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Yamaguchi H, Fukumitsu N, Numajiri H, Ogino H, Okimoto T, Ogino T, Suzuki M, Murayama S. The Japanese nationwide cohort data of proton beam therapy for liver oligometastasis in breast cancer patients. JOURNAL OF RADIATION RESEARCH 2024; 65:231-237. [PMID: 38321606 PMCID: PMC10959435 DOI: 10.1093/jrr/rrad106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Revised: 11/17/2023] [Indexed: 02/08/2024]
Abstract
A nationwide multicenter cohort study on particle therapy was launched by the Japanese Society for Radiation Oncology in Japan in May 2016. We analyzed the outcome of proton beam therapy (PBT) for liver oligometastasis in breast cancers. Cases in which PBT was performed at all Japanese proton therapy facilities between May 2016 and February 2019 were enrolled. The patients were selected based on the following criteria: the primary cancer was controlled, liver recurrence without extrahepatic tumors and no more than three liver lesions. Fourteen females, with a median age of 57 years (range, 44-73) and 22 lesions, were included. The median lesion size, fraction (fr) size and biological effective dose were 44 (20-130) mm, 6.6 (2-8) gray (Gy) (relative biological effectiveness)/fr and 109.6 (52.7-115.2) Gy, respectively. The median follow-up period was 22.8 (4-54) months. The 1-, 2- and 3-year local control (LC) rates of liver metastasis from breast cancer were 100% for all. The 1-, 2- and 3-year overall survival rates were 85.7, 62.5 and 62.5%, respectively. The 1-, 2- and 3-year progression-free survival (PFS) rates were 50.0%, 33.3%, and 16.7%, respectively. The median PFS time was 16 months. Only one patient did not complete PBT due to current disease progression. One patient had Grade 3 radiation-induced dermatitis. None of the patients experienced radiation-induced liver failure during the acute or late phase. Owing to the low incidence of adverse events and the high LC rate, PBT appears to be a feasible option for liver oligometastasis in breast cancers.
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Affiliation(s)
- Hisashi Yamaguchi
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Fukushima 960-1295, Japan
| | - Nobuyoshi Fukumitsu
- Department of Radiation Oncology, Hyogo Ion Beam Medical Center Kobe Proton Center, 1-6-8 Minatojima-minamimachi, Chuo-ku, Kobe, Hyogo 650-0047, Japan
| | - Haruko Numajiri
- Department of Radiation Oncology, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki 305-8575, Japan
| | - Hiroyuki Ogino
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City University West Medical Center, 1-1-1 Hirate-cho, Kita-ku, Nagoya 462-8508, Japan
| | - Tomoaki Okimoto
- Department of Radiology, Hyogo Ion Beam Medical Center, 1-2-1 Koto, Shingu-cho, Tatsuno, Hyogo 679-5165, Japan
| | - Takashi Ogino
- Medipolis Proton Therapy and Research Center, 4423 Higashikata, Ibusuki, Kagoshima 891-0304, Japan
| | - Motohisa Suzuki
- Department of Radiology, Southern Tohoku Proton Therapy Center, 7-172 Yatsuyamada, Koriyama, Fukushima 963-8052, Japan
| | - Shigeyuki Murayama
- Division of Proton Therapy, Radiation and Proton Therapy Center, Shizuoka Cancer Center Hospital, 1007 Shimonagakubo, Nagaizumi-cho, Suntou-gun, Shizuoka 411-8777, Japan
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Hall JT, Moon AM, Young M, Tan X, Darawsheh R, Danquah F, Tepper JE, Yanagihara TK. Biochemical Safety of SBRT to Multiple Intrahepatic Lesions for Hepatocellular Carcinoma. J Hepatocell Carcinoma 2024; 11:443-454. [PMID: 38476559 PMCID: PMC10928924 DOI: 10.2147/jhc.s447025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Accepted: 02/06/2024] [Indexed: 03/14/2024] Open
Abstract
Background We aim to better characterize stereotactic body radiation therapy (SBRT)-related hepatic biochemical toxicity in patients with multiple intrahepatic lesions from hepatocellular carcinoma (HCC). Methods We conducted a retrospective analysis of patients with HCC who underwent SBRT for 2 or more synchronous or metachronous liver lesions. We collected patient characteristics and dosimetric data (mean liver dose [MLD], cumulative effective volume [Veff], cumulative volume of liver receiving 15 Gy [V15Gy], and cumulative planning target volume [PTV]) along with liver-related toxicity (measured by albumin-bilirubin [ALBI] and Child-Pugh [CP] scores). A linear mixed-effects model was used to assess the effect of multi-target SBRT on changes in ALBI. Results There were 25 patients and 56 lesions with median follow-up of 29 months. Eleven patients had synchronous lesions, and 14 had recurrent lesions treated with separate SBRT courses. Among those receiving multiple SBRT courses, there were 7 lesions with overlap of V15Gy (median V15Gy overlap: 35 mL, range: 0.5-388 mL). There was no association between cumulative MLD, Veff, V15Gy, or PTV and change in ALBI. Four of 25 patients experienced non-classic radiation-induced liver disease (RILD), due to an increase of CP score by ≥2 points 3 to 6 months after SBRT. Sixteen of 25 patients experienced an increase in ALBI grade by 1 or more points 3 to 6 months after SBRT. Comparing the groups that received SBRT in a single course versus multiple courses revealed no statistically significant differences in liver toxicity. Conclusion Liver SBRT for multiple lesions in a single or in separate courses is feasible and with acceptable risk of hepatotoxicity. Prospective studies with a larger cohort are needed to better characterize safety in this population.
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Affiliation(s)
- Jacob T Hall
- Department of Radiation Oncology, University of North Carolina Hospitals, Chapel Hill, NC, USA
| | - Andrew M Moon
- Division of Gastroenterology and Hepatology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina Hospitals, Chapel Hill, NC, USA
| | - Michael Young
- Department of Radiation Oncology, University of North Carolina Hospitals, Chapel Hill, NC, USA
| | - Xianming Tan
- Lineberger Comprehensive Cancer Center, University of North Carolina Hospitals, Chapel Hill, NC, USA
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Rami Darawsheh
- University of North Carolina School of Medicine, Chapel Hill, NC, USA
| | - Flora Danquah
- Lineberger Comprehensive Cancer Center, University of North Carolina Hospitals, Chapel Hill, NC, USA
| | - Joel E Tepper
- Department of Radiation Oncology, University of North Carolina Hospitals, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina Hospitals, Chapel Hill, NC, USA
| | - Ted K Yanagihara
- Department of Radiation Oncology, University of North Carolina Hospitals, Chapel Hill, NC, USA
- Lineberger Comprehensive Cancer Center, University of North Carolina Hospitals, Chapel Hill, NC, USA
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Yamaguchi H, Fukumitsu N, Numajiri H, Ogino H, Katoh N, Okimoto T, Suzuki M, Sakurai H. The Japanese nationwide cohort data of proton beam therapy for liver oligometastasis in esophagogastric cancer patients. JOURNAL OF RADIATION RESEARCH 2023; 64:926-932. [PMID: 37697668 PMCID: PMC10665303 DOI: 10.1093/jrr/rrad066] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Revised: 08/03/2023] [Indexed: 09/13/2023]
Abstract
A nationwide multicenter cohort study on particle therapy was launched by the Japanese Society for Radiation Oncology in Japan in May 2016. We analyzed the outcome of proton beam therapy (PBT) for liver oligometastasis of esophagogastric cancers. Cases in which PBT was performed at all PBT facilities in Japan between May 2016 and February 2019 were enrolled. The patients were selected based on the following criteria: controlled primary cancer, liver recurrence without extrahepatic tumors and no more than three liver lesions. Twenty-two males and two females with a median age of 69 (range, 52-80) years and 35 lesions were included. This study included 6 patients with esophageal and 18 patients with gastric cancer. The median lesion size, fraction size and biological effective dose (BED)10 were 32 (7-104) mm, 3.8 gray (relative biological effect)/fractions (Gy (RBE)/fr) (2-8 Gy (RBE)/fr) and 96.9 (88.8-115.2) Gy, respectively. The median follow-up period was 18 (4-47) months. The 1-, 2- and 3-year overall survival (OS) rates were 75, 51.8 and 45.3%, respectively, and the median OS was 25.3 months. The 1-, 2- and 3-year cumulative local recurrence (LR) rates were 3, 6 and 6%, respectively. Patients' age (P < 0.01), performance status (P = 0.017) and tumor size (P = 0.024) were significant OS-related factors. No Grade 3 or higher adverse events (AEs) were observed. Owing to the low incidence of AEs and the low LR cumulative incidence, PBT is a feasible option for liver oligometastasis of esophagogastric cancers.
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Affiliation(s)
- Hisashi Yamaguchi
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, 1 Hikarigaoka, Fukushima, Fukushima 960-1295, Japan
- Department of Radiology, Southern Tohoku Proton Therapy Center, 7-172 Yatsuyamada, Koriyama, Fukushima 963-8052, Japan
| | - Nobuyoshi Fukumitsu
- Department of Radiation Oncology, Hyogo Ion Beam Medical Center Kobe Proton Center, 1-6-8 Minatojima-minamimachi, Chuo-ku, Kobe, Hyogo 650-0047, Japan
| | - Haruko Numajiri
- Department of Radiation Oncology, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki 305-8575, Japan
| | - Hiroyuki Ogino
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City University West Medical Center, 1-1-1 Hirate-cho, Kita-ku, Nagoya 462-8508, Japan
| | - Norio Katoh
- Department of Radiation Oncology, Hokkaido University Faculty of Medicine, North-15 West-7, Kita-ku, Sapporo 060-8638, Japan
| | - Tomoaki Okimoto
- Department of Radiology, Hyogo Ion Beam Medical Center, 1-2-1 Koto, Shingu-cho, Tatsuno, Hyogo 679-5165, Japan
| | - Motohisa Suzuki
- Department of Radiology, Southern Tohoku Proton Therapy Center, 7-172 Yatsuyamada, Koriyama, Fukushima 963-8052, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, Ibaraki 305-8575, Japan
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Gharzai LA, Wang C, Tang M, Jackson WC, Maurino C, Cousins MM, Mendiratta-Lala M, Parikh ND, Mayo CS, Haken RKT, Owen D, Cuneo KC, Schipper MJ, Lawrence TS. Efficacy of a Second Course of Radiation for Patients With Metachronous Hepatocellular Carcinoma. Pract Radiat Oncol 2023; 13:e504-e514. [PMID: 37295727 DOI: 10.1016/j.prro.2023.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/17/2023] [Accepted: 05/25/2023] [Indexed: 06/12/2023]
Abstract
PURPOSE Liver-directed radiation therapy is an effective treatment for hepatocellular carcinoma (HCC), but metachronous lesions develop outside the irradiated field in >50% of patients. We hypothesized that irradiation of these new lesions would produce an outcome like that of patients receiving a first course (C1) of treatment. METHODS AND MATERIALS We included patients with HCC who received a second course (C2) of radiation therapy >1 month after C1. Toxicity was defined as Child-Pugh score increase ≥2 within 6 months posttreatment (binary model) and as the change in albumin-bilirubin during the year after treatment (longitudinal model). Overall survival (OS) and local failure (LF) were captured at the patient and lesion level, respectively; both were summarized with Kaplan-Meier estimates. Predictors of toxicity and OS were assessed using generalized linear mixed and Cox regression models, respectively. RESULTS Of 340 patients with HCC, 47 underwent irradiation for metachronous HCC, receiving similar prescription dose in C1/C2. Median follow-up was 17 months after C1 and 15 months after C2. Twenty-two percent of patients experienced toxicity after C1, and 25% experienced toxicity after C2. Worse baseline albumin-bilirubin predicted toxicity in both binary (odds ratio, 2.40; 95% CI, 1.46-3.94; P = .0005) and longitudinal models (P < .005). Two-year LF rate was 11.2% after C1 and 8.3% after C2; tumor dose (hazard ratio [HR], 0.982; 95% CI, 0.969-0.995; P = .007) and tumor size (HR, 1.135; 95% CI, 1.068-1.206; P < .005) predicted LF. Two-year OS was 46.0% after C1 and 42.6% after C2; tumor dose (HR, 0.986; 95% CI, 0.979-0.992; P < .005) and tumor size (HR, 1.049; 95% CI, 1.010-1.088; P = .0124) predicted OS. Reirradiation was not associated with toxicity (P > .7), LF (P = .79), or OS (P = .39). CONCLUSIONS In this largest series in the Western hemisphere, we demonstrate that irradiation for metachronous HCC offers low rates of LF with acceptable toxicity and OS like that of patients receiving a C1. These findings support judicious selection of patients for reirradiation in metachronous HCC.
