Proton beam therapy for hepatocellular carcinoma with portal vein tumor thrombus

Hata, Masaharu; Tokuuye, Koichi; Sugahara, Shinji; Kagei, Kenji; Igaki, Hiroshi; Hashimoto, Takayuki; Ohara, Kiyoshi; Matsuzaki, Yasushi; Tanaka, Naomi; Akine, Yasuyuki

doi:10.1002/cncr.21237

Cited by 99 publications

(57 citation statements)

References 38 publications

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“…Despite technical limitations imposed by fixed gantries, an analysis of patients treated at this facility showed excellent local control rates with minimal adverse effects. [12][13][14][15] In November 2001, a hospital-based proton beam therapy facility opened, featuring rotational gantries. A total of 333 patients with hepatocellular carcinoma were treated at the new facility between November 2001 and December 2007.…”

Section: -5mentioning

confidence: 99%

Proton beam therapy for hepatocellular carcinoma

Nakayama

Sugahara

Tokita

et al. 2009

Cancer

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118

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BACKGROUND:The authors have published a series of studies evaluating the safety and efficacy of proton beam therapy for the treatment of hepatocellular carcinoma in a variety of clinical settings. In the current study, they retrospectively reviewed their entire experience treating hepatocellular carcinoma patients with proton beam therapy at their hospital-based facility at the University of Tsukuba. METHODS: From November 2001 to December 2007, 333 patients with hepatocellular carcinoma were treated with proton beam therapy at the University of Tsukuba. A total of 318 patients were included in this study. Total dose delivered and fractionation scheme were determined by protocols that varied based on location of tumor. Survival rates and prognostic factors were assessed. RESULTS: Overall actuarial survival rates at 1-year, 3-years, and 5-years were 89.5% (95% confidence interval [95% CI], 85.7-93.1%), 64.7% (95% CI, 56.6-72.9%), and 44.6% (95% CI, 29.7-59.5%), respectively. Child-Pugh liver function (hazards ratio [HR], 2.84; P < .01), T stage (HR, 1.94; P < .05), performance status (HR, 2.12; P < .01), and planning target volume (HR, 2.12; P < .05) significantly impacted survival. The 3-year and 5-year survival rates were 69.1% (95% CI, 59.9-78.3%) and 55.9% (95% CI, 41.5-70.3%), respectively, for patients with Child-Pugh A disease and 51.9% (95% CI, 32.3-71.5%) and 44.5% (95% CI, 23.1-65.8%), respectively, for patients with Child-Pugh B disease. The actuarial survival rates of patients with Child-Pugh class A were statistically different between groups of planned target volume 125 mL and >125 mL (P < .05). CONCLUSIONS: The authors have shown proton beam therapy to be both safe and effective for the treatment of patients with hepatocellular carcinoma. They strongly recommend the consideration of proton beam therapy in patients for whom other treatment options are risky or contraindicated.

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Section: -5mentioning

confidence: 99%

Proton beam therapy for hepatocellular carcinoma

Nakayama

Sugahara

Tokita

et al. 2009

Cancer

Self Cite

118

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“…We report our updated results on the use of PBT [13] for HCC patients with PVTT treated from 1991 through 2005.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2009

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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 with portal vein tumor thrombus

Cited by 99 publications

References 38 publications

Proton beam therapy for hepatocellular carcinoma

Proton beam therapy for hepatocellular carcinoma

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

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

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