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Ishida T, Mizumoto M, Saito T, Okumura T, Miura K, Makishima H, Iizumi T, Numajiri H, Baba K, Murakami M, Nakamura M, Nakai K, Sakurai H. Proton Beam Therapy for Treating Patients with Hepatocellular Carcinoma with Major Portal Vein Tumor Invasion: A Single Center Retrospective Study. Cancers (Basel) 2024; 16:2050. [PMID: 38893169 PMCID: PMC11171269 DOI: 10.3390/cancers16112050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Revised: 05/27/2024] [Accepted: 05/27/2024] [Indexed: 06/21/2024] Open
Abstract
Hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) has a poor prognosis and is generally not indicated for surgery. Proton beam therapy (PBT) may offer an alternative treatment. In this study, long-term outcomes were examined in 116 patients (median age 66 years, 100 males) with HCC with advanced PVTT (Vp3 or Vp4) who received PBT from April 2008 to March 2018. Of these patients, 63 received PBT as definitive treatment and 53 as palliative treatment. The representative dose was 72.6 Gy (RBE) in 22 fractions. Eight patients died in follow-up, including 72 due to tumor progression. The 5-year overall survival (OS) rate was 18.0% (95% CI 9.8-26.2%) and the 5-year local control (LC) rate was 86.1% (74.9-97.3%). In multivariate analyses, performance status and treatment strategy were significantly associated with OS. The median follow-up period for survivors with definitive treatment was 33.5 (2-129) months, and the 5-year OS rate was 25.1% (12.9-37.3%) in these cases. The median survival time after definitive irradiation was >20 months. The 5-year OS rate was 9.1% (0-19.7%) for palliative irradiation. These results compare favorably with those of other therapies and suggest that PBT is a useful option for cases of HCC with advanced PVTT that cannot undergo surgery, with an expected survival benefit and good local control. Determining the optimal indication for this treatment is a future challenge.
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Affiliation(s)
- Toshiki Ishida
- Department of Radiation Oncology, University of Tsukuba Hospital, 2-1-1 Tsukuba, Ibaraki 305-8576, Japan; (T.I.); (T.S.); (T.O.); (K.M.); (H.M.); (T.I.); (H.N.); (K.B.); (M.M.); (M.N.); (K.N.); (H.S.)
| | - Masashi Mizumoto
- Department of Radiation Oncology, University of Tsukuba Hospital, 2-1-1 Tsukuba, Ibaraki 305-8576, Japan; (T.I.); (T.S.); (T.O.); (K.M.); (H.M.); (T.I.); (H.N.); (K.B.); (M.M.); (M.N.); (K.N.); (H.S.)
| | - Takashi Saito
- Department of Radiation Oncology, University of Tsukuba Hospital, 2-1-1 Tsukuba, Ibaraki 305-8576, Japan; (T.I.); (T.S.); (T.O.); (K.M.); (H.M.); (T.I.); (H.N.); (K.B.); (M.M.); (M.N.); (K.N.); (H.S.)
| | - Toshiyuki Okumura
- Department of Radiation Oncology, University of Tsukuba Hospital, 2-1-1 Tsukuba, Ibaraki 305-8576, Japan; (T.I.); (T.S.); (T.O.); (K.M.); (H.M.); (T.I.); (H.N.); (K.B.); (M.M.); (M.N.); (K.N.); (H.S.)
- Department of Radiation Oncology, Ibaraki Prefectural Central Hospital, Ibaraki 309-1703, Japan
| | - Kosei Miura
- Department of Radiation Oncology, University of Tsukuba Hospital, 2-1-1 Tsukuba, Ibaraki 305-8576, Japan; (T.I.); (T.S.); (T.O.); (K.M.); (H.M.); (T.I.); (H.N.); (K.B.); (M.M.); (M.N.); (K.N.); (H.S.)
- Department of Radiation Oncology, JCHO Tokyo Shinjuku Medical Center, Tokyo 162-8543, Japan
| | - Hirokazu Makishima
- Department of Radiation Oncology, University of Tsukuba Hospital, 2-1-1 Tsukuba, Ibaraki 305-8576, Japan; (T.I.); (T.S.); (T.O.); (K.M.); (H.M.); (T.I.); (H.N.); (K.B.); (M.M.); (M.N.); (K.N.); (H.S.)
| | - Takashi Iizumi
- Department of Radiation Oncology, University of Tsukuba Hospital, 2-1-1 Tsukuba, Ibaraki 305-8576, Japan; (T.I.); (T.S.); (T.O.); (K.M.); (H.M.); (T.I.); (H.N.); (K.B.); (M.M.); (M.N.); (K.N.); (H.S.)
| | - Haruko Numajiri
- Department of Radiation Oncology, University of Tsukuba Hospital, 2-1-1 Tsukuba, Ibaraki 305-8576, Japan; (T.I.); (T.S.); (T.O.); (K.M.); (H.M.); (T.I.); (H.N.); (K.B.); (M.M.); (M.N.); (K.N.); (H.S.)
