Article

Repeated proton beam therapy for hepatocellular carcinoma.

Proton Medical Research Center, Institute of Clinical Medicine, University of Tsukuba, Ibaraki, Japan.
International Journal of Radiation OncologyBiologyPhysics (Impact Factor: 4.52). 06/2006; 65(1):196-202. DOI: 10.1016/j.ijrobp.2005.11.043
Source: PubMed

ABSTRACT To retrospectively evaluate the safety and effectiveness of repeated proton beam therapy for newly developed or recurrent hepatocellular carcinoma (HCC).
From June 1989 through July 2000, 225 patients with HCC underwent their first course of proton beam therapy at the University of Tsukuba. Of them, 27 with 68 lesions who had undergone two or more courses were retrospectively reviewed in this study. Median interval between the first and second course was 24.5 months (range 3.3-79.8 months). Median total dose of 72 Gy in 16 fractions and 66 Gy in 16 fractions were given for the first course and the rest of the courses, respectively.
The 5-year survival rate and median survival period from the beginning of the first course for the 27 patients were 55.6% and 62.2 months, respectively. Five-year local control rate for the 68 lesions was 87.8%. Of the patients, 1 with Child-Pugh class B and another with class C before the last course suffered from acute hepatic failure.
Repeated proton beam therapy for HCC is safe when the patient has a target in the peripheral region of the liver and liver function is Child-Pugh class A.

0 Bookmarks
 · 
89 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Due to advances in technical radiotherapy delivery over the past two decades there has been a rapid increase in the use of radiotherapy for intrahepatic malignancies. This overview provides a succinct summary of the current evidence for external beam radiotherapy in the management of primary liver tumours, highlighting areas for future research. Internationally, hepatocellular carcinoma is a leading cause of cancer death and UK incidence rates are rising rapidly. The main risk factor is chronic liver disease and, as a result, most patients will be unsuitable for curative surgical modalities of treatment. Conformal radiotherapy may be used in patients with localised disease who are unsuitable for alternative local therapies. It may also be used in patients with portal venous thrombosis or for palliation in advanced disease. Caution should be used in patients with pre-existent liver dysfunction (Childs Pugh B or C) due to increased rates of toxicity. Stereotactic body radiotherapy has been used for early stage disease, with promising long-term local control rates and a favourable toxicity profile. Stereotactic body radiotherapy has also been investigated as a 'bridge to transplant'. Charged particle therapy may be used for patients with more advanced liver dysfunction, or as a means of dose escalation, and warrants further investigation in early stage disease. Cholangiocarcinoma is a rare but aggressive primary liver malignancy in which only a minority of patients will be suitable for resection. Conformal radiotherapy and stereotactic body radiotherapy have been used in both the adjuvant and locally advanced settings, although small patient numbers and a lack of prospective trial data limit interpretation of their role. To fully define the role of radiotherapy in the management pathway for primary liver tumours, prospective randomised studies are required.
    Clinical oncology (Royal College of Radiologists (Great Britain)). 06/2014;
  • [Show abstract] [Hide abstract]
    ABSTRACT: This paper aimed to review the literature concerning the use of proton therapy systematically in the treatment of hepatocellular carcinoma, focusing on clinical results and technical issues. The literature search was conducted according to a specific protocol in the Medline and Scopus databases by two independent researchers covering the period of 1990–2012. Both clinical and technical studies referring to a population of patients actually treated with protons were included. The PRISMA guidelines for reporting systematic reviews were followed. A final set of 16 studies from seven proton therapy institutions worldwide were selected from an initial dataset of 324 reports. Seven clinical studies, five reports on technical issues, three studies on treatment related toxicity and one paper reporting both clinical results and toxicity analysis were retrieved. Four studies were not published as full papers. Passive scattering was the most adopted delivery technique. More than 900 patients with heterogeneous stages of disease were treated with various fractionation schedules. Only one prospective full paper was found. Local control was approximately 80% at 3–5 years, average overall survival at 5 years was 32%, with data comparable to surgery in the most favorable groups. Toxicity was low (mainly gastrointestinal). Normal liver V0Gy < 30%volume and V30Gy < 18–25%volume were suggested as cut-off values for hepatic toxicity. The good clinical results of the selected papers are counterbalanced by a low level of evidence. However, the rationale to enroll patients in prospective studies appears to be strong.
    Radiotherapy and Oncology 01/2014; · 4.52 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose To evaluate the feasibility of a respiratory-gated proton beam therapy for liver tumors. Methods and materials Fifteen patients were enrolled in a prospective institutional review board-approved protocol. Eligibility criteria included Childs-Pugh A/B cirrhosis, unresectable biopsy- proven hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (ICC), or metastatic disease (solid tumors only), 1-3 lesions, and tumor size of ≤ 6 cm. Patients received 15 fractions to a total dose of 45-75 GyE [gray equivalent] using respiratory-gated proton beam therapy. Gating was performed with an external respiratory position monitoring based system. Results Of the 15 patients enrolled in this clinical trial, 11 had HCC, 3 had ICC, and 1 had metastasis from another primary. Ten patients had a single lesion, 3 patients had 2 lesions, and 2 patients had 3 lesions. Toxicities were grade 3 bilirubinemia-2, grade 3 gastrointestinal bleed-1, and grade 5 stomach perforation-1. One patient had a marginal recurrence, 3 had hepatic recurrences elsewhere in the liver, and 2 had extrahepatic recurrence. With a median follow-up for survivors of 69 months, 1-, 2-, and 3-year overall survivals are 53%, 40%, and 33%, respectively. Progression-free survivals are 40%, 33%, and 27% at 1, 2, and 3 years, respectively. Conclusions Respiratory-gated proton beam therapy for liver tumors is feasible. Phase 2 studies for primary liver tumors and metastatic tumors are underway.
    Practical Radiation Oncology. 01/2013;