title: Risk-adapted simultaneous integrated boost-proton beam therapy (SIB-PBT) for advanced hepatocellular carcinoma with tumour vascular thrombosis.
abstract: To evaluate clinical effectiveness and safety of simultaneous integrated boost-proton beam therapy (SIB-PBT) in hepatocellular carcinoma (HCC) patients with tumour vascular thrombosis (TVT).
  
  
  
  Forty-one HCC patients with TVT underwent SIB-PBT using three dose-fractionation schemes: if gross tumour volume <1cm (n=27), 1-1.9cm (n=7), and ⩾2cm (n=7) from gastrointestinal structures, 50GyE (EQD2, 62.5GyE10), 60Gy (EQD2, 80GyE10), 66Gy (EQD2, 91.3GyE10), respectively, in 10 fractions was prescribed to planning target volume 1 (PTV1), and 30GyE (EQD2, 32.5GyE10) in 10 fractions was prescribed to PTV2.
  
  
  
  Overall, treatment was well tolerated, with no grade toxicity ⩾3. Median overall survival (OS) was 34.4months and 2-year local progression-free survival (LPFS), relapse free survival (RFS), and OS rates were 88.1%, 25%, and 51.1%, respectively. Patients treated with EQD2 of ⩾80GyE10tended to show better TVT response (92.8% vs. 55.5%, p=0.002) 2-year LPFS (92.9% vs. 82.5%, p=0.463), RFS (28.8% vs. 19%, p=0.545), and OS (58.4% vs. 46.8%, p=0.428) rates than those with EQD2 of <80GyE10. Multivariate analysis showed that TVT response and Child Pugh classification were independent prognostic factors for OS.
  
  
  
  SIB-PBT is feasible and promising for HCC patients with TVT.
authors.affiliation: Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea.
authors.forename: Dae Yong
authors.initials: DY
authors.lastname: Kim
authors.affiliation: Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea.
authors.forename: Joong-Won
authors.initials: JW
authors.lastname: Park
authors.affiliation: Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea. Electronic address: k2onco@naver.com.
authors.forename: Tae Hyun
authors.initials: TH
authors.lastname: Kim
authors.affiliation: Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea.
authors.forename: Bo Hyun
authors.initials: BH
authors.lastname: Kim
authors.affiliation: Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea.
authors.forename: Sung Ho
authors.initials: SH
authors.lastname: Moon
authors.affiliation: Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea.
authors.forename: Sang Soo
authors.initials: SS
authors.lastname: Kim
authors.affiliation: Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea.
authors.forename: Sang Myung
authors.initials: SM
authors.lastname: Woo
authors.affiliation: Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea.
authors.forename: Young-Hwan
authors.initials: YH
authors.lastname: Koh
authors.affiliation: Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea.
authors.forename: Woo Jin
authors.initials: WJ
authors.lastname: Lee
authors.affiliation: Center for Liver Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Republic of Korea.
authors.forename: Chang-Min
authors.initials: CM
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006528:Carcinoma, Hepatocellular / Q000150:complications* / Q000532:radiotherapy*; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications* / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D061766:Proton Therapy / Q000379:methods*; D012306:Risk; D015996:Survival Rate; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000150:complications*; D055815:Young Adult
keywords: Hepatocellular carcinoma; Proton beam therapy; Tumour vascular thrombosis