| | - Keiichiro Baba
- Department of Radiation Oncology, University of Tsukuba Hospital, 2-1-1 Tsukuba, Ibaraki 305-8576, Japan; (T.I.); (T.S.); (T.O.); (K.M.); (H.M.); (T.I.); (H.N.); (K.B.); (M.M.); (M.N.); (K.N.); (H.S.)
| | - Motohiro Murakami
- Department of Radiation Oncology, University of Tsukuba Hospital, 2-1-1 Tsukuba, Ibaraki 305-8576, Japan; (T.I.); (T.S.); (T.O.); (K.M.); (H.M.); (T.I.); (H.N.); (K.B.); (M.M.); (M.N.); (K.N.); (H.S.)
| | - Masatoshi Nakamura
- Department of Radiation Oncology, University of Tsukuba Hospital, 2-1-1 Tsukuba, Ibaraki 305-8576, Japan; (T.I.); (T.S.); (T.O.); (K.M.); (H.M.); (T.I.); (H.N.); (K.B.); (M.M.); (M.N.); (K.N.); (H.S.)
| | - Kei Nakai
- Department of Radiation Oncology, University of Tsukuba Hospital, 2-1-1 Tsukuba, Ibaraki 305-8576, Japan; (T.I.); (T.S.); (T.O.); (K.M.); (H.M.); (T.I.); (H.N.); (K.B.); (M.M.); (M.N.); (K.N.); (H.S.)
| | - Hideyuki Sakurai
- Department of Radiation Oncology, University of Tsukuba Hospital, 2-1-1 Tsukuba, Ibaraki 305-8576, Japan; (T.I.); (T.S.); (T.O.); (K.M.); (H.M.); (T.I.); (H.N.); (K.B.); (M.M.); (M.N.); (K.N.); (H.S.)
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Mizumoto M, Ogino H, Okumura T, Terashima K, Murakami M, Ogino T, Tamamura H, Akimoto T, Waki T, Katoh N, Araya M, Onoe T, Takagi M, Iwata H, Numajiri H, Okimoto T, Uchinami Y, Maruo K, Shibuya K, Sakurai H. Proton Beam Therapy for Hepatocellular Carcinoma: Multicenter Prospective Registry Study in Japan. Int J Radiat Oncol Biol Phys 2024; 118:725-733. [PMID: 37778422 DOI: 10.1016/j.ijrobp.2023.09.047] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Revised: 09/13/2023] [Accepted: 09/21/2023] [Indexed: 10/03/2023]
Abstract
PURPOSE A prospective multicenter registry study was started May 2016 in Japan to evaluate the efficacy and safety of proton beam therapy (PBT) for hepatocellular carcinoma (HCC). METHODS AND MATERIALS Patients who received PBT for HCC from May 2016 to June 2018 were registered in the database of the Particle Beam Therapy Committee and Subcommittee of the Japanese Society for Radiation Oncology. Overall survival (OS), progression-free survival (PFS), and local recurrence were evaluated. RESULTS Of the 755 registered patients, 576 with initial PBT and no duplicate cancer were evaluated. At final follow-up, 322 patients were alive and 254 had died. The median follow-up period for survivors was 39 months (0-58 months). The median OS time of the 576 patients was 48.8 months (95% CI, 42.0-55.6 months) and the 1-, 2-, 3-, and 4-year OS rates were 83.8% (95% CI, 80.5%-86.6%), 68.5% (64.5%-72.2%), 58.2% (53.9%-62.2%), and 50.1% (44.9%-55.0%), respectively. Recurrence was observed in 332 patients, including local recurrence in 45 patients. The median PFS time was 14.7 months (95% CI, 12.4-17.0 months) and the 1-, 2-, 3-, and 4-year PFS rates were 55.2% (95% CI, 51.0%-59.2%), 37.5% (33.5%-41.5%), 30.2% (26.3%-34.2%), and 22.8% (18.5%-27.4%), respectively. The 1-, 2-, 3-, and 4-year OS rates were significantly higher for tumor size <5 versus 5 to 10 cm (P < .001) and <5 versus ≥10 cm (P < .001); Child-Pugh score A/B versus C (P < .001); and distance of the tumor from the gastrointestinal tract <1 versus 1 to 2 cm (P < .008) and <1 versus >2 cm (P < .001). At final follow-up, 27 patients (4.7%) had late adverse events of grade 3 or higher, with liver failure (n = 7), and dermatitis (n = 7) being most common. CONCLUSIONS This multicenter prospective data registry indicated that PBT for HCC gives good therapeutic effects (3-year local control rate of 90%) with a low risk of severe late adverse events.
