Long-term outcomes of proton beam therapy in patients with previously untreated hepatocellular carcinoma - PubMed (original) (raw)

Observational Study

. 2017 Mar;108(3):497-503.

doi: 10.1111/cas.13145.

Toshiyuki Okumura 2, Masato Abei 1, Nobuyoshi Fukumitsu 2, Kazunori Ishige 1, Masashi Mizumoto 2, Naoyuki Hasegawa 1, Haruko Numajiri 2, Kayoko Ohnishi 2, Hitoshi Ishikawa 2, Koji Tsuboi 2, Hideyuki Sakurai 2, Ichinosuke Hyodo 1

Affiliations

Observational Study

Long-term outcomes of proton beam therapy in patients with previously untreated hepatocellular carcinoma

Kuniaki Fukuda et al. Cancer Sci. 2017 Mar.

Abstract

Long-term efficacy of proton beam therapy (PBT) remains unclear for patients with previously untreated hepatocellular carcinoma (HCC). We aimed to study the long-term outcomes of PBT according to Barcelona Clinic Liver Cancer (BCLC) staging classifications in patients with previously untreated HCC. The major eligibility criteria of this observational study were an Eastern Cooperative Oncology Group performance status (PS) 0-2, Child-Pugh grade A or B, previously untreated HCC covered within an irradiation field, and no massive ascites. A total of 66.0-77.0 GyE was administered in 10-35 fractions. Local tumor control (LTC), defined as no progression in the irradiated field, progression-free survival (PFS), and overall survival (OS) were assessed according to BCLC staging. From 2002 to 2009 at our institution, 129 patients were eligible. The 5-year LTC, PFS, and OS rates were 94%, 28%, and 69% for patients with 0/A stage disease (n = 9/21), 87%, 23%, and 66% for patients with B stage disease (n = 34), and 75%, 9%, and 25% for patients with C stage disease (n = 65), respectively. The 5-year LTC and OS rates of 15 patients with tumor thrombi in major vessels were 90% and 34%, respectively. Multivariate analyses revealed that PS (0 versus 1-2) was a significant prognostic factor for OS. No grade 3 or higher adverse effects were observed. PBT showed favorable long-term efficacies with mild adverse effects in BCLC stage 0 to C, and can be an alternative treatment for localized HCC especially when accompanied with tumor thrombi. This study was registered with UMIN Clinical Trials Registry (UMIN000025342).

Keywords: Aged patients; Barcelona Clinic Liver Cancer staging; hepatocellular carcinoma; proton beam therapy; vascular tumor thrombi.

© 2017 The Authors. Cancer Science published by John Wiley & Sons Australia, Ltd on behalf of Japanese Cancer Association.

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Figures

Figure 1

Figure 1

Kaplan–Meier curves of

LTC

,

PFS

, and

OS

according to

BCLC

stage in previously untreated

HCC

patients treated with

PBT

. Kaplan–Meier curves of the local tumor control (a), progression‐free survival (b), and overall survival (c).

BCLC

staging: stage 0/A stage (solid line; n = 30), B stage (dotted line; n = 34), and C stage (broken line; n = 65).

BCLC

, Barcelona Clinic Liver Cancer;

HCC

, hepatocellular carcinoma;

LTC

, local tumor control;

OS

, overall survival;

PBT

, proton beam therapy;

PFS

, progression free survival.

Figure 2

Figure 2

Kaplan–Meier curves of

OS

according to

PS

in previously untreated

HCC

patients treated with

PBT

.

PS

0 (solid line; n = 70),

PS

1 (dotted line; n = 50) and

PS

2 (broken line; n = 9).

HCC

, hepatocellular carcinoma;

OS

, overall survival;

PBT

, proton beam therapy;

PS

, Eastern Cooperative Oncology Group performance status.

Figure 3

Figure 3

Computed tomography (

CT

) images of an 81‐year‐old woman with advanced

HCC

involving a massive tumor thrombus in the

IVC

. Images were obtained before

PBT

(a), during isodose distribution of

PBT

(b), and 2 months after the completion of

PBT

(c).

PBT

demonstrated marked regression of both the main tumor and tumor thrombus (arrows). Isodose distribution is shown using contour lines (red line, 90% isodose; blue line, 10% isodose).

HCC

, hepatocellular carcinoma;

IVC

, inferior vena cava;

PBT

, proton beam therapy.

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