Abstract
We evaluated the effectiveness and toxicity of proton beam therapy (PBT) for hepatocellular carcinomas (HCC) >5 cm without fiducial markers using four-dimensional CT (4D-CT) planning. The subjects were 29 patients treated at our hospital between March 2011 and March 2015. The median total dose was 76 Cobalt Gray Equivalents (CGE) in 20 fractions (range; 66–80.5 CGE in 10–32 fractions). Therapy was delivered with end-expiratory phase gating. An internal target volume (ITV) margin was added through the analysis of respiratory movement with 4D-CT. Patient age ranged from 38 to 87 years (median, 71 years). Twenty-four patients were Child–Pugh class A and five patients were class B. Tumor size ranged from 5.0 to 13.9 cm (median, 6.9 cm). The follow-up period ranged from 2 to 72 months (median; 27 months). All patients completed PBT according to the treatment protocol without grade 4 (CTCAE v4.03 (draft v5.0)) or higher adverse effects. The two-year local tumor control (LTC), progression-free survival (PFS), and overall survival (OS) rates were 95%, 22%, and 61%, respectively. The LTC was not inferior to that of previous reports using fiducial markers. Respiratory-gated PBT with 4D-CT planning without fiducial markers is a less invasive and equally effective treatment for large HCCs as PBT with fiducial markers.
Highlights
Hepatocellular carcinoma (HCC) is a common cancer in East Asia, including Japan, where hepatitis B and hepatitis C infection are prevalent [1]
There were some significant factors associated with progression-free survival (PFS) in univariate analysis: T stage, size of tumor, planning target volume (PTV), operability, and history of prior treatment
This suggests that our method offers effective treatment without the need for fiducial markers
Summary
Hepatocellular carcinoma (HCC) is a common cancer in East Asia, including Japan, where hepatitis B and hepatitis C infection are prevalent [1]. Classic photon radiation therapy has rarely been used in HCC because the dose tolerance of normal liver tissue is considerably lower than that necessary for tumor control. Highly conformal radiotherapy, such as stereotactic body radiation therapy (SBRT), has been reported to achieve good control for small HCCs with a tolerable liver dose [6,7]. Recent studies have reported that PBT for HCC achieves good local control with less toxicity than photon therapy [9,10]. Combining the 4D-CT planning technique and adaptive PBT with frequent evaluation of the target during treatment may allow for PBT without fiducial markers. We evaluated the effectiveness and toxicity of 4D-CT planning for PBT for large HCCs (>5 cm) without fiducial markers
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