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Affiliation(s)
- Laila A Gharzai
- Department of Radiation Oncology, Northwestern University, Evanston, Illinois.
| | - Chang Wang
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan; Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Ming Tang
- Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - William C Jackson
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Christopher Maurino
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Matthew M Cousins
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | | | - Neehar D Parikh
- Division of Gastroenterology and Hepatology, University of Michigan, Ann Arbor, Michigan
| | - Charles S Mayo
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Randall K Ten Haken
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Dawn Owen
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Kyle C Cuneo
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Matthew J Schipper
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan; Department of Biostatistics, University of Michigan, Ann Arbor, Michigan
| | - Theodore S Lawrence
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
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5
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Lee SU, Kim TH. Current evidence and the potential role of proton beam therapy for hepatocellular carcinoma. Clin Mol Hepatol 2023; 29:958-968. [PMID: 37822213 PMCID: PMC10577334 DOI: 10.3350/cmh.2023.0274] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/24/2023] [Accepted: 08/27/2023] [Indexed: 10/13/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is a leading cause of cancer-related death, and external beam radiation therapy has emerged as a promising approach for managing HCC. Proton beam therapy (PBT) offers dosimetric advantages over X-ray therapy, with superior physical properties known as the Bragg peak. PBT holds promise for reducing hepatotoxicity and allowing safe dose-escalation to the tumor. It has been tried in various clinical conditions and has shown promising local tumor control and survival outcomes. A recent phase III trial demonstrated the non-inferiority of PBT in local tumor control compared to current standard radiofrequency ablation in early-stage HCC. PBT also tended to show more favorable outcomes compared to transarterial chemoembolization in the intermediate stage, and has proven effective in-field disease control and safe toxicity profiles in advanced HCC. In this review, we discuss the rationale, clinical studies, optimal indication, and future directions of PBT in HCC treatment.
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Affiliation(s)
- Sung Uk Lee
- Center for Proton Therapy, National Cancer Center, Goyang, Korea
| | - Tae Hyun Kim
- Center for Proton Therapy, National Cancer Center, Goyang, Korea
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Goyang, Korea
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6
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Kobeissi JM, Hilal L, Simone CB, Lin H, Crane CH, Hajj C. Proton Therapy in the Management of Hepatocellular Carcinoma. Cancers (Basel) 2022; 14:2900. [PMID: 35740567 PMCID: PMC9220794 DOI: 10.3390/cancers14122900] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 05/29/2022] [Accepted: 06/07/2022] [Indexed: 12/04/2022] Open
Abstract
Proton radiation therapy plays a central role in the treatment of hepatocellular carcinoma (HCC). Because of the near-zero exit dose and improved sparing of normal liver parenchyma, protons are being used even in challenging scenarios, including larger or multifocal liver tumors, and those associated with vascular tumor thrombus. There is a mounting level of evidence that suggests that protons are superior to photons in terms of survival and toxicity outcomes, specifically the progression to liver failure. A randomized controlled trial comparing protons to photons is currently underway to verify this hypothesis.
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Affiliation(s)
- Jana M. Kobeissi
- Department of Radiation Oncology, School of Medicine, American University of Beirut Medical Center, Beirut 1107, Lebanon; (J.M.K.); (L.H.)
| | - Lara Hilal
- Department of Radiation Oncology, School of Medicine, American University of Beirut Medical Center, Beirut 1107, Lebanon; (J.M.K.); (L.H.)
| | - Charles B. Simone
- New York Proton Center, Department of Radiation Oncology, New York, NY 10035, USA; (C.B.S.2nd); (H.L.)
- Memorial Sloan Kettering Cancer Center, Department of Radiation Oncology, New York, NY 10027, USA;
| | - Haibo Lin
- New York Proton Center, Department of Radiation Oncology, New York, NY 10035, USA; (C.B.S.2nd); (H.L.)
| | - Christopher H. Crane
- Memorial Sloan Kettering Cancer Center, Department of Radiation Oncology, New York, NY 10027, USA;
| | - Carla Hajj
- New York Proton Center, Department of Radiation Oncology, New York, NY 10035, USA; (C.B.S.2nd); (H.L.)
- Memorial Sloan Kettering Cancer Center, Department of Radiation Oncology, New York, NY 10027, USA;
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7
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Tong VJW, Shelat VG, Chao YK. Clinical application of advances and innovation in radiation treatment of hepatocellular carcinoma. J Clin Transl Res 2021; 7:811-833. [PMID: 34988334 PMCID: PMC8715712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 09/22/2021] [Accepted: 09/29/2021] [Indexed: 02/08/2023] Open
Abstract
Background Hepatocellular carcinoma (HCC) management has evolved over the past two decades, with the development of newer treatment modalities. While various options are available, unmet needs are reflected through the mixed treatment outcome for intermediate-stage HCC. As HCC is radiosensitive, radiation therapies have a significant role in management. Radiation therapies offer local control for unresectable lesions and for patients who are not surgical candidates. Radiotherapy also provides palliation in metastatic disease, and acts as a bridge to resection and transplantation in selected patients. Advancements in radiotherapy modalities offer improved dose planning and targeted delivery, allowing for better tumor response and safer dose escalations while minimizing the risks of radiation-induced liver damage. Radiotherapy modalities are broadly classified into external beam radiation therapy and selective internal radiation therapy. With emerging modalities, radiotherapy plays a complementary role in the multidisciplinary care of HCC patients. Aim We aim to provide an overview of the role and clinical application of radiation therapies in HCC management. Relevance for Patients The continuous evolution of radiotherapy techniques allows for improved therapeutic outcomes while mitigating unwanted adverse effects, making it an attractive modality in HCC management. Rigorous clinical studies, quality research and comprehensive datasets will further its application in the present era of evidence-based practice in Medicine.
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Affiliation(s)
- Valerie J. W. Tong
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Vishal G. Shelat
- Department of General Surgery, Tan Tock Seng Hospital, 308433, Singapore
| | - Yew Kuo Chao
- Department of Gastroenterology and Hepatology, Tan Tock Seng Hospital, 308433, Singapore
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8
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Yoo GS, Yu JI, Park HC. Current role of proton beam therapy in patients with hepatocellular carcinoma. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2021. [DOI: 10.18528/ijgii210043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Affiliation(s)
- Gyu Sang Yoo
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Il Yu
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hee Chul Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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9
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Yamaguchi H, Honda M, Hamada K, Kobayashi H, Todate Y, Seto I, Takayama K, Suzuki M, Wada H, Kikuchi Y, Murakami M. The effectiveness of proton beam therapy for liver metastatic recurrence in gastric cancer patients. Jpn J Clin Oncol 2020; 50:903-908. [PMID: 32363379 DOI: 10.1093/jjco/hyaa052] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Accepted: 03/25/2020] [Indexed: 01/27/2023] Open
Abstract
OBJECTIVE The purpose of this cross-sectional study was to evaluate the efficacy and safety of proton beam therapy for liver metastatic recurrence in gastric cancer patients. METHODS Consecutive patients who underwent proton beam therapy from 2010 to 2015 were isolated from our institutional database. Patients with extrahepatic metastatic lesions were excluded. Seven patients were enrolled. The median diameter of target lesions was 31 mm (13-68 mm). The most frequent dosage was 72.6 Gy equivalent in 22 fractions. The effectiveness was assessed based on the local control, overall survival and progression-free survival rates. The local control, overall survival and progression-free survival rates were calculated using the Kaplan-Meier method. Adverse events were described according to the patients' medical records. RESULTS The median follow-up period was 41.7 months (20.7-66.3 months). The 3-year local control, overall survival and progression-free survival rates were 85.7, 68.6 and 43%, respectively. All patients completed proton beam therapy without interruption. No grade ≥3 adverse events were observed. CONCLUSIONS Proton beam therapy might be a treatment option for patients with liver metastasis of gastric cancer.
