The safety and efficacy of high‐dose proton beam radiotherapy for hepatocellular carcinoma: a phase 2 prospective trial

• Published in: Cancer Vol. 117; no. 13; pp. 3053 - 3059
• Main Authors: Bush, David A., Kayali, Zeid, Grove, Roger, Slater, Jerry D.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.07.2011; Wiley-Blackwell
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Carcinoma, Hepatocellular - pathology; Carcinoma, Hepatocellular - radiotherapy; cirrhosis; Disease-Free Survival; Female; Gastroenterology. Liver. Pancreas. Abdomen; hepatocellular carcinoma; Humans; Liver Cirrhosis - radiotherapy; Liver Neoplasms - pathology; Liver Neoplasms - radiotherapy; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Middle Aged; protons; Protons - adverse effects; Protons - therapeutic use; radiotherapy; Radiotherapy Dosage; Treatment Outcome; Tumors; Treatment efficiency; Hepatic disease; Hepatocellular carcinoma; Malignant tumor; Radiotherapy; Prospective; Liver cancer; Cirrhosis; Cancerology; Proton beam; Treatment; Phase II trial; Proton; Digestive diseases; protons; High dose; Cancer
• ISSN: 0008-543X; 1097-0142; 1097-0142
• DOI: 10.1002/cncr.25809

BACKGROUND: Proton beam therapy (PBT) may provide useful local‐regional treatment for hepatocellular carcinoma (HCC). The purpose of this study was to evaluate the safety and efficacy of PBT for HCC. METHODS: Patients with cirrhosis who had radiological features or biopsy‐proven HCC were included in the study. Patients without cirrhosis and patients with extrahepatic metastasis were excluded. The mean age was 62.7 years. The mean tumor size was 5.5 cm. Eleven patients had multiple tumors, and 46% were within the Milan criteria. Patients received 63 Gy delivered over a 3‐week period with PBT. RESULTS: Seventy‐six patients were treated and followed prospectively for treatment outcomes at Loma Linda University Medical Center. Acute toxicity was minimal; all patients completed the full course of treatment. Radiation‐induced liver disease was evaluated using liver enzyme, bilirubin, and albumin levels; no significant change supervened 6 months posttreatment. Median progression‐free survival for the entire group was 36 months, with a 60% 3‐year progression‐free survival rate for patients within the Milan criteria. Eighteen patients subsequently underwent liver transplantation; 6 (33%) explants showed pathological complete response and 7 (39%) showed only microscopic residual. CONCLUSIONS: PBT was found to be a safe and effective local‐regional therapy for inoperable HCC. A randomized controlled trial to compare its efficacy to a standard therapy has been initiated. Cancer 2011. © 2011 American Cancer Society. Proton beam therapy was found to be a safe and effective treatment for patients with cirrhosis who had inoperable hepatocellular carcinoma. A randomized, controlled comparison with standard treatment has been underway.