do not have an exit dose along the beam path once they enter the body. The inherent physical attributes of proton radiotherapy offer a way to maximize tumor control via dose escalation while avoiding excessive radiation to the remaining liver, thus increasing biological effectiveness. In this review we discuss the physical attributes and rationale for proton radiotherapy in HCC. We also review recent literature regarding clinical outcomes of using proton radiotherapy for the treatment of HCC.

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Section: Clinical Outcomes Of Hcc Treated With Proton Radiotherapymentioning

confidence: 99%

Section: Clinical Outcomes Of Hcc Treated With Proton Radiotherapymentioning

confidence: 99%

Proton therapy for hepatocellular carcinoma

Ling

Kang

Bush

et al. 2012

Chin. J. Cancer Res.

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“…Local control rates upto 45% for 2 years have been reported. 22 Similarly encouraging responses with retreatment for recurrent or synchronous HCC have been reported with 5-year local control rate of 87.8% and 5-year overall survival rate of 56%. 23 A prospective phase II trial had reported preliminary results in 34 cases of unresectable HCC with 2-year local control of 75% and overall survival of 55% and no incidence of RILD.…”

Section: Charged Particle Therapymentioning

confidence: 68%

Role of External Beam Radiation Therapy in Management of Hepatocellular Carcinoma

Sharma

2014

Journal of Clinical and Experimental Hepatology

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Diagnosis at advanced disease stage and early vascular invasion are the bane of majority of patients with hepatocellular carcinoma (HCC) in India. The currently standardized curative and palliative treatment modalities [surgery, ablative techniques, trans-catheter chemotherapy, systemic chemotherapy] are suboptimal for a significant proportion of disease stages. Interest in radiotherapy for hepatocellular carcinoma has seen a resurgence with revolutionary improvements in targeting radiation doses safely. Encouraging results have been reported with a host of radiation techniques from conformal radiotherapy, stereotactic whole body radiation therapy to charged particle based therapies. The dissemination of this knowledge has been slow across other specialties involved in care of patients with HCC. However the increasing availability of radiotherapy services predicts a hopeful future for wider evaluation of radiotherapy in HCC. ( J CLIN EXP HEPATOL 2014;4:S122-S125)

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“…Along with these two high-volume studies, the group has also extensively published subgroup analyses on HCC associated with severe cirrhosis (42,43), severe ascites (30), portal vein tumor thrombosis (44,45), porta hepatis involvement (46), limited treatment options (47), elderly patients (48), LR (29,36), tumor adjacent to the GI tract (49), large-sized tumors (50), and altered fractionation (51,52).…”

Section: Livermentioning

confidence: 99%

Clinical outcomes and toxicities of proton radiotherapy for gastrointestinal neoplasms: a systematic review

Verma

Lin

Simone

et al. 2016

J. Gastrointest. Oncol.

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Background: Proton beam radiotherapy (PBT) is frequently shown to be dosimetrically superior to photon radiotherapy (RT), though supporting data for clinical benefit are severely limited. Because of the potential for toxicity reduction in gastrointestinal (GI) malignancies, we systematically reviewed the literature on clinical outcomes (survival/toxicity) of PBT. Methods: A systematic search of PubMed, EMBASE, abstracts from meetings of the American Society for Radiation Oncology, Particle Therapy Co-Operative Group, and American Society of Clinical Oncology was conducted for publications from 2000-2015. Thirty-eight original investigations were analyzed. Results: Although results of PBT are not directly comparable to historical data, outcomes roughly mirror previous data, generally with reduced toxicities for PBT in some neoplasms. For esophageal cancer, PBT is associated with reduced toxicities, postoperative complications, and hospital stay as compared to photon radiation, while achieving comparable local control (LC) and overall survival (OS). In pancreatic cancer, numerical survival for resected/unresected cases is also similar to existing photon data, whereas grade ≥3 nausea/emesis and post-operative complications are numerically lower than those reported with photon RT.The strongest data in support of PBT for HCC comes from phase II trials demonstrating very low toxicities, and a phase III trial of PBT versus transarterial chemoembolization demonstrating trends towards improved LC and progression-free survival (PFS) with PBT, along with fewer post-treatment hospitalizations. Survival and toxicity data for cholangiocarcinoma, liver metastases, and retroperitoneal sarcoma are also roughly equivalent to historical photon controls. There are two small reports for gastric cancer and three for anorectal cancer; these are not addressed further. Conclusions: Limited quality (and quantity) of data hamper direct comparisons and conclusions. However, the available data, despite the inherent caveats and limitations, suggest that PBT offers the potential to achieve significant reduction in treatment-related toxicities without compromising survival or LC for multiple GI malignancies. Several randomized comparative trials are underway that will provide more definitive answers.

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Proton-Beam Therapy for Hepatocellular Carcinoma Associated with Portal Vein Tumor Thrombosis*

Abstract: PBT improved local control and significantly prolonged survival in HCC patients with PVTT.

Cited by 112 publications

References 39 publications

Proton therapy for hepatocellular carcinoma

Proton therapy for hepatocellular carcinoma

Role of External Beam Radiation Therapy in Management of Hepatocellular Carcinoma

Clinical outcomes and toxicities of proton radiotherapy for gastrointestinal neoplasms: a systematic review

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