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Affiliation(s)
- Hisashi Yamaguchi
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima City, Fukushima, Japan.,Department of Radiology, Southern Tohoku Proton Therapy Center, Koriyama City, Fukushima, Japan
| | - Michitaka Honda
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima City, Fukushima, Japan.,Department of Surgery, Southern Tohoku General Hospital, Koriyama City, Fukushima, Japan
| | - Koichi Hamada
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima City, Fukushima, Japan.,Department of Gastroenterology, Southern Tohoku General Hospital, Koriyama City, Fukushima, Japan
| | - Hiroshi Kobayashi
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima City, Fukushima, Japan.,Department of Surgery, Southern Tohoku General Hospital, Koriyama City, Fukushima, Japan
| | - Yukitoshi Todate
- Department of Minimally Invasive Surgical and Medical Oncology, Fukushima Medical University, Fukushima City, Fukushima, Japan.,Department of Surgery, Southern Tohoku General Hospital, Koriyama City, Fukushima, Japan
| | - Ichiro Seto
- Department of Radiology, Southern Tohoku Proton Therapy Center, Koriyama City, Fukushima, Japan
| | - Kanako Takayama
- Department of Radiology, Southern Tohoku Proton Therapy Center, Koriyama City, Fukushima, Japan
| | - Motohisa Suzuki
- Department of Radiology, Southern Tohoku Proton Therapy Center, Koriyama City, Fukushima, Japan
| | - Hitoshi Wada
- Department of Radiology, Southern Tohoku Proton Therapy Center, Koriyama City, Fukushima, Japan
| | - Yasuhiro Kikuchi
- Department of Radiology, Southern Tohoku Proton Therapy Center, Koriyama City, Fukushima, Japan
| | - Masao Murakami
- Department of Radiology, Southern Tohoku Proton Therapy Center, Koriyama City, Fukushima, Japan
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10
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Murakami M, Fukumitsu N, Okumura T, Numajiri H, Murofushi K, Ohnishi K, Mizumoto M, Ishikawa H, Tsuboi K, Sakurai H. Three cases of hepatocellular carcinoma treated 4 times with proton beams. Mol Clin Oncol 2019; 12:31-35. [PMID: 31814974 PMCID: PMC6888171 DOI: 10.3892/mco.2019.1950] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Accepted: 08/16/2019] [Indexed: 12/17/2022] Open
Abstract
HCC may recur following surgery or radiofrequency ablation. Proton beam therapy (PBT) is a type of radiotherapy that achieves excellent local control of HCC without severe toxicity. The present study reported the long-term outcome of 3 HCC patients who each received 4 repeat courses of PBT. All patients had a hepatitis B or C viral infection. A total of 14 lesions were treated using a curative PBT protocol and irradiated liver volumes in each treatment were 7-50% of the total liver volume. Liver function in all cases was considerably preserved until the last follow-up and patient survival was 51-107 months from the first PBT with no local recurrence observed in the 14 lesions. The presented cases indicated that repeated PBT is an effective treatment option for recurrent HCC due to reduced liver damage and superior local treatment compared with other treatment options such as transarterial chemoembolization.
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Affiliation(s)
- Motohiro Murakami
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8576, Japan
| | - Nobuyoshi Fukumitsu
- Department of Radiation Oncology, Kobe Proton Center, Kobe. Hyōgo 650-0047, Japan
| | - Toshiyuki Okumura
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8576, Japan
| | - Haruko Numajiri
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8576, Japan
| | - Keiko Murofushi
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8576, Japan
| | - Kayoko Ohnishi
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8576, Japan
| | - Masashi Mizumoto
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8576, Japan
| | - Hitoshi Ishikawa
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8576, Japan
| | - Koji Tsuboi
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8576, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology and Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, Tsukuba, Ibaraki 305-8576, Japan
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Apisarnthanarax S, Bowen SR, Combs SE. Proton Beam Therapy and Carbon Ion Radiotherapy for Hepatocellular Carcinoma. Semin Radiat Oncol 2018; 28:309-320. [PMID: 30309641 DOI: 10.1016/j.semradonc.2018.06.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Charged particle therapy with proton beam therapy (PBT) and carbon ion radiotherapy (CIRT) has emerged as a promising radiation modality to minimize radiation hepatotoxicity while maintaining high rates of tumor local control. Both PBT and CIRT deposit the majority of their dose at the Bragg peak with little to no exit dose, resulting in superior sparing of normal liver tissue. CIRT has an additional biological advantage of increased relative biological effectiveness, which may allow for increased hypofractionation regimens. Retrospective and prospective studies have demonstrated encouragingly high rates of local control and overall survival and low rates of hepatotoxicity with PBT and CIRT. Ongoing randomized trials will evaluate the value of PBT over photons and other standard liver-directed therapies and future randomized trials are needed to assess the value of CIRT over PBT.
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Affiliation(s)
| | - Stephen R Bowen
- Departments of Radiation Oncology and Radiology, University of Washington, Seattle, WA
| | - Stephanie E Combs
- Department of Radiation Oncology, University Hospital Rechts der Isar, Technical University München, Munich, Germany; Institute of Innovative Radiotherapy, Helmholtzzentrum München, Munich, Germany
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12
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Yoo GS, Yu JI, Park HC. Proton therapy for hepatocellular carcinoma: Current knowledges and future perspectives. World J Gastroenterol 2018; 24:3090-3100. [PMID: 30065555 PMCID: PMC6064962 DOI: 10.3748/wjg.v24.i28.3090] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 05/28/2018] [Accepted: 06/25/2018] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the second leading cause of cancer-related death, as few patients can be treated with currently available curative local modalities. In patients with HCC where curative modalities are not feasible, radiation therapy (RT) has emerged as an alternative or combination therapy. With the development of various technologies, RT has been increasingly used for the management of HCC. Among these advances, proton beam therapy (PBT) has several unique physical properties that give it a finite range in a distal direction, and thus no exit dose along the beam path. Therefore, PBT has dosimetric advantages compared with X-ray therapy for the treatment of HCC. Indeed, various reports in the literature have described the favorable clinical outcomes and improved safety of PBT for HCC patients compared with X-ray therapy. However, there are some technical issues regarding the use of PBT in HCC, including uncertainty of organ motion and inaccuracy during calculation of tissue density and beam range, all of which may reduce the robustness of a PBT treatment plan. In this review, we discuss the physical properties, current clinical data, technical issues, and future perspectives on PBT for the treatment of HCC.
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Affiliation(s)
- Gyu Sang Yoo
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, South Korea
| | - Jeong Il Yu
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, South Korea
| | - Hee Chul Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, South Korea
- Department of Medical Device Management and Research, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul 06351, South Korea
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13
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Engwall E, Fredriksson A, Glimelius L. 4D robust optimization including uncertainties in time structures can reduce the interplay effect in proton pencil beam scanning radiation therapy. Med Phys 2018; 45:4020-4029. [PMID: 30014478 DOI: 10.1002/mp.13094] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 07/04/2018] [Accepted: 07/04/2018] [Indexed: 02/28/2024] Open
Abstract
PURPOSE Interplay effects in proton radiotherapy can create large distortions in the dose distribution and severely degrade the plan quality. Standard methods to mitigate these effects include abdominal compression, gating, and rescanning. We propose a new method to include the time structures of the delivery and organ motion in the framework of four-dimensional (4D) robust optimization to generate plans that are robust against interplay effects. METHODS The method considers multiple scenarios reflecting the uncertainties in the delivery and in the organ motion. In each scenario, the pencil beam scanning spots are distributed to different phases of the breathing cycle according to each individual spot time stamp, and a partial beam dose is calculated for each phase. The partial beam doses are accumulated on a reference phase through deformable image registrations. Minimax optimization is performed to take all scenarios into account simultaneously. For simplicity, the uncertainties in this proof of concept study are limited to variations in the breathing pattern. The method is evaluated for three different nonsmall cell lung cancer patients and compared to plans using conventional 4D robust optimization both with and without rescanning. We assess the ability of the method to mitigate distortions from the interplay effect over multiple evaluation scenarios using 4D dose calculations. This interplay evaluation is performed in an experimentally validated framework, which is independent of the optimization in the plan generation step. RESULTS For the three studied patients, 4D optimization including time structures is efficient, especially for large tumor motions, where rescanning of conventional 4D robustly optimized plans is not sufficient to mitigate the interplay effect. The most efficient approach of the new method is achieved when it is combined with rescanning. For the patient with the largest motion, the mean V95% is 99.2% and mean V107% is 3.65% for the best rescanned 4D plan optimized with time structure. This can be compared to conventional 4D optimized plans with mean V95% of 92.7% and mean V107% of 13.1%. CONCLUSIONS The current study shows the potential of reducing interplay effects in proton pencil beam scanning radiotherapy by incorporating organ motion and delivery characteristics in a 4D robust optimization.
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Affiliation(s)
- Erik Engwall
- RaySearch Laboratories, Sveavägen 44, Stockholm, SE-111 34, Sweden
| | | | - Lars Glimelius
- RaySearch Laboratories, Sveavägen 44, Stockholm, SE-111 34, Sweden
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14
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Li X, Zha X, Wang Y, Jia R, Hu B, Zhao B. Toxic effects and foundation of proton radiation on the early-life stage of zebrafish development. CHEMOSPHERE 2018; 200:302-312. [PMID: 29494911 DOI: 10.1016/j.chemosphere.2018.02.141] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2017] [Revised: 02/22/2018] [Accepted: 02/23/2018] [Indexed: 06/08/2023]
Abstract
Proton is a major particle of space radiation environment and a prospective radiotherapy beam. However, its risk needs to be fully evaluated for the understanding and to establish the better protective strategy for astronaut and patient. Zebrafish is an ideal model for the toxicity studies on medicines and environmental genetic toxicants. In the current study, embryos of zebrafish at 24 h post-fertilization (hpf) were exposed to proton beam. Some toxic parameters of embryo-larval development were investigated. Microarray combining with qRT-PCR were used to detect the gene expression situation. Generally, fractions of a variety of abnormal phenotypes of embryos and larvae increased in a dose-dependent manner after irradiation. The copy number of mitochondria, the basal respiration rate and the maximum respiration rate of embryos significantly decreased after irradiation. Microarray data demonstrated that MAPK signaling pathway, cell communication, glycolysis and TGF-β signaling pathway were significantly affected in the irradiated group. The expressions of matrix metallopeptidase 9 (mmp9) and TIMP metallopeptidase inhibitor 2b (timp2b) genes, and enzymatic activity of MMP9 were significantly upregulated in irradiated group. Overall, these results suggest that acute radiation of proton severely affects the development of organism and results in aberration occurrence in the early stage of zebrafish development, which may relates to mitochondrial and glycolytic dysfunction.
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Affiliation(s)
- Xiaoman Li
- State Key Laboratory of Toxicology and Medical Countermeasures, Institute of Pharmacology and Toxicology, Academy of Military Medical Sciences, Beijing 100850, China; CAS Key Laboratory of Heavy Ion Radiation Biology and Medicine & Key Laboratory of Space Radiobiology of Gansu Province, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Xiaodan Zha
- State Key Laboratory of Toxicology and Medical Countermeasures, Institute of Pharmacology and Toxicology, Academy of Military Medical Sciences, Beijing 100850, China
| | - Yongan Wang
- State Key Laboratory of Toxicology and Medical Countermeasures, Institute of Pharmacology and Toxicology, Academy of Military Medical Sciences, Beijing 100850, China
| | - Rong Jia
- CAS Key Laboratory of Heavy Ion Radiation Biology and Medicine & Key Laboratory of Space Radiobiology of Gansu Province, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, China; University of Chinese Academy of Sciences, Beijing 100049, China
| | - Burong Hu
- CAS Key Laboratory of Heavy Ion Radiation Biology and Medicine & Key Laboratory of Space Radiobiology of Gansu Province, Institute of Modern Physics, Chinese Academy of Sciences, Lanzhou 730000, China.
| | - Baoquan Zhao
- State Key Laboratory of Toxicology and Medical Countermeasures, Institute of Pharmacology and Toxicology, Academy of Military Medical Sciences, Beijing 100850, China.
