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Cancers (Basel). 2019 Feb 15;11(2). pii: E230. doi: 10.3390/cancers11020230.

Does Risk-Adapted Proton Beam Therapy Have a Role as a Complementary or Alternative Therapeutic Option for Hepatocellular Carcinoma?

Author information

1
Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang 410-769, Korea. k2onco@ncc.re.kr.
2
Center for Proton Therapy, Research Institute and Hospital, National Cancer Center, Goyang 410-769, Korea. k2onco@ncc.re.kr.
3
Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang 410-769, Korea. jwpark1@ncc.re.kr.
4
Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang 410-769, Korea. bohkim@ncc.re.kr.
5
Center for Proton Therapy, Research Institute and Hospital, National Cancer Center, Goyang 410-769, Korea. 12777@ncc.re.kr.
6
Center for Proton Therapy, Research Institute and Hospital, National Cancer Center, Goyang 410-769, Korea. shmoon@ncc.re.kr.
7
Center for Proton Therapy, Research Institute and Hospital, National Cancer Center, Goyang 410-769, Korea. sangsookim@ncc.re.kr.
8
Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang 410-769, Korea. wsm@ncc.re.kr.
9
Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang 410-769, Korea. mrikyh@ncc.re.kr.
10
Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang 410-769, Korea. lwj@ncc.re.kr.
11
Center for Proton Therapy, Research Institute and Hospital, National Cancer Center, Goyang 410-769, Korea. radiopia@ncc.re.kr.
12
Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang 410-769, Korea. cmkim53@ncc.re.kr.

Abstract

To evaluate the role of risk-adapted proton beam therapy (PBT) in hepatocellular carcinoma (HCC) patients, a total of 243 HCC patients receiving risk-adapted PBT with three dose-fractionation regimens (regimen A [n = 40], B [n = 60], and C [n = 143]) according to the proximity of their gastrointestinal organs (<1 cm, 1⁻1.9 cm, and ≥2 cm, respectively) were reviewed: The prescribed doses to planning target volume 1 (PTV1) were 50 gray equivalents (GyE) (EQD2 [equivalent dose in 2 Gy fractions], 62.5 GyE10), 60 GyE (EQD2, 80 GyE10), and 66 GyE (EQD2, 91.3 GyE10) in 10 fractions, respectively, and those of PTV2 were 30 GyE (EQD2, 32.5 GyE10) in 10 fractions. In all patients, the five-year local recurrence-free survival (LRFS) and overall survival (OS) rates were 87.5% and 48.1%, respectively, with grade ≥3 toxicity of 0.4%. In regimens A, B, and C, the five-year LRFS and OS rates were 54.6%, 94.7%, and 92.4% (p < 0.001), and 16.7%, 39.2%, and 67.9% (p < 0.001), respectively. The five-year OS rates of the patients with the Modified Union for International Cancer Control (mUICC) stages I, II, III, and IVA and Barcelona Clinic Liver Cancer (BCLC) stages A, B, and C were 69.2%, 65.4%, 43.8%, and 26.6% (p < 0.001), respectively, and 65.1%, 40%, and 32.2% (p < 0.001), respectively. PBT could achieve promising long-term tumor control and have a potential role as a complementary or alternative therapeutic option across all stages of HCC.

KEYWORDS:

hepatocellular carcinoma; overall survival; proton beam therapy

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