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Affiliation(s)
- Masashi Mizumoto
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki, 305-8576, Japan.
| | - Hiroyuki Ogino
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City University West Medical Center, Nagoya, 462-8508, Japan
| | - Toshiyuki Okumura
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki, 305-8576, Japan
| | - Kazuki Terashima
- Department of Radiology, Hyogo Ion Beam Medical Center, Tatsuno, Hyogo, 679-5165, Japan
| | - Masao Murakami
- Department of Radiation Oncology, Southern Tohoku Proton Therapy Center, Koriyama, Fukushima, 963-8052, Japan
| | - Takashi Ogino
- Medipolis Proton Therapy and Research Center, 4423 Higashikata, Ibusuki, Kagoshima, 891-0304, Japan
| | - Hiroyasu Tamamura
- Proton Therapy Center, Fukui Prefectural Hospital, Fukui, Fukui, 910-8526, Japan
| | - Tetsuo Akimoto
- Department of Radiation Oncology, National Cancer Center Hospital East, Chiba, 277-8577, Japan
| | - Takahiro Waki
- Department of Radiology, Tsuyama Chuo Hospital, Tsuyama, Okayama, 708-0841, Japan
| | - Norio Katoh
- Department of Radiation Oncology, Hokkaido University Institute of Medicine, Hokkaido, 060-8648, Japan
| | - Masayuki Araya
- Proton Therapy Center, Aizawa Hospital, Matsumoto, Nagano, 390-8510, Japan
| | - Tsuyoshi Onoe
- Radiation and Proton Therapy Center, Shizuoka Cancer Center, Nagaizumi, Suntou-gun, Shizuoka, 411-8777, Japan
| | - Masaru Takagi
- Department of Radiation Oncology, Sapporo Teishinkai Hospital, Sapporo, Hokkaido, 065-0033, Japan
| | - Hiromitsu Iwata
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City University West Medical Center, Nagoya, 462-8508, Japan
| | - Haruko Numajiri
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki, 305-8576, Japan
| | - Tomoaki Okimoto
- Department of Radiology, Hyogo Ion Beam Medical Center, Tatsuno, Hyogo, 679-5165, Japan
| | - Yusuke Uchinami
- Department of Radiation Oncology, Hokkaido University Institute of Medicine, Hokkaido, 060-8648, Japan
| | - Kazushi Maruo
- Department of Biostatistics, Institute of Medicine, University of Tsukuba, Tsukuba, Ibaraki, 305-8575, Japan
| | - Kei Shibuya
- Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, 371-8511, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki, 305-8576, Japan
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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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Iwata H, Ogino H, Hattori Y, Nakajima K, Nomura K, Hashimoto S, Hayashi K, Toshito T, Sasaki S, Mizoe JE, Shibamoto Y. A Phase 2 Study of Image-Guided Proton Therapy for Operable or Ablation-Treatable Primary Hepatocellular Carcinoma. Int J Radiat Oncol Biol Phys 2021; 111:117-126. [PMID: 33798564 DOI: 10.1016/j.ijrobp.2021.03.049] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 03/18/2021] [Accepted: 03/23/2021] [Indexed: 12/18/2022]
Abstract
PURPOSE Because most previous data on proton therapy for hepatocellular carcinoma (HCC) were retrospectively collected from inoperable or previously treated cases, our aim was to evaluate the outcome of image-guided proton therapy (IGPT) for operable or radiofrequency ablation-treatable primary HCC. METHODS AND MATERIALS This phase 2 study prospectively investigated the efficacy and safety of IGPT and quality of life (QoL) after IGPT for operable/ablatable HCC. The primary endpoint was overall survival, and the secondary endpoints were local control, incidence of grade ≥3 adverse events, and changes in QoL. Toxicities were evaluated with Common Terminology Criteria for Adverse Events, version 4.0. QoL scores were assessed with European Organization for Research and Treatment of Cancer Quality of Life Questionnaire, version 3.0, and Quality of Life Questionnaire-Hepatocellular Carcinoma/Primary Liver Cancer Module. IGPT was performed using respiratory-gated techniques. RESULTS Forty-five patients (median age: 68 years; range, 36-80 years) were enrolled between June 2013 and February 2016; 38 were considered operable and 14 were indicated for radiofrequency ablation. The major underlying liver diseases were hepatitis B (n = 16), hepatitis C (n = 13), alcoholic hepatitis (n = 3), and nonalcoholic fatty liver disease (n = 13). The Child-Pugh score was A5 in 32 patients, A6 in 9 patients, and B7 in 4 patients. Thirty-seven patients with a peripherally located tumor were given 66 Gy relative biological effectiveness in 10 fractions, and 8 patients with a centrally located tumor received 72.6 Gy relative biological effectiveness in 22 fractions. The median follow-up period of surviving patients was 60 months (range, 42-75 months). Two- and 5-year overall survival rates were 84% (95% confidence interval [CI], 74%-95%) and 70% (95% CI, 56%-84%), respectively, and local control rates were 95% (95% CI, 89%-100%) and 92% (95% CI, 84%-100%), respectively. Grade 3 radiation-induced liver disease was observed in 1 patient. No significant changes were noted in QoL scores 1 year after treatment, except for body image. CONCLUSIONS Although the primary endpoint did not meet statistical significance as planned in the study design, IGPT is a safe and effective treatment for solitary primary HCC and may become a treatment option.