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15
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McDuff SGR, Remillard KA, Zheng H, Raldow AC, Wo JY, Eyler CE, Drapek LC, Goyal L, Blaszkowsky LS, Clark JW, Allen JN, Parikh AR, Ryan DP, Ferrone CR, Tanabe KK, Wolfgang JA, Zhu AX, Hong TS. Liver reirradiation for patients with hepatocellular carcinoma and liver metastasis. Pract Radiat Oncol 2018; 8:414-421. [PMID: 29937235 DOI: 10.1016/j.prro.2018.04.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 03/27/2018] [Accepted: 04/18/2018] [Indexed: 01/20/2023]
Abstract
PURPOSE This study aimed to assess the safety and efficacy of administering liver reirradiation to patients with primary liver tumors or liver metastasis. METHODS AND MATERIALS A total of 49 patients (with 64 individual tumors) who received liver reirradiation at our institution between June 2008 and December 2016 were identified for retrospective review. Patients were treated to the same, different, or a combination of previously treated liver tumors for recurrent primary (53%) or metastatic (47%) disease using photons or protons. Clinical and treatment-related factors were compiled and patients were monitored for toxicity and evidence of classic or nonclassic radiation-induced liver disease. Survival was estimated with the Kaplan-Meier method and cumulative incidence of local failure (LF) was used to estimate LF using the Response Evaluation Criteria in Solid Tumors version 1.1. RESULTS The median age at the time of reirradiation was 72 years and the median interval between radiation courses was 9 months. At a median follow-up of 10.5 months, 36 patients (73%) had died, 9 patients (18%) were alive, and 4 patients (8%) were lost to follow-up. The median survival for the cohort was 14 months. The overall 1-year estimate of LF was 46.4%. The 1-year estimates of LF for liver metastases and hepatocellular carcinoma were 61.0% and 32.5%, respectively. The average prescription dose was similar between the reirradiation and initial courses (equivalent dose in 2 Gy fractions EQD2: 65.0 vs 64.3 Gyα/β = 10, respectively) but the average dose to the untreated liver was lower at the time of reirradiation (EQD2: 10.5 vs 13.9 Gyα/β = 3, respectively, P = .01). Among patients with hepatocellular carcinoma, the average normal liver dose was significantly larger for patients who exhibited a worsening of Child-Pugh score after reirradiation compared with those who did not (1210 cGy vs 759 cGy, P = .04). With regard to toxicity, 85.7% of patients experienced grade 1 to 2 toxicity, 4.1% developed grade 3, and only 2 patients (4.1%) met the criteria for radiation-induced liver disease after reirradiation. CONCLUSIONS Liver reirradiation may be an effective and safe option for select patients; however, further prospective study is necessary to establish treatment guidelines and recommended dosing.
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Affiliation(s)
- Susan G R McDuff
- Harvard Radiation Oncology Program, Massachusetts General Hospital, Boston, Massachusetts; Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts.
| | - Kyla A Remillard
- Department of Radiation Oncology, Medical Physics and Dosimetry, Massachusetts General Hospital, Boston, Massachusetts
| | - Hui Zheng
- Biostatistics Center, Massachusetts General Hospital, Boston, Massachusetts
| | - Ann C Raldow
- Department of Radiation Oncology, Ronald Reagan UCLA Medical Center, Los Angeles, California
| | - Jennifer Y Wo
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Christine E Eyler
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Lorraine C Drapek
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Lipika Goyal
- Department of Internal Medicine and Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Lawrence S Blaszkowsky
- Department of Internal Medicine and Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jeffrey W Clark
- Department of Internal Medicine and Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Jill N Allen
- Department of Internal Medicine and Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Aparna R Parikh
- Department of Internal Medicine and Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - David P Ryan
- Department of Internal Medicine and Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Cristina R Ferrone
- Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - Kenneth K Tanabe
- Department of General and Gastrointestinal Surgery, Massachusetts General Hospital, Boston, Massachusetts
| | - John A Wolfgang
- Department of Radiation Oncology, Medical Physics and Dosimetry, Massachusetts General Hospital, Boston, Massachusetts
| | - Andrew X Zhu
- Department of Internal Medicine and Hematology/Oncology, Massachusetts General Hospital, Boston, Massachusetts
| | - Theodore S Hong
- Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts
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16
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Choi SH, Seong J. Strategic application of radiotherapy for hepatocellular carcinoma. Clin Mol Hepatol 2018; 24:114-134. [PMID: 29439305 PMCID: PMC6038936 DOI: 10.3350/cmh.2017.0073] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 12/06/2017] [Indexed: 12/22/2022] Open
Abstract
With increasing clinical use, radiotherapy (RT) has been considered reliable and effective method for hepatocellular carcinoma (HCC) treatment, depending on extent of disease and patient characteristics. RT for HCC can improve therapeutic outcomes through excellent local control, downstaging, conversion from unresectable to resectable status, and treatments of unresectable HCCs with vessel invasion or multiple intrahepatic metastases. In addition, further development of modern RT technologies, including image-guided radiotherapy (IGRT), intensity-modulated radiotherapy (IMRT), and stereotactic body radiotherapy, has expanded the indication of RT. An essential feature of IGRT is that it allows image guidance therapy through in-room images obtained during radiation delivery. Compared with 3D-conformal RT, distinctions of IMRT are inverse treatment planning process and use of a large number of treatment fields or subfields, which provide high precision and exquisitely conformal dose distribution. These modern RT techniques allow more precise treatment by reducing inter- and intra-fractional errors resulting from daily changes and irradiated dose at surrounding normal tissues. More recently, particle therapy has been actively investigated to improve effectiveness of RT. This review discusses modern RT strategies for HCC, as well as optimal selection of RT in multimodal approach for HCC.
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Affiliation(s)
- Seo Hee Choi
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
| | - Jinsil Seong
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea
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17
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Anderle K, Stroom J, Vieira S, Pimentel N, Greco C, Durante M, Graeff C. Treatment planning with intensity modulated particle therapy for multiple targets in stage IV non-small cell lung cancer. Phys Med Biol 2018; 63:025034. [PMID: 29165322 DOI: 10.1088/1361-6560/aa9c62] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Intensity modulated particle therapy (IMPT) can produce highly conformal plans, but is limited in advanced lung cancer patients with multiple lesions due to motion and planning complexity. A 4D IMPT optimization including all motion states was expanded to include multiple targets, where each target (isocenter) is designated to specific field(s). Furthermore, to achieve stereotactic treatment planning objectives, target and OAR weights plus objective doses were automatically iteratively adapted. Finally, 4D doses were calculated for different motion scenarios. The results from our algorithm were compared to clinical stereotactic body radiation treatment (SBRT) plans. The study included eight patients with 24 lesions in total. Intended dose regimen for SBRT was 24 Gy in one fraction, but lower fractionated doses had to be delivered in three cases due to OAR constraints or failed plan quality assurance. The resulting IMPT treatment plans had no significant difference in target coverage compared to SBRT treatment plans. Average maximum point dose and dose to specific volume in OARs were on average 65% and 22% smaller with IMPT. IMPT could also deliver 24 Gy in one fraction in a patient where SBRT was limited due to the OAR vicinity. The developed algorithm shows the potential of IMPT in treatment of multiple moving targets in a complex geometry.
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Affiliation(s)
- Kristjan Anderle
- GSI Helmholtz Centre for Heavy Ion Research, Planckstr. 1, 64291 Darmstadt, Germany
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18
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A systematic review of publications on charged particle therapy for hepatocellular carcinoma. Int J Clin Oncol 2017; 23:423-433. [PMID: 28871342 DOI: 10.1007/s10147-017-1190-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 08/21/2017] [Indexed: 02/08/2023]
Abstract
Charged particle therapy (proton beam therapy and carbon ion therapy) is a form of radiotherapy which has the unique characteristic of superior depth dose distribution, and has been used for the treatment of hepatocellular carcinoma (HCC) in a limited number of patients, especially in Japan. We undertook a systematic review to define the clinical utility of charged particle therapy for patients with HCC. We searched the MEDLINE database from 1983 to June 2016 to identify clinical studies on charged particle therapy for HCC. Primary outcomes of interest were local control, overall survival, and late radiation morbidities. A total of 13 cohorts from 11 papers were selected from an initial dataset of 78 papers. They included a randomized controlled trial comparing proton beam therapy with transarterial chemoembolization, 9 phase I or II trials and 2 retrospective studies. The reported actuarial local control rates ranged from 71.4-95% at 3 years, and the overall survival rates ranged from 25-42.3% at 5 years. Late severe radiation morbidities were uncommon, and a total of 18 patients with grade ≥3 late adverse events were reported among the 787 patients included in this analysis. Charged particle therapy for HCC was associated with good local control with limited probability of severe morbidities. The cost-effectiveness and the distinctive clinical advantages of charged particle therapies should be clarified in order to become a socially accepted treatment modality for HCC.
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19
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Fukumitsu N, Okumura T, Numajiri H, Takizawa D, Ohnishi K, Mizumoto M, Aihara T, Ishikawa H, Tsuboi K, Sakurai H. Follow-up study of liver metastasis from breast cancer treated by proton beam therapy. Mol Clin Oncol 2017; 7:56-60. [PMID: 28685076 DOI: 10.3892/mco.2017.1283] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2016] [Accepted: 03/17/2017] [Indexed: 02/07/2023] Open
Abstract
Liver metastasis from breast cancer (LMBC) is an incurable, fatal disease with a very poor prognosis. Although various local treatments have been applied, their clinical utility has not been established. The purpose of this study was to investigate the safety and effectiveness of proton beam therapy (PBT) for the treatment of patients with LMGC. A total of 8 female patients (aged 38-63 years) with LMBC who received PBT between 2002 and 2012 were retrospectively reviewed. Patients who had tumors confined to the liver were investigated, whereas patients with extrahepatic tumors were excluded. A total of 5 patients had solitary tumors and 3 had multiple tumors. The total irradiation dose was 66-72.6 Gray equivalent [Gy relative biological effectiveness (RBE)] and 2 patients received concurrent chemotherapy or hormone therapy. The overall and progression-free survival (OS and PFS) rates, local control (LC) rate and adverse effects were investigated. All the patients completed treatment without interruption and late adverse effects of grade >3 were not observed. The OS rate was 88/73/58%, the PFS rate was 50/25/0% and the LC rate was 86/86/86% at 1/3/5 years, respectively. Thus, PBT is a safe treatment and the OS and PFS rates are comparable to those with other local treatments. PBT may be considered as an effective local treatment option for the treatment of LMBC patients.
