Long-Term Clinical Outcomes of Patients Receiving Proton Beam Therapy for Caudate Lobe Hepatocellular Carcinoma

Abstract BackgroundHepatocellular carcinoma (HCC) located in the caudate lobe (caudate HCC) is rare; however, patients with this type of tumour have poorer prognoses than do those with HCC in other segments. Despite many published reports on the clinical usefulness of proton beam therapy (PBT) for HCC, data on the clinical outcomes of patients undergoing PBT for caudate HCC remain scare. Therefore, the present study aimed to investigate the outcomes of this group of patients.MethodsThirty patients with caudate HCC who underwent definitive PBT between February 2001 and February 2014 were retrospectively analysed. The total irradiation doses ranged from 55 to 77 (median 72.6) Gy relative biological dose.ResultsThe median follow-up period was 37.5 (range, 3.0–152.0) months. The overall survival rates at 1, 3, and 5 years were 86.6%, 62.8%, and 46.1%, respectively. According to univariate and multivariate analyses, Child-Pugh A (P < 0.01), having a single tumour (P = 0.02), and a low serum alpha-fetoprotein level (P < 0.01) were significant factors predicting longer survival. The local control rates at 1, 3, and 5 years were 100.0%, 85.9%, and 85.9%, respectively, while the corresponding progression-free survival rates were 65.0%, 27.5%, and 22.0%, respectively. No grade 3 or worse adverse events were observed.ConclusionsPBT is effective and safe for the treatment of caudate HCC, and should therefore be considered a feasible option for intervention in patients with this disease.

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Clinical outcomes of previously untreated patients with unresectable intrahepatic cholangiocarcinoma following proton beam therapy

Radiation Oncology ◽

10.1186/s13014-019-1451-5 ◽

2019 ◽

Vol 14 (1) ◽

Cited By ~ 3

Author(s):

Shosei Shimizu ◽

Toshiyuki Okumura ◽

Yoshiko Oshiro ◽

Nobuyoshi Fukumitsu ◽

Kuniaki Fukuda ◽

...

Keyword(s):

Overall Survival ◽

Proton Beam ◽

Intrahepatic Cholangiocarcinoma ◽

Initial Treatment ◽

Survival Rates ◽

Progression Free Survival ◽

Proton Beam Therapy ◽

Target Volume ◽

Tumor Control ◽

Intraductal Growth

Abstract Background The effectiveness of proton beam therapy (PBT) as initial treatment for patients with unresectable intrahepatic cholangiocarcinoma (ICC) is unclear, particularly as related to ICC histological subtypes. We performed this study to address this gap in knowledge. Methods Thirty-seven patients with unresectable ICC who underwent PBT as their initial treatment were evaluated. Twenty-seven patients had Child-Pugh class A liver function, 11 exhibited jaundice, and 10 had multiple tumors. Nineteen, 7, and 11 tumors were classified as mass forming (MF), periductal infiltrating (PI), and intraductal growth (IG) types, respectively, based on gross appearance in imaging studies. Patients were classified into the curative group (n = 25) and palliative group (n = 12) depending on whether the planning target volume covered all the macroscopic tumors. Results The 1- and 2-year overall survival rates were 60.3, and 41.4%, respectively; the median survival time (MST) was 15 months for all patients. The MSTs for curative and palliative groups were 25 and 7 months, respectively. Curative treatment and adjuvant chemotherapy significantly improved overall survival, while the presence of periductal infiltrating type tumors was a negative prognostic factor. In the curative group, the 1- and 2-year local control rates were 100 and 71.5%, respectively, while the 1-, and 2-year progression-free survival rates were 58.5, and 37.6%, respectively. No severe acute toxicities were observed. Three patients experienced grade 3 biliary tract infection, although it was unclear whether this was radiotherapy-related. Conclusion PBT may yield to improve survival and local tumor control among patients with unresectable ICC.

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Does Risk-Adapted Proton Beam Therapy Have a Role as a Complementary or Alternative Therapeutic Option for Hepatocellular Carcinoma?

Cancers ◽

10.3390/cancers11020230 ◽

2019 ◽

Vol 11 (2) ◽

pp. 230 ◽

Cited By ~ 3

Author(s):

Tae Kim ◽

Joong-Won Park ◽

Bo Kim ◽

Hyunjung Kim ◽

Sung Moon ◽

...

Keyword(s):

Hepatocellular Carcinoma ◽

Proton Beam ◽

Therapeutic Option ◽

Cancer Control ◽

Proton Beam Therapy ◽

Target Volume ◽

Dose Fractionation ◽

Tumor Control ◽

Grade 3

To evaluate the role of risk-adapted proton beam therapy (PBT) in hepatocellular carcinoma (HCC) patients, a total of 243 HCC patients receiving risk-adapted PBT with three dose-fractionation regimens (regimen A [n = 40], B [n = 60], and C [n = 143]) according to the proximity of their gastrointestinal organs (<1 cm, 1–1.9 cm, and ≥2 cm, respectively) were reviewed: The prescribed doses to planning target volume 1 (PTV1) were 50 gray equivalents (GyE) (EQD2 [equivalent dose in 2 Gy fractions], 62.5 GyE10), 60 GyE (EQD2, 80 GyE10), and 66 GyE (EQD2, 91.3 GyE10) in 10 fractions, respectively, and those of PTV2 were 30 GyE (EQD2, 32.5 GyE10) in 10 fractions. In all patients, the five-year local recurrence-free survival (LRFS) and overall survival (OS) rates were 87.5% and 48.1%, respectively, with grade ≥3 toxicity of 0.4%. In regimens A, B, and C, the five-year LRFS and OS rates were 54.6%, 94.7%, and 92.4% (p < 0.001), and 16.7%, 39.2%, and 67.9% (p < 0.001), respectively. The five-year OS rates of the patients with the Modified Union for International Cancer Control (mUICC) stages I, II, III, and IVA and Barcelona Clinic Liver Cancer (BCLC) stages A, B, and C were 69.2%, 65.4%, 43.8%, and 26.6% (p < 0.001), respectively, and 65.1%, 40%, and 32.2% (p < 0.001), respectively. PBT could achieve promising long-term tumor control and have a potential role as a complementary or alternative therapeutic option across all stages of HCC.