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Affiliation(s)
- Hiromitsu Iwata
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Nagoya, Japan; Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan.
| | - Hiroyuki Ogino
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Nagoya, Japan; Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yukiko Hattori
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Nagoya, Japan
| | - Koichiro Nakajima
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Nagoya, Japan; Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kento Nomura
- Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Nagoya, Japan; Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shingo Hashimoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Kensuke Hayashi
- Department of Proton Therapy Technology, Nagoya Proton Therapy Center, Nagoya, Japan
| | - Toshiyuki Toshito
- Department of Proton Therapy Physics, Nagoya Proton Therapy Center, Nagoya, Japan
| | - Shigeru Sasaki
- Department of Diagnostic Radiology, Nagoya City West Medical Center, Nagoya, Japan
| | - Jun-Etsu Mizoe
- Sapporo High Functioning Radiotherapy Center, Hokkaido Ohno Memorial Hospital, Sapporo, Japan
| | - Yuta Shibamoto
- Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Fujimoto K, Shiinoki T, Yuasa Y, Tanaka H. Estimation of liver elasticity using the finite element method and four-dimensional computed tomography images as a biomarker of liver fibrosis. Med Phys 2021; 48:1286-1298. [PMID: 33449406 DOI: 10.1002/mp.14723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 01/08/2021] [Accepted: 01/08/2021] [Indexed: 10/22/2022] Open
Abstract
PURPOSE Current radiotherapy planning procedures are generally designed based on anatomical information only and use computed tomography (CT) images that do not incorporate organ-functional information. In this study, we developed a method for estimating liver elasticity using the finite element method (FEM) and four-dimensional CT (4DCT) images acquired during radiotherapy planning, and we subsequently evaluated its feasibility as a biomarker for liver fibrosis. MATERIALS AND METHODS Twenty patients who underwent 4DCT and ultrasound-based transient elastography (UTE) were enrolled. All patients had chronic liver disease or cirrhosis. Liver elasticity measurements of the UTE were performed on the right lobe of the patient's liver in 20 patients. The serum biomarkers of the aspartate aminotransferase (AST)-to-platelet ratio index (APRI) and fibrosis-4 index (FIB-4) were available in 18 of the 20 total patients, which were measured within 1 week after undergoing 4DCT. The displacement between the 4DCT images obtained at the endpoints of exhalation and inspiration was determined using the actual (via deformable image registration) and simulated (via FEM) respiration-induced displacement. The elasticity of each element of the liver model was optimized by minimizing the error between the actual and simulated respiration-induced displacement. Then, each patient's estimated liver elasticity was defined as the mean Young's modulus of the liver's right lobe and that of the whole liver using the estimated elasticity map. The estimated liver elasticity was evaluated for correlations with the elasticity obtained via UTE and with two serum biomarkers (APRI and FIB-4). RESULTS The mean ± standard deviation (SD) of the errors between the actual and simulated respiration-induced displacement in the liver model was 0.54 ± 0.33 mm. The estimated liver's right lobe elasticity was statistically significantly correlated with the UTE (r = 0.87, P < 0.001). Furthermore, the estimated whole liver elasticity was statistically significantly correlated with the UTE (r = 0.84, P < 0.001), APRI score (r = 0.62, P = 0.005), and FIB-4 score (r = 0.54, P = 0.021). CONCLUSION In this study, liver elasticity was estimated through FEM-based simulation and actual respiratory-induced liver displacement obtained from 4DCT images. Furthermore, we assessed that the estimated elasticity of the liver's right lobe was strongly correlated with the UTE. Therefore, the estimated elasticity has the potential to be a feasible imaging biomarker for assessing liver fibrosis using only 4DCT images without additional inspection or equipment costs. Because our results were derived from a limited sample of 20 patients, it is necessary to evaluate the accuracy of elasticity estimation for each liver segment on larger groups of biopsied patients to utilize liver elasticity information for radiotherapy planning.
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Affiliation(s)
- Koya Fujimoto
- Department of Radiation Oncology, Graduate School of Medicine, Yamaguchi University, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8535, Japan
| | - Takehiro Shiinoki
- Department of Radiation Oncology, Graduate School of Medicine, Yamaguchi University, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8535, Japan
| | - Yuki Yuasa
- Department of Radiation Oncology, Graduate School of Medicine, Yamaguchi University, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8535, Japan
| | - Hidekazu Tanaka
- Department of Radiation Oncology, Graduate School of Medicine, Yamaguchi University, 1-1-1 Minamikogushi, Ube, Yamaguchi, 755-8535, Japan
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Transitions of Liver and Biliary Enzymes during Proton Beam Therapy for Hepatocellular Carcinoma. Cancers (Basel) 2020; 12:cancers12071840. [PMID: 32650519 PMCID: PMC7408831 DOI: 10.3390/cancers12071840] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 06/30/2020] [Accepted: 07/06/2020] [Indexed: 02/07/2023] Open
Abstract
Proton beam therapy (PBT) is a curative treatment for hepatocellular carcinoma (HCC), because it can preserve liver function due to dose targeting via the Bragg peak. However, the degree of direct liver damage by PBT is unclear. In this study, we retrospectively analyzed liver/biliary enzymes and total bilirubin (T-Bil) as markers of direct liver damage during and early after PBT in 300 patients. The levels of these enzymes and bilirubin were almost stable throughout the treatment period. In patients with normal pretreatment levels, aminotransferase (AST), alanine aminotransferase (ALT), alkaline phosphatase (ALP), gamma-glutamyl transpeptidase (GGT), and T-Bil were abnormally elevated in only 2 (1.2%), 1 (0.4%), 0, 2 (1.2%), and 8 (3.5%) patients, respectively, and in 8 of these 13 patients (61.5%) the elevations were temporary. In patients with abnormal pretreatment levels, the levels tended to decrease during PBT. GGT and T-Bil were elevated by 1.62 and 1.57 times in patients who received 66 Gy (RBE) in 10 fractions and 74 Gy (RBE) in 37 fractions, respectively, but again these changes were temporary. These results suggest that direct damage to normal liver caused by PBT is minimal, even if a patient has abnormal pretreatment enzyme levels.
