title: Proton beam therapy for hepatocellular carcinoma patients with severe cirrhosis.
abstract: OBJECTIVE
  Hepatocellular carcinoma (HCC) patients with severe cirrhosis are usually treated with supportive care because of their poor prognosis. However, the survival of severe cirrhotic patients has recently improved due to advanced treatments. The aim of this study was to define the role of proton beam therapy for HCC patients with severe cirrhosis.
  
  
  METHODS
  19 HCC patients with Child-Pugh class C cirrhosis received proton beam therapy. The hepatic tumors were solitary in 14 patients and multiple in five, and the tumor size was 25-80 mm (median 40 mm) in maximum diameter. No patient had regional lymph node or distant metastasis. Total doses of 50-84 Gy (median 72 Gy) in ten to 24 fractions (median 16) were delivered to the tumors.
  
  
  RESULTS
  Of the 19 patients, six, eight and four died of cancer, liver failure and intercurrent diseases, respectively, during the follow-up period of 3-63 months (median 17 months) after treatment. A remaining patient was alive with no evidence of disease 33 months after treatment. All but one of irradiated tumors were controlled during the follow-up period. Ten patients had new intrahepatic tumors outside the irradiated volume. The overall and progression-free survival rates were 53% and 47% at 1 year, respectively, and 42% each at 2 years. Performance status and Child-Pugh score were significant prognostic factors for survival. Therapy-related toxicity of grade 3 or more was not observed.
  
  
  CONCLUSIONS
  Proton beam therapy for HCC patients with severe cirrhosis was tolerable. It may improve survival for patients with relatively good general condition and liver function.
authors.affiliation: Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki, Japan.
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 / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D002423:Cause of Death; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications* / Q000175:diagnosis / Q000401:mortality / Q000473:pathology; D017093:Liver Failure / Q000401:mortality / Q000473:pathology; D008113:Liver Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009378:Neoplasms, Multiple Primary / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D011379:Prognosis; D061766:Proton Therapy; D011832:Radiation Injuries / Q000209:etiology; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D016019:Survival Analysis; D017356:Synchrotrons; D014057:Tomography, X-Ray Computed; D011522:Protons
chemical_list: D011522:Protons