Abstract
Proton beam therapy (PBT) is a curative treatment for hepatocellular carcinoma (HCC), because it can preserve liver function due to dose targeting via the Bragg peak. However, the degree of direct liver damage by PBT is unclear. In this study, we retrospectively analyzed liver/biliary enzymes and total bilirubin (T-Bil) as markers of direct liver damage during and early after PBT in 300 patients. The levels of these enzymes and bilirubin were almost stable throughout the treatment period. In patients with normal pretreatment levels, aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), gamma-glutamyl transpeptidase (GGT), and T-Bil were abnormally elevated in only 2 (1.2%), 1 (0.4%), 0, 2 (1.2%), and 8 (3.5%) patients, respectively, and in 8 of these 13 patients (61.5%) the elevations were temporary. In patients with abnormal pretreatment levels, the levels tended to decrease during PBT. GGT and T-Bil were elevated by 1.62 and 1.57 times in patients who received 66 Gy (RBE) in 10 fractions and 74 Gy (RBE) in 37 fractions, respectively, but again these changes were temporary. These results suggest that direct damage to normal liver caused by PBT is minimal, even if a patient has abnormal pretreatment enzyme levels.
Highlights
Hepatocellular carcinoma (HCC) is the most common cancer in the liver, accounting for approximately 90% of primary liver cancers [1,2,3]
Radiotherapy techniques have progressed in recent decades, and radiotherapy has been used for radical treatment of hepatocellular carcinoma (HCC) for patients who are not indicated for surgical resection or ablative therapy
The proton beam used in Proton beam therapy (PBT) in has a narrow energy peak called the Bragg that can reduce the dose area compared to photon beam therapy, such as stereotactic body radiotherapy and intensity modulated radiotherapy [29,30,31,32]
Summary
Hepatocellular carcinoma (HCC) is the most common cancer in the liver, accounting for approximately 90% of primary liver cancers [1,2,3]. As one modality of radiotherapy, we have obtained many favorable results of proton beam therapy (PBT) for HCC [7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22], including good preservation of liver function after PBT [21]. Cancers 2020, 12, 1840 study, we examined direct liver damage based on analysis of hepatobiliary enzymes and bilirubin, as markers of damage to hepatocytes and cholangiocytes [23,24,25,26,27,28]
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