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Zhou X, Cai BB, Hou XQ, Kang XK, Xu XX, Wang WM. Development and validation of a risk score for predicting mortality after resection of primary hepatocellular carcinoma. Aging (Albany NY) 2020; 12:11878-11892. [PMID: 32568098 PMCID: PMC7343477 DOI: 10.18632/aging.103360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 05/20/2020] [Indexed: 12/24/2022]
Abstract
Background: Primary hepatocellular carcinoma (PHCC) has a poor prognosis and high short-term mortality rate, even after resection. Thus, early diagnosis in PHCC cases can help improve quality of life via personalized management strategies. Results: The risk score system (RSS) were classified as low risk (<5 points), medium risk (5–10 points), or high risk (>10 points). The areas under the receiver operating characteristic curves were 0.80 in the training cohort and 0.69 in the validation cohort, which indicated satisfactory prognostic performance. The Hosmer-Lemeshow goodness of fit test (P>0.05) revealed consistent performance in both groups. The concordance index (C-index: 0.663, 95% CI: 0.618–0.708) revealed excellent discrimination and good calibration in the validation cohort. Conclusions: This simple RSS, which is based on clinical and laboratory data from patients undergoing resection of PHCC, might allow clinicians and medical staff to better manage PHCC. Materials and Methods: A total of 672 PHCC cases were retrospectively obtained from the First Affiliated Hospital of Wenzhou Medical University between January 2007 and February 2015. Cox proportional hazard models were used to identify independent predictors of mortality. Kaplan-Meier curves and the log-rank test were used to examine the relationships between the prognostic factors and overall mortality.
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Affiliation(s)
- Xiang Zhou
- Key Laboratory of Diagnosis and Treatment of Severe Hepato-Pancreatic Diseases of Zhejiang Province, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Bin-Bin Cai
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xiang-Qing Hou
- Department of Preventive Medicine, School of Public Health and Management, Wenzhou Medical University, Wenzhou, Zhejiang, China
| | - Xing-Kai Kang
- Key Laboratory of Diagnosis and Treatment of Severe Hepato-Pancreatic Diseases of Zhejiang Province, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiang-Xiang Xu
- Key Laboratory of Diagnosis and Treatment of Severe Hepato-Pancreatic Diseases of Zhejiang Province, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wei-Ming Wang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang, China
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Mei J, Li S, Wang Q, Zhong X, Lu L, Kan A, Wei W, Guo R. A novel treatment strategy using indocyanine green for transarterial chemoembolization in BCLC stage C hepatocellular carcinoma. Cancer Med 2020; 9:62-76. [PMID: 31701652 PMCID: PMC6943082 DOI: 10.1002/cam4.2671] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Revised: 10/07/2019] [Accepted: 10/18/2019] [Indexed: 02/05/2023] Open
Abstract
PURPOSE The aim of our study was to propose a strategy based on indocyanine green (ICG) (SBI) to provide better clinical guidelines for transarterial chemoembolization (TACE) treatments for Barcelona clinic liver cancer (BCLC) stage C hepatocellular carcinoma (HCC) patients. MATERIALS AND METHODS From October 2005 to December 2012, 112 BCLC stage C HCC patients initially treated with TACE were investigated, randomly divided into a training cohort (n = 79) and validation cohort (n = 33). In training group, the patients were grouped based on their 15 minutes ICG retention rate (ICG R15), different chemo drugs and dose of lipidol in TACE. Overall survival (OS) and progression-free survival (PFS) were analyzed in subgroups. Strategy based on ICG was built and verified in validation group. RESULTS For those patients with ICG R15 values >10%, the lipiodol ≤10 mL group showed better survival than the lipiodol >10 mL group. For those patients with ICG R15 values ≤10%, the group that received triple-drug chemotherapy treatments with lipiodol diameter ratio values between 1 and 3 showed better survival than the other group. Patients who conformed with the SBI had better survival times than those who did not conform with the SBI, in both the training cohort (median OS 10.3 vs 5.1 months; P < .001; median PFS, 3.3 vs 2.1 months; P = .006) and the validation cohort (median OS 8.9 vs 7.1 months; P = .087; median PFS, 6.6 vs 2.3 months; P < .001). CONCLUSIONS The SBI is suitable and may provide survival benefits for TACE treatments in BCLC stage C HCC patients.
