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- Title
Proton Beam Therapy for Treating Patients with Hepatocellular Carcinoma with Major Portal Vein Tumor Invasion: A Single Center Retrospective Study.
- Authors
Ishida, Toshiki; Mizumoto, Masashi; Saito, Takashi; Okumura, Toshiyuki; Miura, Kosei; Makishima, Hirokazu; Iizumi, Takashi; Numajiri, Haruko; Baba, Keiichiro; Murakami, Motohiro; Nakamura, Masatoshi; Nakai, Kei; Sakurai, Hideyuki
- Abstract
Simple Summary: Hepatocellular carcinoma (HCC) is a life-threatening disease of the liver. Patients who also have a blockage of the portal vein, which takes blood into the liver, are at particular risk for death. This condition is known as portal vein tumor thrombosis (PVTT). Proton beam therapy (PBT) is an excellent treatment option for tumors because it allows the tumor to be irradiated while avoiding radiation effects on normal tissue. In this study, we found that the long-term outcomes in patients with HCC with advanced PVTT (Vp3 or Vp4) were improved by treatment with PBT. In particular, the median survival time after was >20 months in patients treated with PBT for cure of the disease. These results are better than those with other therapies and suggest that PBT gives a survival benefit in these cases. There were also very few adverse events, indicating that PBT is a safe method. 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.
- Subjects
PROTON therapy; PORTAL vein; CANCER invasiveness; PATIENT safety; VENOUS thrombosis; TREATMENT effectiveness; RETROSPECTIVE studies; DESCRIPTIVE statistics; MULTIVARIATE analysis; BLOOD-vessel tumors; MEDICAL records; ACQUISITION of data; SURVIVAL analysis (Biometry); CONFIDENCE intervals; HEPATOCELLULAR carcinoma; DISEASE complications
- Publication
Cancers, 2024, Vol 16, Issue 11, p2050
- ISSN
2072-6694
- Publication type
Article
- DOI
10.3390/cancers16112050