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Affiliation(s)
- Nobuyoshi Fukumitsu
- Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan
| | - Toshiyuki Okumura
- Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan
| | - Haruko Numajiri
- Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan
| | - Daichi Takizawa
- Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan
| | - Kayoko Ohnishi
- Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan
| | - Masashi Mizumoto
- Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan
| | - Teruhito Aihara
- Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan
| | - Hitoshi Ishikawa
- Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan
| | - Koji Tsuboi
- Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan
| | - Hideyuki Sakurai
- Proton Medical Research Center, University of Tsukuba, Tsukuba, Ibaraki 305-8575, Japan
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20
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Fukumitsu N, Nitta K, Terunuma T, Okumura T, Numajiri H, Oshiro Y, Ohnishi K, Mizumoto M, Aihara T, Ishikawa H, Tsuboi K, Sakurai H. Registration error of the liver CT using deformable image registration of MIM Maestro and Velocity AI. BMC Med Imaging 2017; 17:30. [PMID: 28472925 PMCID: PMC5418691 DOI: 10.1186/s12880-017-0202-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2016] [Accepted: 04/20/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Understanding the irradiated area and dose correctly is important for the reirradiation of organs that deform after irradiation, such as the liver. We investigated the spatial registration error using the deformable image registration (DIR) software products MIM Maestro (MIM) and Velocity AI (Velocity). METHODS Image registration of pretreatment computed tomography (CT) and posttreatment CT was performed in 24 patients with liver tumors. All the patients received proton beam therapy, and the follow-up period was 4-14 (median: 10) months. We performed DIR of the pretreatment CT and compared it with that of the posttreatment CT by calculating the dislocation of metallic markers (implanted close to the tumors). RESULTS The fiducial registration error was comparable in both products: 0.4-32.9 (9.3 ± 9.9) mm for MIM and 0.5-38.6 (11.0 ± 10.0) mm for Velocity, and correlated with the tumor diameter for MIM (r = 0.69, P = 0.002) and for Velocity (r = 0.68, P = 0.0003). Regarding the enhancement effect, the fiducial registration error was 1.0-24.9 (7.4 ± 7.7) mm for MIM and 0.3-29.6 (8.9 ± 7.2) mm for Velocity, which is shorter than that of plain CT (P = 0.04, for both). CONCLUSIONS The DIR performance of both MIM and Velocity is comparable with regard to the liver. The fiducial registration error of DIR depends on the tumor diameter. Furthermore, contrast-enhanced CT improves the accuracy of both MIM and Velocity. INSTITUTIONAL REVIEW BOARD APPROVAL H28-102; July 14, 2016 approved.
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Affiliation(s)
- Nobuyoshi Fukumitsu
- Proton Medical Research Center, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Japan.
| | - Kazunori Nitta
- Division of Radiology, Ibaraki Prefectural Central Hospital, 6528, Koibuchi, Kasama, Japan
| | - Toshiyuki Terunuma
- Proton Medical Research Center, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Japan
| | - Toshiyuki Okumura
- Proton Medical Research Center, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Japan
| | - Haruko Numajiri
- Proton Medical Research Center, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Japan
| | - Yoshiko Oshiro
- Proton Medical Research Center, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Japan
| | - Kayoko Ohnishi
- Proton Medical Research Center, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Japan
| | - Masashi Mizumoto
- Proton Medical Research Center, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Japan
| | - Teruhito Aihara
- Proton Medical Research Center, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Japan
| | - Hitoshi Ishikawa
- Proton Medical Research Center, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Japan
| | - Koji Tsuboi
- Proton Medical Research Center, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Japan
| | - Hideyuki Sakurai
- Proton Medical Research Center, University of Tsukuba, 1-1-1, Tennoudai, Tsukuba, Japan
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21
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Oshiro Y, Mizumoto M, Okumura T, Fukuda K, Fukumitsu N, Abei M, Ishikawa H, Takizawa D, Sakurai H. Analysis of repeated proton beam therapy for patients with hepatocellular carcinoma. Radiother Oncol 2017; 123:240-245. [DOI: 10.1016/j.radonc.2017.03.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2016] [Revised: 02/13/2017] [Accepted: 03/03/2017] [Indexed: 12/19/2022]
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22
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Fukumitsu N, Okumura T, Takizawa D, Numajiri H, Ohnishi K, Mizumoto M, Aihara T, Ishikawa H, Tsuboi K, Sakurai H. Proton beam therapy for liver metastases from gastric cancer. JOURNAL OF RADIATION RESEARCH 2017; 58:357-362. [PMID: 27974509 PMCID: PMC5440857 DOI: 10.1093/jrr/rrw102] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 04/28/2016] [Indexed: 05/31/2023]
Abstract
Liver metastases from gastric cancer (LMGC) is a non-curable, fatal disease with a 5-year survival rate of <10%. Although various local treatments have been applied, their clinical utility has not been established. The purpose of this study was to investigate the safety and effectiveness of proton beam therapy (PBT) for the treatment of patients with LMGC. A total of nine patients (seven men, two women; aged 56-78 years) with LMGC who received PBT between 2002 and 2012 were retrospectively reviewed. Patients who had tumors confined to the liver were investigated, and patients who had extrahepatic tumors were excluded. Six of the patients had solitary tumors, and three patients had multiple tumors. The total irradiation dose was 64-77 Gy relative biological effectiveness (RBE), and three patients received concurrent chemotherapy. The overall and progression-free survival (OS and PFS) rates, local control (LC) rate, and adverse effects were investigated. All patients completed treatment without interruption, and late adverse effects of higher than Grade 3 were not observed. The OS rates at 1, 3 and 5 years were 100%, 78% and 56%, respectively (median, 5.5 years); the PFS rates were 67%, 40% and 40% (median, 2.6 years); and the LC rates were 89%, 71% and 71%. PBT was demonstrated to be a safe treatment, and the OS and PFS rates were not inferior to those for other types of local treatment. Therefore, PBT should be considered as an effective local treatment option for patients with LMGC.
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Affiliation(s)
- Nobuyoshi Fukumitsu
- Proton Medical Research Center, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba 305-8575, Japan
| | - Toshiyuki Okumura
- Proton Medical Research Center, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba 305-8575, Japan
| | - Daichi Takizawa
- Proton Medical Research Center, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba 305-8575, Japan
| | - Haruko Numajiri
- Proton Medical Research Center, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba 305-8575, Japan
| | - Kayoko Ohnishi
- Proton Medical Research Center, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba 305-8575, Japan
| | - Masashi Mizumoto
- Proton Medical Research Center, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba 305-8575, Japan
| | - Teruhito Aihara
- Proton Medical Research Center, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba 305-8575, Japan
| | - Hitoshi Ishikawa
- Proton Medical Research Center, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba 305-8575, Japan
| | - Koji Tsuboi
- Proton Medical Research Center, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba 305-8575, Japan
| | - Hideyuki Sakurai
- Proton Medical Research Center, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba 305-8575, Japan
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Seo YS, Kim MS, Yoo HJ, Jang WI, Paik EK, Han CJ, Lee BH. Radiofrequency ablation versus stereotactic body radiotherapy for small hepatocellular carcinoma: a Markov model-based analysis. Cancer Med 2016; 5:3094-3101. [PMID: 27709795 PMCID: PMC5119964 DOI: 10.1002/cam4.893] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 08/12/2016] [Indexed: 12/14/2022] Open
Abstract
The aim of this study is to compare radiofrequency ablation (RFA) with stereotactic body radiotherapy (SBRT) for hepatocellular carcinomas (HCC) smaller than 3 cm. A Markov cohort model was developed to simulate a cohort of patients aged 60–65 years with small HCCs who had undergone either RFA or SBRT and were followed up over their remaining life expectancy. The inclusion criteria were: (1) HCC ≤3 cm in diameter with ≤ 3 nodules; (2) absence of extrahepatic metastasis or portal/hepatic vein invasion; (3) Child‐Pugh Class A or B. Twenty thousand virtual patients were randomly assigned to undergo RFA or SBRT. Predicted life expectancy was 6.452 and 6.371 years in the RFA and SBRT groups, respectively. The probability distributions of the expected overall survival were nearly identical. The 95% confidence intervals were 6.25–6.66 and 6.17–6.58 years for RFA and SBRT, respectively. The difference between RFA and SBRT was insignificant (P = 0.2884). Two‐way sensitivity analysis demonstrated that if the tumor is 2–3 cm, SBRT is the preferred treatment option. Our Markov model has shown that expected overall survival of SBRT is nearly identical to RFA in HCCs smaller than 3 cm, but SBRT may have an advantage for tumors 2 cm and larger. A randomized trial is required to confirm these findings.
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Affiliation(s)
- Young-Seok Seo
- Department of Radiation Oncology, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Mi-Sook Kim
- Department of Radiation Oncology, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Hyung-Jun Yoo
- Department of Radiation Oncology, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Won Il Jang
- Department of Radiation Oncology, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Eun Kyung Paik
- Department of Radiation Oncology, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Chul Ju Han
- Department of Internal Medicine, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
| | - Byung-Hee Lee
- Department of Radiology, Korea Institute of Radiological & Medical Sciences, Seoul, Korea
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Verma V, Lin SH, Simone CB, Mehta MP. Clinical outcomes and toxicities of proton radiotherapy for gastrointestinal neoplasms: a systematic review. J Gastrointest Oncol 2016; 7:644-64. [PMID: 27563457 DOI: 10.21037/jgo.2016.05.06] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Proton beam radiotherapy (PBT) is frequently shown to be dosimetrically superior to photon radiotherapy (RT), though supporting data for clinical benefit are severely limited. Because of the potential for toxicity reduction in gastrointestinal (GI) malignancies, we systematically reviewed the literature on clinical outcomes (survival/toxicity) of PBT. METHODS A systematic search of PubMed, EMBASE, abstracts from meetings of the American Society for Radiation Oncology, Particle Therapy Co-Operative Group, and American Society of Clinical Oncology was conducted for publications from 2000-2015. Thirty-eight original investigations were analyzed. RESULTS Although results of PBT are not directly comparable to historical data, outcomes roughly mirror previous data, generally with reduced toxicities for PBT in some neoplasms. For esophageal cancer, PBT is associated with reduced toxicities, postoperative complications, and hospital stay as compared to photon radiation, while achieving comparable local control (LC) and overall survival (OS). In pancreatic cancer, numerical survival for resected/unresected cases is also similar to existing photon data, whereas grade ≥3 nausea/emesis and post-operative complications are numerically lower than those reported with photon RT. The strongest data in support of PBT for HCC comes from phase II trials demonstrating very low toxicities, and a phase III trial of PBT versus transarterial chemoembolization demonstrating trends towards improved LC and progression-free survival (PFS) with PBT, along with fewer post-treatment hospitalizations. Survival and toxicity data for cholangiocarcinoma, liver metastases, and retroperitoneal sarcoma are also roughly equivalent to historical photon controls. There are two small reports for gastric cancer and three for anorectal cancer; these are not addressed further. CONCLUSIONS Limited quality (and quantity) of data hamper direct comparisons and conclusions. However, the available data, despite the inherent caveats and limitations, suggest that PBT offers the potential to achieve significant reduction in treatment-related toxicities without compromising survival or LC for multiple GI malignancies. Several randomized comparative trials are underway that will provide more definitive answers.
