Repeated proton beam therapy for hepatocellular carcinoma.
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.
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ABSTRACT: In the 15th Nationwide follow-up survey of primary liver cancer, 18,843 newly registered patients (1998-1999) and 18,405 follow-up patients from 791 hospitals in Japan were analyzed. Of the newly registered patients, approximately 95% were patients with hepatocellular carcinoma (HCC) and 3.3% had intrahepatic cholangiocarcinoma (ICC). The patients were assessed using 194 items that were related to epidemiological and clinicopathological factors, diagnosis, and treatment. Furthermore, the survival rates of all of the newly registered patients in the 10th-15th follow-up survey were calculated for each histological type, background factor(s) and treatment, respectively. In patients with hepatocellular carcinoma, the survival rates of patients who underwent hepatectomy, ethanol injection therapy, microwave coagulation therapy, or transcatheter arterial embolization were calculated by tumor size, tumor number, and clinical stage. This follow-up survey will be helpful to assess the progress of research and medical practice in the treatment of primary liver cancer.Hepatology Research 02/2004; 28(1):21-29. · 2.07 Impact Factor
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ABSTRACT: The importance of knowledge on tolerance of normal tissue organs to irradiation by radiation oncologists cannot be overemphasized. Unfortunately, current knowledge is less than adequate. With the increasing use of 3-D treatment planning and dose delivery, this issue, particularly volumetric information, will become even more critical. As a part of the NCI contract N01 CM-47316, a task force, chaired by the primary author, was formed and an extensive literature search was carried out to address this issue. In this issue. In this manuscript we present the updated information on tolerance of normal tissues of concern in the protocols of this contract, based on available data, with a special emphasis on partial volume effects. Due to a lack of precise and comprehensive data base, opinions and experience of the clinicians from four universities involved in the contract have also been contributory. Obviously, this is not and cannot be a comprehensive work, which is beyond the scope of this contract.International Journal of Radiation OncologyBiologyPhysics 06/1991; 21(1):109-22. · 4.52 Impact Factor
Article: Partial irradiation of the liver.[show abstract] [hide abstract]
ABSTRACT: The use of three-dimensional radiotherapy (RT) and the prospective follow-up of patients for radiation-induced liver disease (RILD) have led to a more quantitative understanding of the partial organ tolerance of the liver compared with previous estimates based on clinical judgment alone. Parameters of both the Lyman normal tissue complication probability (NTCP) model and a local damage-organ injury (D-I) NTCP model have been fit to clinical data from patients who have received hepatic radiation. Based on analyses of over 180 patients, the liver exhibits a large volume effect and a low threshold volume for RILD. Mean liver dose is associated with RILD, and no cases of RILD have been reported in patients with a mean liver dose of less than 31 Gy. Most recent estimates of the partial liver tolerance to RT suggest that if less than 25% of the normal liver is treated with RT, then there may be no upper limit on dose associated with RILD. Estimates of the liver doses associated with a 5% risk of RILD for uniform irradiation of one third, two thirds, and the whole liver are 90 Gy, 47 Gy, and 31 Gy, respectively.Seminars in Radiation Onchology 08/2001; 11(3):240-6. · 3.97 Impact Factor