title: Proton beam therapy for hepatocellular carcinoma: a comparison of three treatment protocols.
abstract: BACKGROUND
  Our previous results for treatment of hepatocellular carcinoma (HCC) with proton beam therapy revealed excellent local control with low toxicity. Three protocols were used to avoid late complications such as gastrointestinal ulceration and bile duct stenosis. In this study, we examined the efficacy of these protocols.
  
  
  METHODS
  The subjects were 266 patients (273 HCCs) treated by proton beam therapy at the University of Tsukuba between January 2001 and December 2007. Three treatment protocols (A, 66 GyE in 10 fractions; B, 72.6 GyE in 22 fractions; and C, 77 GyE in 35 fractions) were used, depending on the tumor location.
  
  
  RESULTS
  Of the 266 patients, 104, 95, and 60 patients were treated with protocols A, B, and C, respectively. Seven patients with double lesions underwent two different protocols. The overall survival rates after 1, 3 and 5 years were 87%, 61%, and 48%, respectively (median survival, 4.2 years). Multivariate analysis showed that better liver function, small clinical target volume, and no prior treatment (outside the irradiated field) were associated with good survival. The local control rates after 1, 3, and 5 years were 98%, 87%, and 81%, respectively. Multivariate analysis did not identify any factors associated with good local control.
  
  
  CONCLUSIONS
  This study showed that proton beam therapy achieved good local control for HCC using each of three treatment protocols. This suggests that selection of treatment schedules based on tumor location may be used to reduce the risk of late toxicity and maintain good treatment efficacy.
authors.affiliation: Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki, Japan.
authors.forename: Masashi
authors.initials: M
authors.lastname: Mizumoto
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Okumura
authors.forename: Takayuki
authors.initials: T
authors.lastname: Hashimoto
authors.forename: Kuniaki
authors.initials: K
authors.lastname: Fukuda
authors.forename: Yoshiko
authors.initials: Y
authors.lastname: Oshiro
authors.forename: Nobuyoshi
authors.initials: N
authors.lastname: Fukumitsu
authors.forename: Masato
authors.initials: M
authors.lastname: Abei
authors.forename: Atsushi
authors.initials: A
authors.lastname: Kawaguchi
authors.forename: Yasutaka
authors.initials: Y
authors.lastname: Hayashi
authors.forename: Ayako
authors.initials: A
authors.lastname: Ookawa
authors.forename: Haruko
authors.initials: H
authors.lastname: Hashii
authors.forename: Ayae
authors.initials: A
authors.lastname: Kanemoto
authors.forename: Takashi
authors.initials: T
authors.lastname: Moritake
authors.forename: Eriko
authors.initials: E
authors.lastname: Tohno
authors.forename: Koji
authors.initials: K
authors.lastname: Tsuboi
authors.forename: Takeji
authors.initials: T
authors.lastname: Sakae
authors.forename: Hideyuki
authors.initials: H
authors.lastname: Sakurai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D002985:Clinical Protocols; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D061766:Proton Therapy; D011832:Radiation Injuries / Q000473:pathology; D015996:Survival Rate; D047368:Tumor Burden; D011522:Protons
chemical_list: D011522:Protons