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Affiliation(s)
- Jie Mei
- Department of Hepatobiliary Oncology of the Sun Yat‐sen University Cancer CenterGuangzhouP.R. China
- State Key Laboratory of Oncology in South ChinaGuangzhouP.R. China
- Collaborative Innovation Center for Cancer MedicineGuangzhouP.R. China
| | - Shao‐Hua Li
- Department of Hepatobiliary Oncology of the Sun Yat‐sen University Cancer CenterGuangzhouP.R. China
- State Key Laboratory of Oncology in South ChinaGuangzhouP.R. China
- Collaborative Innovation Center for Cancer MedicineGuangzhouP.R. China
| | - Qiao‐Xuan Wang
- State Key Laboratory of Oncology in South ChinaGuangzhouP.R. China
- Collaborative Innovation Center for Cancer MedicineGuangzhouP.R. China
- Department of Radiation Oncology of the Sun Yat‐sen University Cancer CenterGuangzhouP.R. China
| | - Xiao‐Ping Zhong
- Department of Burn and Plastic Surgery2nd Affiliated Hospital of Shantou University Medical CollegeShantouChina
| | - Liang‐He Lu
- Department of Hepatobiliary Oncology of the Sun Yat‐sen University Cancer CenterGuangzhouP.R. China
- State Key Laboratory of Oncology in South ChinaGuangzhouP.R. China
- Collaborative Innovation Center for Cancer MedicineGuangzhouP.R. China
| | - Anna Kan
- Department of Hepatobiliary Oncology of the Sun Yat‐sen University Cancer CenterGuangzhouP.R. China
- State Key Laboratory of Oncology in South ChinaGuangzhouP.R. China
- Collaborative Innovation Center for Cancer MedicineGuangzhouP.R. China
| | - Wei Wei
- Department of Hepatobiliary Oncology of the Sun Yat‐sen University Cancer CenterGuangzhouP.R. China
- State Key Laboratory of Oncology in South ChinaGuangzhouP.R. China
- Collaborative Innovation Center for Cancer MedicineGuangzhouP.R. China
| | - Rong‐Ping Guo
- Department of Hepatobiliary Oncology of the Sun Yat‐sen University Cancer CenterGuangzhouP.R. China
- State Key Laboratory of Oncology in South ChinaGuangzhouP.R. China
- Collaborative Innovation Center for Cancer MedicineGuangzhouP.R. China
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9
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Precision Locoregional Therapies for Hepatocellular Carcinoma: Percutaneous Ablation and Radiotherapy. ACTA ACUST UNITED AC 2019. [DOI: 10.1007/978-3-030-21540-8_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/03/2023]
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10
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Fukumitsu N, Takahashi S, Okumura T, Ishida T, Murofushi KN, Ohnishi K, Aihara T, Ishikawa H, Tsuboi K, Sakurai H. Normal liver tissue change after proton beam therapy. Jpn J Radiol 2018; 36:559-565. [PMID: 29980916 DOI: 10.1007/s11604-018-0757-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2018] [Accepted: 06/27/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Nobuyoshi Fukumitsu
- Proton Medical Research Center, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, 305-8575, Japan.
| | - Shinsei Takahashi
- 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
| | - Toshiki Ishida
- Proton Medical Research Center, University of Tsukuba, 1-1-1 Tennoudai, Tsukuba, 305-8575, Japan
| | - Keiko Nemoto Murofushi
- 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
| | - 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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11
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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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12
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Zhang D, Song XJ, Li SY, Wang SY, Chen BJ, Bai XD, Tang LM. Evaluation of liver function and electroacupuncture efficacy of animals with alcoholic liver injury by the novel imaging methods. Sci Rep 2016; 6:30119. [PMID: 27443832 PMCID: PMC4957079 DOI: 10.1038/srep30119] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Accepted: 06/29/2016] [Indexed: 12/12/2022] Open
Abstract
Imaging methods to evaluate hepatic microcirculation (HM) and liver function (LF) by directly monitoring overall liver tissue remain lacking. This study establish imaging methods for LF that combines Laser speckle perfusion imaging (LSPI) and in vivo optical imaging (IVOI) technologies to investigate changes of hepatic microcirculation and reserve function in the animals gavaged with 50% ethanol (15 ml/kg·bw) for a model of acute alcoholic liver injury (ALI), and for evaluation of electroacupuncture (EA) effect. The liver blood perfusion and indocyanine green (ICG) distribution were observe by LSPI and IVOI separately. After EA, the livers were collected to measure the levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), thromboxane A (TXA2), prostacyclin (PGI2) and endothelin (ET). The acquisitions of newly established LSPI of liver and ICG in vivo fluorescence imaging (ICG-IVFI), combining the results of other indexes showed: hepatic microcirculation perfusion (HMP) significantly reduced, ICG metabolism reduced, and ALT/AST increased in animal model with acute ALI. EA can reverse these changes. The use of LSPI of liver and ICG-IVFI, which was novel imaging methods for LF established in this study, could display the LF characteristics of ALI and the EA efficacy.
