Hypofractionated proton beam radiotherapy in patients with unresectable liver tumors: multi-institutional prospective re
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RESEARCH
Hypofractionated proton beam radiotherapy in patients with unresectable liver tumors: multi‑institutional prospective results from the Proton Collaborative Group Jacob S. Parzen1†, William Hartsell2, John Chang3, Smith Apisarnthanarax4, Jason Molitoris5, Michael Durci6, Henry Tsai7, James Urbanic8, Jonathan Ashman9, Carlos Vargas9, Craig Stevens1 and Peyman Kabolizadeh1,10*
Abstract Background: Recent advances in radiotherapy techniques have allowed ablative doses to be safely delivered to inoperable liver tumors. In this setting, proton beam radiotherapy (PBT) provides the means to escalate radiation dose to the target volume while sparing the uninvolved liver. This study evaluated the safety and efficacy of hypofractionated PBT for liver tumors, predominantly hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC). Methods: We evaluated the prospective registry of the Proton Collaborative Group for patients undergoing definitive PBT for liver tumors. Demographic, clinicopathologic, toxicity, and dosimetry information were compiled. Results: To date, 63 patients have been treated at 9 institutions between 2013 and 2019. Thirty (48%) had HCC and 25 (40%) had ICC. The median dose and biological equivalent dose (BED) delivered was 58.05 GyE (range 32.5–75) and 80.5 GyE (range 53.6–100), respectively. The median mean liver BED was 13.9 GyE. Three (4.8%) patients experienced at least one grade ≥ 3 toxicity. With median follow-up of 5.1 months (range 0.1–40.8), the local control (LC) rate at 1 year was 91.2% for HCC and 90.9% for ICC. The 1-year LC was significantly higher (95.7%) for patients receiving BED greater than 75.2 GyE than for patients receiving BED of 75.2 GyE or lower (84.6%, p = 0.029). The overall survival rate at 1 year was 65.6% for HCC and 81.8% for ICC. Conclusions: Hypofractionated PBT results in excellent LC, sparing of the uninvolved liver, and low toxicity, even in the setting of dose-escalation. Higher dose correlates with improved LC, highlighting the importance of PBT especially in patients with recurrent or bulky disease. Keywords: Proton therapy, Unresectable liver tumors, Hepatocellular carcinoma, Cholangiocarcinoma
*Correspondence: [email protected] † Jacob S. Parzen: Responsible for statistical analyses. 10 Department of Radiation Oncology, Oakland University William Beaumont School of Medicine, 3601 W Thirteen Mile Rd, Royal Oak, MI 48073, USA Full list of author information is available at the end of the article
Introduction The incidence of liver and intrahepatic bile duct tumors is increasing the most rapidly of any cancer in the United States [1]. Unfortunately, a minority of patients are eligible for curative surgical resection at presentation for either medical or anatomical reasons, leading to a dismal 18% 5-year overall survival rate [1]. Inoperable patients are often treated with other non-surgical local therapies, such as transarterial chemoembolization, transarterial radioembolization, and radiofrequency ablation.
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