Proton beam therapy for hepatocellular carcinoma: a comparison of three treatment protocols.
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.
Mizumoto
Masashi
M
Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki, Japan.
Okumura
Toshiyuki
T
Hashimoto
Takayuki
T
Fukuda
Kuniaki
K
Oshiro
Yoshiko
Y
Fukumitsu
Nobuyoshi
N
Abei
Masato
M
Kawaguchi
Atsushi
A
Hayashi
Yasutaka
Y
Ookawa
Ayako
A
Hashii
Haruko
H
Kanemoto
Ayae
A
Moritake
Takashi
T
Tohno
Eriko
E
Tsuboi
Koji
K
Sakae
Takeji
T
Sakurai
Hideyuki
H
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
D011522:Protons