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Affiliation(s)
- Vivek Verma
- 1 Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, USA ; 2 Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA ; 3 Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA ; 4 Miami Cancer Institute, Baptist Health South Florida, Coral Gables, FL, USA
| | - Steven H Lin
- 1 Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, USA ; 2 Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA ; 3 Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA ; 4 Miami Cancer Institute, Baptist Health South Florida, Coral Gables, FL, USA
| | - Charles B Simone
- 1 Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, USA ; 2 Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA ; 3 Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA ; 4 Miami Cancer Institute, Baptist Health South Florida, Coral Gables, FL, USA
| | - Minesh P Mehta
- 1 Department of Radiation Oncology, University of Nebraska Medical Center, Omaha, NE, USA ; 2 Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA ; 3 Department of Radiation Oncology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA ; 4 Miami Cancer Institute, Baptist Health South Florida, Coral Gables, FL, USA
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Seol SW, Yu JI, Park HC, Lim DH, Oh D, Noh JM, Cho WK, Paik SW. Treatment outcome of hepatic re-irradiation in patients with hepatocellular carcinoma. Radiat Oncol J 2015; 33:276-83. [PMID: 26756027 PMCID: PMC4707210 DOI: 10.3857/roj.2015.33.4.276] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Revised: 11/02/2015] [Accepted: 12/06/2015] [Indexed: 12/21/2022] Open
Abstract
PURPOSE We evaluated the efficacy and toxicity of repeated high dose 3-dimensional conformal radiation therapy (3D-CRT) for patients with unresectable hepatocellular carcinoma. MATERIALS AND METHODS Between 1998 and 2011, 45 patients received hepatic re-irradiation with high dose 3D-CRT in Samsung Medical Center. After excluding two ineligible patients, 43 patients were retrospectively reviewed. RT was delivered with palliative or salvage intent, and equivalent dose of 2 Gy fractions for α/β = 10 Gy ranged from 31.25 Gy10 to 93.75 Gy10 (median, 44 Gy10). Tumor response and toxicity were evaluated based on the modified Response Evaluation Criteria in Solid Tumors criteria and the Common Terminology Criteria for Adverse Events (CTCAE) ver. 4.0. RESULTS The median follow-up duration was 11.2 months (range, 4.1 to 58.3 months). An objective tumor response rate was 62.8%. The tumor response rates were 81.0% and 45.5% in patients receiving ≥45 Gy10 and <45 Gy10, respectively (p = 0.016). The median overall survival (OS) of all patients was 11.2 months. The OS was significantly affected by the Child-Pugh class as 14.2 months vs. 6.1 months (Child-Pugh A vs. B, p < 0.001), and modified Union for International Cancer Control (UICC) T stage as 15.6 months vs. 8.3 months (T1-3 vs. T4, p = 0.004), respectively. Grade III toxicities were developed in two patients, both of whom received ≥50 Gy10. CONCLUSION Hepatic re-irradiation may be an effective and tolerable treatment for patients who are not eligible for further local treatment modalities, especially in patients with Child-Pugh A and T1-3.
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Affiliation(s)
- Seung Won Seol
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jeong Il Yu
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Hee Chul Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Do Hoon Lim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dongryul Oh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jae Myoung Noh
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Won Kyung Cho
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Woon Paik
- Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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26
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Swisher-McClure S, Hahn SM, Bekelman J. Proton beam therapy: the next disruptive innovation in healthcare? Postgrad Med J 2015; 91:241-3. [PMID: 25976493 DOI: 10.1136/postgradmedj-2014-132935] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Samuel Swisher-McClure
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Stephen M Hahn
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Justin Bekelman
- Department of Radiation Oncology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
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Qi WX, Fu S, Zhang Q, Guo XM. Charged particle therapy versus photon therapy for patients with hepatocellular carcinoma: a systematic review and meta-analysis. Radiother Oncol 2014; 114:289-95. [PMID: 25497556 DOI: 10.1016/j.radonc.2014.11.033] [Citation(s) in RCA: 86] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Revised: 11/03/2014] [Accepted: 11/20/2014] [Indexed: 12/13/2022]
Abstract
PURPOSE To perform a systematic review and meta-analysis to compare the clinical outcomes and toxicity of hepatocellular carcinoma (HCC) patients treated with charged particle therapy (CPT) with those of individuals receiving photon therapy. METHODS We identified relevant clinical studies through searching databases. Primary outcomes of interest were overall survival (OS) at 1, 3, 5 years, progression-free survival (PFS), and locoregional control (LC) at longest follow-up. RESULTS 73 cohorts from 70 non-comparative observational studies were included. Pooled OS was significantly higher at 1, 3, 5 years for CPT than for conventional radiotherapy (CRT) [relative risk (RR) 1·68, 95% CI 1·22-2·31; p<0·001; RR 3.46, 95% CI: 1.72-3.51, p<0.001; RR 25.9, 95% CI: 1.64-408.5, p=0.02; respectively]. PFS and LC at longest follow-up was also significantly higher for CPT than for CRT (p=0·013 and p<0.001, respectively), while comparable efficacy was found between CPT and SBRT in terms of OS, PFS and LC at longest follow-up. Additionally, high-grade acute and late toxicity associated with CPT was lower than that of CRT and SBRT. CONCLUSION Survival rates for CPT are higher than those for CRT, but similar to SBRT in patients with HCC. Toxicity tends to be lower for CPT compared to photon radiotherapy.
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Affiliation(s)
- Wei-Xiang Qi
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, China
| | - Shen Fu
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, China; Department of Radiation Oncology, Fudan University Shanghai Cancer Center, China.
| | - Qing Zhang
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, China
| | - Xiao-Mao Guo
- Department of Radiation Oncology, Shanghai Proton and Heavy Ion Center, China; Department of Radiation Oncology, Fudan University Shanghai Cancer Center, China
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The Role of Radiotherapy and Chemoradiation in the Management of Primary Liver Tumours. Clin Oncol (R Coll Radiol) 2014; 26:569-80. [DOI: 10.1016/j.clon.2014.05.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 02/18/2014] [Accepted: 05/28/2014] [Indexed: 12/11/2022]
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Sharma H. Role of external beam radiation therapy in management of hepatocellular carcinoma. J Clin Exp Hepatol 2014; 4:S122-5. [PMID: 25755603 PMCID: PMC4284217 DOI: 10.1016/j.jceh.2014.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2013] [Accepted: 05/08/2014] [Indexed: 12/12/2022] Open
Abstract
Diagnosis at advanced disease stage and early vascular invasion are the bane of majority of patients with hepatocellular carcinoma (HCC) in India. The currently standardized curative and palliative treatment modalities [surgery, ablative techniques, trans-catheter chemotherapy, systemic chemotherapy] are suboptimal for a significant proportion of disease stages. Interest in radiotherapy for hepatocellular carcinoma has seen a resurgence with revolutionary improvements in targeting radiation doses safely. Encouraging results have been reported with a host of radiation techniques from conformal radiotherapy, stereotactic whole body radiation therapy to charged particle based therapies. The dissemination of this knowledge has been slow across other specialties involved in care of patients with HCC. However the increasing availability of radiotherapy services predicts a hopeful future for wider evaluation of radiotherapy in HCC.
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Affiliation(s)
- Hanish Sharma
- Address for correspondence: Hanish Sharma, Senior Research Associate, Department of Gastroenterology and Human Nutrition, All India Institute of Medical Sciences, New Delhi, India.
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30
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Dionisi F, Widesott L, Lorentini S, Amichetti M. Is there a role for proton therapy in the treatment of hepatocellular carcinoma? A systematic review. Radiother Oncol 2014; 111:1-10. [DOI: 10.1016/j.radonc.2014.02.001] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2013] [Revised: 01/28/2014] [Accepted: 02/02/2014] [Indexed: 02/06/2023]
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31
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Hong TS, DeLaney TF, Mamon HJ, Willett CG, Yeap BY, Niemierko A, Wolfgang JA, Lu HM, Adams J, Weyman EA, Arellano RS, Blaszkowsky LS, Allen JN, Tanabe KK, Ryan DP, Zhu AX. A prospective feasibility study of respiratory-gated proton beam therapy for liver tumors. Pract Radiat Oncol 2013; 4:316-322. [PMID: 25194100 DOI: 10.1016/j.prro.2013.10.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2013] [Revised: 10/01/2013] [Accepted: 10/03/2013] [Indexed: 12/29/2022]
Abstract
PURPOSE To evaluate the feasibility of a respiratory-gated proton beam therapy for liver tumors. METHODS AND MATERIALS Fifteen patients were enrolled in a prospective institutional review board-approved protocol. Eligibility criteria included Childs-Pugh A/B cirrhosis, unresectable biopsy- proven hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (ICC), or metastatic disease (solid tumors only), 1-3 lesions, and tumor size of ≤6 cm. Patients received 15 fractions to a total dose of 45-75 GyE [gray equivalent] using respiratory-gated proton beam therapy. Gating was performed with an external respiratory position monitoring based system. RESULTS Of the 15 patients enrolled in this clinical trial, 11 had HCC, 3 had ICC, and 1 had metastasis from another primary. Ten patients had a single lesion, 3 patients had 2 lesions, and 2 patients had 3 lesions. Toxicities were grade 3 bilirubinemia-2, grade 3 gastrointestinal bleed-1, and grade 5 stomach perforation-1. One patient had a marginal recurrence, 3 had hepatic recurrences elsewhere in the liver, and 2 had extrahepatic recurrence. With a median follow-up for survivors of 69 months, 1-, 2-, and 3-year overall survivals are 53%, 40%, and 33%, respectively. Progression-free survivals are 40%, 33%, and 27% at 1, 2, and 3 years, respectively. CONCLUSIONS Respiratory-gated proton beam therapy for liver tumors is feasible. Phase 2 studies for primary liver tumors and metastatic tumors are underway.
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Affiliation(s)
- Theodore S Hong
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Thomas F DeLaney
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Harvey J Mamon
- Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
| | - Christopher G Willett
- Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina
| | - Beow Y Yeap
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andrzej Niemierko
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - John A Wolfgang
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Hsiao-Ming Lu
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Judith Adams
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Elizabeth A Weyman
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ronald S Arellano
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Lawrence S Blaszkowsky
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Jill N Allen
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kenneth K Tanabe
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - David P Ryan
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Andrew X Zhu
- Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Abei M, Okumura T, Fukuda K, Hashimoto T, Araki M, Ishige K, Hyodo I, Kanemoto A, Numajiri H, Mizumoto M, Sakae T, Sakurai H, Zenkoh J, Ariungerel G, Sogo Y, Ito A, Ohno T, Tsuboi K. A phase I study on combined therapy with proton-beam radiotherapy and in situ tumor vaccination for locally advanced recurrent hepatocellular carcinoma. Radiat Oncol 2013; 8:239. [PMID: 24131485 PMCID: PMC3854490 DOI: 10.1186/1748-717x-8-239] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 10/05/2013] [Indexed: 02/08/2023] Open
Abstract
Background Proton-beam radiotherapy (PBT) has been shown to be effective to hepatocellular carcinoma (HCC) as a nonsurgical local treatment option. However, HCC still remains as one of the most difficult cancers to be cured because of frequent recurrences. Thus, methods to inhibit the recurrence need to be explored. To prevent the HCC recurrence, we here report on a prospective phase I study of ‘in situ’ tumor vaccination using CalTUMP, a newly developed immunoadjuvant consisting of BCG extract bound to hydroxyapatite and microparticulated tuberculin, following local PBT for HCC. Methods Patients with locally advanced recurrent HCC, which had been heavily pretreated with various treatments, were enrolled. PBT was performed with the conventional method to the target HCC. Subsequently, CalTUMP was injected into the same irradiated-tumor three times at one-week intervals. Three dose-levels of CalTUMP (1/10, 1/3, and 1/1) were administered to 3 patients each. Vital signs, blood samples, ultrasound, and computed tomographic scans were monitored to evaluate the safety. Results Three intratumoral injections of CalTUMP following PBT (median dose: 72.6 GyE) were accomplished in 9 patients. Transient low-grade fever and minor laboratory changes were observed in 7 patients after CalTUMP injections. No other treatment-related adverse events were observed. Median progression-free survival was 6.0 months (range: 2.1-14.2) and 4 patients were progression-free for more than 1 year. Conclusions Intratumoral injection of CalTUMP following PBT was feasible and safe in patients with heavily pre-treated HCC. Further clinical studies to evaluate the efficacy of this in situ tumor vaccination are warranted.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Koji Tsuboi
- Proton Medical Research Center, Faculty of Medicine, University of Tsukuba, 1-1-1 Tennohdai, Tsukuba, Ibaraki 305-8575, Japan.