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Affiliation(s)
- Dong Zhang
- Department of biomedical engineering, Institute of Acupuncture &Moxibustion, China Academy of Chinese Medical Sciences, 100700, Beijing, China
| | - Xiao-Jing Song
- Department of biomedical engineering, Institute of Acupuncture &Moxibustion, China Academy of Chinese Medical Sciences, 100700, Beijing, China
| | - Shun-Yue Li
- Department of biomedical engineering, Institute of Acupuncture &Moxibustion, China Academy of Chinese Medical Sciences, 100700, Beijing, China
| | - Shu-You Wang
- Department of biomedical engineering, Institute of Acupuncture &Moxibustion, China Academy of Chinese Medical Sciences, 100700, Beijing, China
| | - Bing-Jun Chen
- Department of biomedical engineering, Institute of Acupuncture &Moxibustion, China Academy of Chinese Medical Sciences, 100700, Beijing, China
| | - Xiao-Dong Bai
- Department of biomedical engineering, Institute of Acupuncture &Moxibustion, China Academy of Chinese Medical Sciences, 100700, Beijing, China
| | - Li-Mei Tang
- Department of biomedical engineering, Institute of Acupuncture &Moxibustion, China Academy of Chinese Medical Sciences, 100700, Beijing, China
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13
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Mizumoto M, Oshiro Y, Okumura T, Fukumitsu N, Numajiri H, Ohnishi K, Aihara T, Ishikawa H, Tsuboi K, Sakurai H. Proton Beam Therapy for Hepatocellular Carcinoma: A Review of the University of Tsukuba Experience. Int J Part Ther 2016; 2:570-578. [PMID: 31772968 DOI: 10.14338/ijpt-15-00035.2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2010] [Accepted: 01/05/2016] [Indexed: 12/11/2022] Open
Abstract
Hepatocellular carcinoma (HCC) is the second most common cause of cancer-related death worldwide. Many treatment modalities were developed for HCC, including surgical resection, percutaneous ethanol injection, radiofrequency ablation, transarterial chemoembolization, liver transplantation, and sorafenib therapy. Our institution has shown that proton beam therapy (PBT) is also a safe, effective, and feasible treatment modality for HCC. The University of Tsukuba began to use PBT for HCC in 1983, and we have reported many findings during the past 3 decades. In this review, we will describe the history of PBT, our experience of using PBT for HCC, and its application based on tumor location, thrombosis, tumor size, and liver function.
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Affiliation(s)
- Masashi Mizumoto
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yoshiko Oshiro
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Toshiyuki Okumura
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Nobuyoshi Fukumitsu
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Haruko Numajiri
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Kayoko Ohnishi
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Teruhito Aihara
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hitoshi Ishikawa
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Koji Tsuboi
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hideyuki Sakurai
- Department of Radiation Oncology, University of Tsukuba, Tsukuba, Ibaraki, Japan
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14
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Chu M, Hai W, Zhang Z, Wo F, Wu Q, Zhang Z, Shao Y, Zhang D, Jin L, Shi D. Melanin nanoparticles derived from a homology of medicine and food for sentinel lymph node mapping and photothermal in vivo cancer therapy. Biomaterials 2016; 91:182-199. [PMID: 27031812 DOI: 10.1016/j.biomaterials.2016.03.018] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Revised: 03/09/2016] [Accepted: 03/13/2016] [Indexed: 10/22/2022]
Abstract
The use of non-toxic or low toxicity materials exhibiting dual functionality for use in sentinel lymph node (SLN) mapping and cancer therapy has attracted considerable attention during the past two decades. Herein, we report that the natural black sesame melanin (BSM) extracted from black sesame seeds (Sesamum indicum L.) shows exciting potential for SLN mapping and cancer photothermal therapy. Aqueous solutions of BSM under neutral and alkaline conditions can assemble into sheet-like nanoparticles ranging from 20 to 200 nm in size. The BSM nanoparticles were encapsulated by liposomes to improve their water solubility and the encapsulated and bare BSM nanoparticles were both non-toxic to cells. Furthermore, the liposome-encapsulated BSM nanoparticles (liposome-BSM) did not exhibit any long-term toxicity in mice. The liposome-BSM nanoparticles were subsequently used to passively target healthy and tumor-bearing mice SLNs, which were identified by the black color of the nanoparticles. BSM also strongly absorbed light in the near-infrared (NIR) range, which was rapidly converted to heat energy. Human esophagus carcinoma cells (Eca-109) were killed efficiently by liposome-BSM nanocomposites upon NIR laser irradiation. Furthermore, mouse tumor tissues grown from Eca-109 cells were seriously damaged by the photothermal effects of the liposome-BSM nanocomposites, with significant tumor growth suppression compared with controls. Given that BSM is a safe and nutritious biomaterial that can be easily obtained from black sesame seed, the results presented herein represent an important development in the use of natural biomaterials for clinical SLN mapping and cancer therapy.
