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- Title
Long-Term Results of Proton Therapy for Hepatocellular Carcinoma Using Four-Dimensional Computed Tomography Planning without Fiducial Markers.
- Authors
Bou, Sayuri; Takamatsu, Shigeyuki; Matsumoto, Sae; Asahi, Satoko; Tatebe, Hitoshi; Sato, Yoshitaka; Kawamura, Mariko; Shibata, Satoshi; Kondou, Tamaki; Tameshige, Yuji; Maeda, Yoshikazu; Sasaki, Makoto; Yamamoto, Kazutaka; Sunagozaka, Hajime; Aoyagi, Hiroyuki; Tamamura, Hiroyasu; Kobayashi, Satoshi; Gabata, Toshifumi
- Abstract
Simple Summary: We investigated the long-term outcomes of patients with hepatocellular carcinoma (HCC) who underwent image-guided respiratory-gated proton therapy (IGPT) without fiducial markers with 4D-CT planning. IGPT achieved good local control, increased overall survival, and caused less severe toxicity. Our results suggest that less invasive IGPT for HCC is safe and effective without causing severe complications. We report here the long-term results of marker-less respiratory-gated proton therapy (PT), without fiducial markers for hepatocellular carcinoma (HCC), which was planned using a four-dimensional computed tomography technique. Local tumor control (LTC) and overall survival (OS) were estimated using the Kaplan–Meier method. Toxicity was graded per CTCAE v5.0. Patients (n = 105; median age 73 years, range 38–90 years) with 128 lesions were treated. The median radiation dose was 66 gray relative biological effectiveness (GyRBE) (range, 52.8–82.5 GyRBE) delivered in 2.0 to 6.6 GyRBE fractions, depending on lesion volume, the involved liver, and the patient's condition. The median follow-up of surviving patients was 63 months (range, 1–126 months), and the 5-year LTC and OS rates were 93.2% and 40.4%, respectively. Univariate and multivariate analyses identified tumors near the gastrointestinal tract as an independent risk factor for local recurrence and revealed that hepatic reserve, tumor stage, performance status, operability, sex, and portal vein thrombosis were independent risk factors for OS. Acute and late treatment-related grade 3 toxicities were experienced by eight patients (7.6%). Adverse events ≥ grade 4 were not evident. Marker-less respiratory-gated PT for HCC is a safe and effective treatment without severe complications.
- Subjects
STATISTICS; CONFIDENCE intervals; MULTIVARIATE analysis; CANCER relapse; RETROSPECTIVE studies; HEALTH status indicators; TREATMENT effectiveness; CANCER patients; GASTROINTESTINAL tumors; SEX distribution; VENOUS thrombosis; PROTON therapy; SURVIVAL analysis (Biometry); KAPLAN-Meier estimator; DESCRIPTIVE statistics; RADIATION doses; PORTAL vein; RADIOTHERAPY; COMPUTED tomography; DATA analysis software; HEPATOCELLULAR carcinoma; PROPORTIONAL hazards models; DISEASE risk factors
- Publication
Cancers, 2022, Vol 14, Issue 23, p5842
- ISSN
2072-6694
- Publication type
Article
- DOI
10.3390/cancers14235842