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33
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Ling TC, Kang JI, Bush DA, Slater JD, Yang GY. Proton therapy for hepatocellular carcinoma. Chin J Cancer Res 2013. [DOI: 10.1007/s11670-012-0276-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
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Park HC. Recent developments in radiotherapy for hepatocellular carcinoma. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2013. [DOI: 10.5124/jkma.2013.56.11.983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Affiliation(s)
- Hee Chul Park
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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35
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Ling TC, Kang JI, Bush DA, Slater JD, Yang GY. Proton therapy for hepatocellular carcinoma. Chin J Cancer Res 2012; 24:361-7. [PMID: 23359779 PMCID: PMC3551328 DOI: 10.3978/j.issn.1000-9604.2012.10.09] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Accepted: 10/24/2012] [Indexed: 12/26/2022] Open
Abstract
Proton radiotherapy has seen an increasing role in the treatment of hepatocellular carcinoma (HCC). Historically, external beam radiotherapy has played a very limited role in HCC due to a high incidence of toxicity to surrounding normal structures. The ability to deliver a high dose of radiation to the tumor is a key factor in improving outcomes in HCC. Advances in photon radiotherapy have improved dose conformity and allowed dose escalation to the tumor. However, despite these advances there is still a large volume of normal liver that receives a considerable radiation dose during treatment. Proton beams do not have an exit dose along the beam path once they enter the body. The inherent physical attributes of proton radiotherapy offer a way to maximize tumor control via dose escalation while avoiding excessive radiation to the remaining liver, thus increasing biological effectiveness. In this review we discuss the physical attributes and rationale for proton radiotherapy in HCC. We also review recent literature regarding clinical outcomes of using proton radiotherapy for the treatment of HCC.
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Affiliation(s)
- Ted C Ling
- Department of Radiation Medicine, Loma Linda University Medical Center, CA 92354, USA
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Kanemoto A, Oshiro Y, Sugahara S, Kamagata S, Hirobe S, Toma M, Okumura T, Sakurai H. Proton Beam Therapy for Inoperable Recurrence of Bronchial High-grade Mucoepidermoid Carcinoma. Jpn J Clin Oncol 2012; 42:552-5. [DOI: 10.1093/jjco/hys047] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Allen AM, Pawlicki T, Dong L, Fourkal E, Buyyounouski M, Cengel K, Plastaras J, Bucci MK, Yock TI, Bonilla L, Price R, Harris EE, Konski AA. An evidence based review of proton beam therapy: the report of ASTRO's emerging technology committee. Radiother Oncol 2012; 103:8-11. [PMID: 22405807 DOI: 10.1016/j.radonc.2012.02.001] [Citation(s) in RCA: 148] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2011] [Revised: 01/30/2012] [Accepted: 02/04/2012] [Indexed: 12/25/2022]
Abstract
Proton beam therapy (PBT) is a novel method for treating malignant disease with radiotherapy. The purpose of this work was to evaluate the state of the science of PBT and arrive at a recommendation for the use of PBT. The emerging technology committee of the American Society of Radiation Oncology (ASTRO) routinely evaluates new modalities in radiotherapy and assesses the published evidence to determine recommendations for the society as a whole. In 2007, a Proton Task Force was assembled to evaluate the state of the art of PBT. This report reflects evidence collected up to November 2009. Data was reviewed for PBT in central nervous system tumors, gastrointestinal malignancies, lung, head and neck, prostate, and pediatric tumors. Current data do not provide sufficient evidence to recommend PBT in lung cancer, head and neck cancer, GI malignancies, and pediatric non-CNS malignancies. In hepatocellular carcinoma and prostate cancer and there is evidence for the efficacy of PBT but no suggestion that it is superior to photon based approaches. In pediatric CNS malignancies PBT appears superior to photon approaches but more data is needed. In large ocular melanomas and chordomas, we believe that there is evidence for a benefit of PBT over photon approaches. PBT is an important new technology in radiotherapy. Current evidence provides a limited indication for PBT. More robust prospective clinical trials are needed to determine the appropriate clinical setting for PBT.
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Affiliation(s)
- Aaron M Allen
- Davidoff Center, Tel Aviv University, Petach Tikvah, Israel.
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Dose volume histogram analysis of focal liver reaction in follow-up multiphasic CT following stereotactic body radiotherapy for small hepatocellular carcinoma. Radiother Oncol 2012; 104:374-8. [PMID: 22248506 DOI: 10.1016/j.radonc.2011.12.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2011] [Revised: 12/11/2011] [Accepted: 12/12/2011] [Indexed: 12/16/2022]
Abstract
PURPOSE To investigate threshold dose (TD) of focal liver reaction (FLR) following stereotactic body radiotherapy (SBRT) for patients with hepatocellular carcinoma (HCC) and liver cirrhosis. MATERIALS AND METHODS In consecutive 50 patients receiving SBRT for small HCC, 38 patients receiving SBRT and follow up >6 months, FLR on follow-up CT had been previously studied. Patients with good concordance between FLR and highly irradiated area were eligible. Dose volume histogram (DVH) was used to identify TDs for FLR. Clinical factors were analyzed for correlation with TDs. RESULTS Of 24 eligible patients, 23 had Child-Pugh score A and 1 scored B. Presence of FLR peaked at a median of 6 (range; 3-12) months. The median and 95% confidential intervals of TDs of pre-contrast and portal-venous phase CT were 32.4 Gy (30.3-35.4) and 34.4 Gy (31.9-36.0), respectively. Each median coefficient representing the concordance was 74.9% (range; 55.8-98.0%) and 80.5% (range; 70.8-92.4%), respectively. No clinical factors significantly correlated with the TDs. CONCLUSION We proposed 30 Gy/5 fractions as TD of FLRs following SBRT for patients with HCC and liver cirrhosis. This TD will enable us to predict injured liver volume and to avoid complication beforehand from toxicity. Further pathological and clinical studies, in addition to more practical and precise data of DVH, are needed to clarify the significance of FLRs.
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Kase Y, Yamashita H, Fuji H, Yamamoto Y, Pu Y, Tsukishima C, Murayama S. A treatment planning comparison of passive-scattering and intensity-modulated proton therapy for typical tumor sites. JOURNAL OF RADIATION RESEARCH 2011; 53:272-280. [PMID: 22129564 DOI: 10.1269/jrr.11136] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Intensity-modulated proton therapy (IMPT) is expected to improve treatment results with fewer side effects than other proton therapies. The purpose of this study was to evaluate the tumor sites for which IMPT was effective under the same beam calculation conditions by planning IMPT for typical cases treated with passive scattering proton therapy (PSPT). We selected 16 cases of nasal cavity, lung, liver or prostate cancers as typical tumor sites receiving PSPT. The dose distributions and dose volume histograms optimized by the IMPT were compared with those optimized by the PSPT. We took particular note of the doses to the skin and organs at risk (OAR) when PSPT was replaced by IMPT. Furthermore, an improvement of the beam angles was also performed to obtain better dose distributions in the IMPT. The IMPT with the same beam angles resulted in near-maximum doses to the skin of average 78%, 64%, 84% and 99% of the PSPT doses for nasal cavity, lung, liver, and prostate cancers, respectively. However, it was difficult to improve the dose homogeneity of the target volume. The change of the IMPT beam angles could reduce the doses to OARs and skin in the case of the nasal cavity, while it had limited effect in the other cases. We concluded that IMPT was effective for reducing the doses to some OARs when treating nasal cavity, lung, liver and prostate cancers. The selection of beam angles was important in the IMPT optimization, especially for nasal cavity cancers.
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Affiliation(s)
- Yuki Kase
- Proton Therapy Division, Shizuoka Cancer Center Research Institute, Nagaizumi, Shizuoka 411-8777, Japan.
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KIM KIHONG, KIM HONGTAE, KIM JONGHEE, SEO SEUNGJUN, CHUNG DUCKSOO, KIM JONGKI. INVESTIGATION OF TUMOR CELL TOXICITY FROM PARTICLE INDUCED X-RAY EMISSION FROM A 45-MeV PROTON BEAM IRRADIATED FERRITE NANOPARTICLE. ACTA ACUST UNITED AC 2011. [DOI: 10.1142/s0129083509001837] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
In order to investigate the potential cytotoxic effects of particle-induced x-ray emission (PIXE) on tumor cells, 45 MeV proton beam was irradiated on C6 glioma cell lines that had taken up alginate-coated ferrite nanoparticles (Alg-SNP). Cells were anchored in vertical 96-well dishes facing a horizontal beam where the Bragg peak was placed on the upper part of the 96-well dish. Experimental groups included cells without SNP as a control (No-SNP), and cells incubated with SNP for 6 hours (6hr-SNP) or overnight (ON-SNP). A 0 to 200 Gy proton beam from an MC50 cyclotron (Scanditronix, Sweden) at the Korea Cancer Center Hospital (Seoul, Korea) was used to irradiate each experimental group. Perinuclear Alg-SNP nanoparticle distribution was observed in glioma cells. The test groups (6hr-SNP or ON-SNP) showed an estimated 20-28% (ANOVA, P < 0.05) less cell survival compared to the control group based on MTT assay. Nuclear damage, indicating apoptosis, was present at a higher frequency in the 6hr-SNP and ON-SNP groups up to relatively low radiation dose of 100 Gy by fluorescence microscopy upon Hoechst 33342 and Acridine Orange staining. Ferrite nanoparticles alone were not cytotoxic at the experimental concentration of 0.15 mg/ml. Therefore ferrite nanoparticles may induce additional cytotoxicity from X-ray emission from potential PIXE effects. PIXE and metal nanoparticles may be developed as a therapeutic factor and prodrug for localized proton beam therapy without side effects of solid or disseminate tumors on the surrounding normal tissue.