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Affiliation(s)
- Maoquan Chu
- Research Center for Translational Medicine at Shanghai East Hospital, School of Life Sciences and Technology, Tongji University, Shanghai, PR China.
| | - Wangxi Hai
- School of Pharmacy, Shanghai Jiao Tong University, Shanghai, 200240, PR China
| | - Zheyu Zhang
- Research Center for Translational Medicine at Shanghai East Hospital, School of Life Sciences and Technology, Tongji University, Shanghai, PR China
| | - Fangjie Wo
- Research Center for Translational Medicine at Shanghai East Hospital, School of Life Sciences and Technology, Tongji University, Shanghai, PR China
| | - Qiang Wu
- Research Center for Translational Medicine at Shanghai East Hospital, School of Life Sciences and Technology, Tongji University, Shanghai, PR China
| | - Zefei Zhang
- Research Center for Translational Medicine at Shanghai East Hospital, School of Life Sciences and Technology, Tongji University, Shanghai, PR China
| | - Yuxiang Shao
- Research Center for Translational Medicine at Shanghai East Hospital, School of Life Sciences and Technology, Tongji University, Shanghai, PR China
| | - Ding Zhang
- Research Center for Translational Medicine at Shanghai East Hospital, School of Life Sciences and Technology, Tongji University, Shanghai, PR China
| | - Lu Jin
- Research Center for Translational Medicine at Shanghai East Hospital, School of Life Sciences and Technology, Tongji University, Shanghai, PR China
| | - Donglu Shi
- School of Medicine, Tongji University, Shanghai, PR China; The Materials Science and Engineering Program, Department of Mechanical and Materials Engineering, College of Engineering & Applied Science, University of Cincinnati, Cincinnati, OH, 45221-0012, USA
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15
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Huertas A, Baumann AS, Saunier-Kubs F, Salleron J, Oldrini G, Croisé-Laurent V, Barraud H, Ayav A, Bronowicki JP, Peiffert D. Stereotactic body radiation therapy as an ablative treatment for inoperable hepatocellular carcinoma. Radiother Oncol 2015; 115:211-6. [PMID: 26028227 DOI: 10.1016/j.radonc.2015.04.006] [Citation(s) in RCA: 101] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2014] [Revised: 03/16/2015] [Accepted: 04/03/2015] [Indexed: 12/13/2022]
Abstract
PURPOSE To describe efficacy and safety of stereotactic body radiation therapy (SBRT) for the treatment of inoperable hepatocellular carcinoma. METHODS The records of 77 consecutive patients treated with SBRT for 97 liver-confined HCC were reviewed. A total dose of 45Gy in 3 fractions was prescribed to the 80% isodose line. Local control (LC), overall survival (OS), progression-free survival (PFS) and toxicity were studied. RESULTS The median follow-up was 12months. The median tumor diameter was 2.4cm. The LC rate was 99% at 1 and 2years. The 1 and 2-year OS were 81.8% and 56.6% respectively. The median time to progression was 9months (0-38). The rate of hepatic toxicity was 7.7% [1.6-13.7], 14.9% [5.7-23.2] and 23.1% [9.9-34.3] at 6months, 1year and 2years respectively. In multivariate analysis, female gender (HR 7.87 [3.14-19.69]), a BCLC B-C stage (HR 3.71 [1.41-9.76]), a sum of all lesion diameters ⩾2cm (HR 7.48 [2.09-26.83]) and a previous treatment (HR 0.10 [0.01-0.79]) were independent prognostic factors of overall survival. CONCLUSION SBRT allows high local control for inoperable hepatocellular carcinomas. It should be considered when an ablative treatment is indicated in Child A patients.
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Affiliation(s)
- Andres Huertas
- Department of Radiotherapy, Institut de Cancérologie de Lorraine, Vandoeuvre-Lès-Nancy, France
| | - Anne-Sophie Baumann
- Department of Radiotherapy, Institut de Cancérologie de Lorraine, Vandoeuvre-Lès-Nancy, France
| | - Fleur Saunier-Kubs
- Department of Radiotherapy, Institut de Cancérologie de Lorraine, Vandoeuvre-Lès-Nancy, France
| | - Julia Salleron
- Department of Biostatistics and Data Management, Institut de Cancérologie de Lorraine, Vandoeuvre-Lès-Nancy, France
| | - Guillaume Oldrini
- Department of Radiology, Institut de Cancérologie de Lorraine, Vandoeuvre-Lès-Nancy, France
| | | | - Hélène Barraud
- Department of Hepatogastroenterology, CHU de Nancy, Vandoeuvre-Lès-Nancy, France
| | - Ahmed Ayav
- Department of Digestive, Hepato-biliary and Endocrine Surgery, CHU de Nancy, Vandoeuvre-Lès-Nancy, France
| | | | - Didier Peiffert
- Department of Radiotherapy, Institut de Cancérologie de Lorraine, Vandoeuvre-Lès-Nancy, France.
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