title: Proton beam therapy for hepatocellular carcinoma with limited treatment options.
abstract: BACKGROUND
  The authors conducted a retrospective review to define the usefulness of proton beam therapy for patients who had hepatocellular carcinoma (HCC) with limited treatment options.
  
  
  METHODS
  Twenty-one patients with HCC for whom other treatment modalities either were contraindicative or were unfeasible because of coexisting diseases and unfavorable conditions received proton beam therapy. Four patients had renal failure, 2 patients had severe heart disease, 9 patients had severe cirrhosis, 1 patient had aplastic anemia, 1 patient had a dissecting abdominal aortic aneurysm before treatment, and 4 patients had bleeding tendency or unresectable tumors. Moreover, 2 of the latter 4 patients were allergic to iodine, and 2 other patients were unable to be catheterized for transcatheter arterial chemoembolization. Hepatic tumors were solitary in 14 patients and multiple in 7 patients, and the tumors ranged in greatest dimension from 25 mm to 100 mm (median, 40 mm). No patient had regional lymph node or distant metastasis. Total doses of 63 grays (Gy) to 84 Gy (median, 73 Gy) in 13 to 27 fractions (median, 18 fractions) were used for tumor treatments.
  
  
  RESULTS
  All but 1 of the irradiated tumors were controlled at a median follow-up of 3.3 years. The objective response rate was 81%, and the primary site-control rate was 93% at 5 years. Eleven patients had intrahepatic recurrences, and 2 patients had distant metastases in the lungs. Four of 11 patients with intrahepatic recurrences received a second course of proton beam therapy, and all recurrent tumors were controlled. The overall and cause-specific survival rates were 62% and 82% at 2 years, respectively, and 33% and 67% at 5 years, respectively. Grade > or =3 therapy-related toxicities were not observed.
  
  
  CONCLUSIONS
  Proton beam therapy was safe and effective for a variety of patients with HCC. The current results suggested that this method was tolerable and effective, even for patients with HCC who had limited treatment options.
authors.affiliation: Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki, Japan. mhata@syd.odn.ne.jp
authors.forename: Masaharu
authors.initials: M
authors.lastname: Hata
authors.forename: Koichi
authors.initials: K
authors.lastname: Tokuuye
authors.forename: Shinji
authors.initials: S
authors.lastname: Sugahara
authors.forename: Nobuyoshi
authors.initials: N
authors.lastname: Fukumitsu
authors.forename: Takayuki
authors.initials: T
authors.lastname: Hashimoto
authors.forename: Kayoko
authors.initials: K
authors.lastname: Ohnishi
authors.forename: Keiko
authors.initials: K
authors.lastname: Nemoto
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Ohara
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Matsuzaki
authors.forename: Yasuyuki
authors.initials: Y
authors.lastname: Akine
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000628:therapy*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D061766:Proton Therapy; D016896:Treatment Outcome; D011522:Protons
chemical_list: D011522:Protons