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Affiliation(s)
- KI-HONG KIM
- Department of Visual Optics, Kyungwoon University, Gumi, 730-739, Korea
| | - HONG-TAE KIM
- Anatomy, School of Medicine, Catholic University of Daegu, Daegu, 705-034, Korea
| | - JONG-HEE KIM
- Center of Advanced Magnetic Materials, Chungnam National University, Korea
| | - SEUNG-JUN SEO
- Biomedical Engineering, School of Medicine, Catholic University of Daegu, Daegu, 705-034, Korea
| | - DUCK-SOO CHUNG
- Radiology and Nuclear Medicine, School of Medicine, Catholic University of Daegu, Daegu, 705-034, Korea
| | - JONG-KI KIM
- Biomedical Engineering & Radiology, School of Medicine, Catholic University of Daegu, Daegu, 705-034, Korea
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Abstract
Historically, the use of external-beam radiotherapy for hepatocellular carcinoma (HCC) has been limited by toxicity to the uninvolved liver and surrounding structures. Advances in photon radiotherapy have improved dose conformality to the tumor and facilitated dose escalation, a key contributor to improved HCC radiation treatment outcomes. However, despite these advances in photon radiotherapy, significant volumes of liver still receive low doses of radiation that can preclude dose escalation, particularly in patients with limited functional liver reserves. By capitalizing on the lack of exit dose along the beam path beyond the tumor and higher biological effectiveness, charged-particle therapy offers the promise of maximizing tumor control via dose escalation without excessive liver toxicity. In this review, we discuss the distinctive biophysical attributes of both proton and carbon ion radiotherapy, particularly as they pertain to treatment of HCC. We also review the available literature regarding clinical outcomes and the toxicity of using charged particles for the treatment of HCC.
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Affiliation(s)
- Heath D. Skinner
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Theodore S. Hong
- Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Sunil Krishnan
- Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX
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Displacement of hepatic tumor at time to exposure in end-expiratory-triggered-pulse proton therapy. Radiother Oncol 2011; 99:124-30. [DOI: 10.1016/j.radonc.2011.05.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Revised: 04/18/2011] [Accepted: 05/03/2011] [Indexed: 01/14/2023]
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Jensen AD, Münter MW, Debus J. Review of clinical experience with ion beam radiotherapy. Br J Radiol 2011; 84 Spec No 1:S35-47. [PMID: 21427183 DOI: 10.1259/bjr/71511359] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
The article describes both the early development of oncology as a core discipline at the University of Heidelberg Hospital and the first steps towards ion beam treatment, from the pilot project carried out in co-operation with the Gesellschaft für Schwerionenforschung Darmstadt to the initial start-up of clinical service at the Heidelberg Heavy Ion Centre (HIT). We present an overview, based on data published in the literature, of the available clinical evidence relating the use of ion beam therapy to treat major indications in active particle centres. A rationale for the use of particle therapy in each of these indications is given. In view of the limited availability of data, we discuss the necessity to conduct clinical trials. We also look forward towards the next activities to be undertaken at the HIT.
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Affiliation(s)
- A D Jensen
- Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany.
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Combs SE, Habermehl D, Ganten T, Schmidt J, Edler L, Burkholder I, Jäkel O, Haberer T, Debus J. Phase i study evaluating the treatment of patients with hepatocellular carcinoma (HCC) with carbon ion radiotherapy: the PROMETHEUS-01 trial. BMC Cancer 2011; 11:67. [PMID: 21314962 PMCID: PMC3045987 DOI: 10.1186/1471-2407-11-67] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2010] [Accepted: 02/12/2011] [Indexed: 01/02/2023] Open
Abstract
Background Treatment options for patients with advanced hepatocellular carcinoma (HCC) are often limited. In most cases, they are not amenable to local therapies including surgery or radiofrequency ablation. The multi-kinase inhibitor sorafenib has shown to increase overall survival in this patient group for about 3 months. Radiation therapy is a treatment alternative, however, high local doses are required for long-term local control. However, due to the relatively low radiation tolerance of liver normal tissue, even using stereotactic techniques, delivery of sufficient doses for successful local tumor control has not be achieved to date. Carbon ions offer physical and biological characteristics. Due to their inverted dose profile and the high local dose deposition within the Bragg peak precise dose application and sparing of normal tissue is possible. Moreover, in comparison to photons, carbon ions offer an increased relative biological effectiveness (RBE), which can be calculated between 2 and 3 depending on the HCC cell line as well as the endpoint analyzed. Japanese Data on the evaluation of carbon ion radiation therapy showed promising results for patients with HCC. Methods/Design In the current Phase I-PROMETHEUS-01-Study, carbon ion radiotherapy will be evaluated for patients with advanced HCC. The study will be performed as a dose-escalation study evaluating the optimal carbon ion dose with respect to toxicity and tumor control. Primary endpoint is toxicity, secondary endpoint is progression-free survival and response. Discussion The Prometheus-01 trial ist the first trial evaluating carbon ion radiotherapy delivered by intensity-modulated rasterscanning for the treatment of HCC. Within this Phase I dose escalation study, the optimal dose of carbon ion radiotherapy will be determined. Trial registration NCT 01167374
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Affiliation(s)
- Stephanie E Combs
- Department of Radiation Oncology, University Hospital of Heidelberg, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany.
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Radiothérapie externe des carcinomes hépatocellulaires. Cancer Radiother 2011; 15:49-53. [DOI: 10.1016/j.canrad.2010.11.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Accepted: 10/12/2010] [Indexed: 12/27/2022]
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Bujold A, Dawson LA. Stereotactic radiation therapy and selective internal radiation therapy for hepatocellular carcinoma. Cancer Radiother 2011; 15:54-63. [PMID: 21239204 DOI: 10.1016/j.canrad.2010.11.003] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2010] [Accepted: 07/21/2010] [Indexed: 12/17/2022]
Abstract
Recent technological advances allow precise and safe radiation delivery in hepatocellular carcinoma. Stereotactic body radiotherapy is a conformal external beam radiation technique that uses a small number of relatively large fractions to deliver potent doses of radiation therapy to extracranial sites. It requires stringent breathing motion control and image guidance. Selective internal radiotherapy or radioembolization refers to the injection of radioisotopes, usually delivered to liver tumors via the hepatic artery. Clinical results for both treatments show that excellent local control is possible with acceptable toxicity. Most appropriate patient populations and when which type of radiation therapy should be best employed in the vast therapeutic armamentarium of hepatocellular carcinoma are still to be clarified.
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Affiliation(s)
- A Bujold
- Radiation Medicine Program, Princess Margaret Hospital, 610 University Avenue, Toronto, Ontario, Canada
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Abstract
Radiation therapy with charged particles, such as protons and heavier ions, provides physical selectivity and therefore allows for favorable dose distributions in comparison with conventional photon radiotherapy. Carbon ions furthermore exhibit biologic advantages related to their high linear energy transfer properties in a number of tumors known to be relatively insensitive to low-linear energy transfer radiation therapy. Over the last 2 decades, major developments in the fields of accelerator technology, diagnostic techniques, and beam delivery methods have been made. These developments formed the basis for the application of particle beams in clinical surroundings. Many clinical centers are already considering the introduction of radiation therapy with charged particles. This article reviews the clinical experience with particle therapy in adults available so far.
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Bouyon-Monteau A, Habrand JL, Datchary J, Alapetite C, Bolle S, Dendale R, Feuvret L, Helfre S, Calugaru V, Cosset JM, Bey P. [Is proton beam therapy the future of radiotherapy? Part I: clinical aspects]. Cancer Radiother 2010; 14:727-38. [PMID: 20427218 DOI: 10.1016/j.canrad.2010.01.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2009] [Revised: 01/16/2010] [Accepted: 01/21/2010] [Indexed: 11/29/2022]
Abstract
Proton beam therapy uses positively charged particles, protons, whose physical properties improve dose-distribution (Bragg peak characterized by a sharp distal and lateral penumbra) compared with conventional photon-based radiation therapy (X-ray). These ballistic advantages apply to the treatment of deep-sited tumours located close to critical structures and requiring high-dose levels. [60-250 MeV] proton-beam therapy is now widely accepted as the "gold standard" in specific indications in adults--ocular melanoma, chordoma and chondrosarcoma of the base of skull --and is regarded as a highly promising treatment modality in the treatment of paediatric malignancies (brain tumours, sarcomas…). This includes the relative sparing of surrounding normal organs from low and mid-doses that can cause deleterious side-effects such as radiation-induced secondary malignancies. Other clinical studies are currently testing proton beam in dose-escalation evaluations, in prostate, lung, hepatocellular cancers, etc. Clinical validation of these new indications appears necessary. To date, over 60,000 patients worldwide have received part or all of their radiation therapy program by proton beams, in approximately 30 treatment facilities.
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Affiliation(s)
- A Bouyon-Monteau
- Centre de protonthérapie d'Orsay, institut Curie, campus universitaire, bâtiment 101, 91898 Orsay cedex, France
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Nakayama H, Sugahara S, Tokita M, Fukuda K, Mizumoto M, Abei M, Shoda J, Sakurai H, Tsuboi K, Tokuuye K. Proton beam therapy for hepatocellular carcinoma: the University of Tsukuba experience. Cancer 2010; 115:5499-506. [PMID: 19645024 DOI: 10.1002/cncr.24619] [Citation(s) in RCA: 104] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND The authors have published a series of studies evaluating the safety and efficacy of proton beam therapy for the treatment of hepatocellular carcinoma in a variety of clinical settings. In the current study, they retrospectively reviewed their entire experience treating hepatocellular carcinoma patients with proton beam therapy at their hospital-based facility at the University of Tsukuba. METHODS From November 2001 to December 2007, 333 patients with hepatocellular carcinoma were treated with proton beam therapy at the University of Tsukuba. A total of 318 patients were included in this study. Total dose delivered and fractionation scheme were determined by protocols that varied based on location of tumor. Survival rates and prognostic factors were assessed. RESULTS Overall actuarial survival rates at 1-year, 3-years, and 5-years were 89.5% (95% confidence interval [95% CI], 85.7-93.1%), 64.7% (95% CI, 56.6-72.9%), and 44.6% (95% CI, 29.7-59.5%), respectively. Child-Pugh liver function (hazards ratio [HR], 2.84; P < .01), T stage (HR, 1.94; P < .05), performance status (HR, 2.12; P < .01), and planning target volume (HR, 2.12; P < .05) significantly impacted survival. The 3-year and 5-year survival rates were 69.1% (95% CI, 59.9-78.3%) and 55.9% (95% CI, 41.5-70.3%), respectively, for patients with Child-Pugh A disease and 51.9% (95% CI, 32.3-71.5%) and 44.5% (95% CI, 23.1-65.8%), respectively, for patients with Child-Pugh B disease. The actuarial survival rates of patients with Child-Pugh class A were statistically different between groups of planned target volume <or=125 mL and >125 mL (P < .05). CONCLUSIONS The authors have shown proton beam therapy to be both safe and effective for the treatment of patients with hepatocellular carcinoma. They strongly recommend the consideration of proton beam therapy in patients for whom other treatment options are risky or contraindicated.
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Affiliation(s)
- Hidetsugu Nakayama
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki, Japan.
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