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Proton beam therapy for liver metastases from gastric cancer

Journal of Radiation Research ◽

10.1093/jrr/rrw102 ◽

2016 ◽

Vol 58 (3) ◽

pp. 357-362 ◽

Cited By ~ 5

Author(s):

Nobuyoshi Fukumitsu ◽

Toshiyuki Okumura ◽

Daichi Takizawa ◽

Haruko Numajiri ◽

Kayoko Ohnishi ◽

...

Keyword(s):

Gastric Cancer ◽

Adverse Effects ◽

Liver Metastases ◽

Proton Beam ◽

Local Treatment ◽

Progression Free Survival ◽

Proton Beam Therapy ◽

Concurrent Chemotherapy ◽

Late Adverse Effects ◽

Grade 3

Abstract Liver metastases from gastric cancer (LMGC) is a non-curable, fatal disease with a 5-year survival rate of <10%. Although various local treatments have been applied, their clinical utility has not been established. The purpose of this study was to investigate the safety and effectiveness of proton beam therapy (PBT) for the treatment of patients with LMGC. A total of nine patients (seven men, two women; aged 56–78 years) with LMGC who received PBT between 2002 and 2012 were retrospectively reviewed. Patients who had tumors confined to the liver were investigated, and patients who had extrahepatic tumors were excluded. Six of the patients had solitary tumors, and three patients had multiple tumors. The total irradiation dose was 64–77 Gy relative biological effectiveness (RBE), and three patients received concurrent chemotherapy. The overall and progression-free survival (OS and PFS) rates, local control (LC) rate, and adverse effects were investigated. All patients completed treatment without interruption, and late adverse effects of higher than Grade 3 were not observed. The OS rates at 1, 3 and 5 years were 100%, 78% and 56%, respectively (median, 5.5 years); the PFS rates were 67%, 40% and 40% (median, 2.6 years); and the LC rates were 89%, 71% and 71%. PBT was demonstrated to be a safe treatment, and the OS and PFS rates were not inferior to those for other types of local treatment. Therefore, PBT should be considered as an effective local treatment option for patients with LMGC.

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Clinical Effectiveness of Hypofractionated Proton Beam Therapy for Liver Metastasis From Breast Cancer

Frontiers in Oncology ◽

10.3389/fonc.2021.783327 ◽

2021 ◽

Vol 11 ◽

Author(s):

Tae Hyun Kim ◽

Keun Seok Lee ◽

Sung Hoon Sim ◽

Yeon-Joo Kim ◽

Dae Yong Kim ◽

...

Keyword(s):

Breast Cancer ◽

Liver Metastasis ◽

Proton Beam ◽

Local Treatment ◽

Progression Free Survival ◽

Clinical Effectiveness ◽

Proton Beam Therapy ◽

Local Progression ◽

Grade 3

BackgroundFew studies of proton beam therapy (PBT) for patients with liver metastasis from breast cancer (LMBC) are available to date. The aim of the present study was to evaluate the clinical effectiveness of PBT for patients with LMBC.Material and MethodsSeventeen patients with LMBC treated with PBT were included in this study. The median prescribed dose of PBT was 66 GyE (range, 60–80) in 10 fractions, 5 times a week. In patients with LMBC receiving PBT, freedom from local progression (FFLP), progression-free survival (PFS), and overall survival (OS) rates were assessed.ResultsThe median follow-up time was 34.2 months (range, 11.5–56.1). The median FFLP time was not yet reached, and the 3-year FFLP rates were 94.1% (95% confidence interval [CI], 82.9–105.3). The median times of PFS and OS were 7.9 months (95% CI, 5.3–10.5) and 39.3 months (95% CI, 33.2–51.9), respectively, and the 3-year PFS and OS rates were 19.6% (95% CI, -1.8–41.0) and 71.7% (95% CI, 46.8–96.6), respectively. Grade 3 or higher adverse events were not observed.ConclusionPBT for patients with LMBC showed promising FFLP and OS with safe toxicity profiles. These findings suggest that PBT can be considered a local treatment option in patients with LMBC.

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Extramedullary Plasmacytoma: Long-Term Clinical Outcomes in a Single-Center in China and Literature Review

Ear Nose & Throat Journal ◽

10.1177/0145561320950587 ◽

2020 ◽

pp. 014556132095058

Author(s):

Xiaoli Zhu ◽

Li Wang ◽

Yingying Zhu ◽

Wenwen Diao ◽

Wuyi Li ◽

...

Keyword(s):

Clinical Outcomes ◽

Regional Lymph Node ◽

Survival Rates ◽

Progression Free Survival ◽

Extramedullary Plasmacytoma ◽

Free Survival ◽

Node Metastasis ◽

Baseline Characteristics

The aim is to analyze the clinical outcomes of patients with extramedullary plasmacytoma (EMP) and review the characteristics of this disease. We retrospectively reviewed the clinical data of a cohort of 22 patients diagnosed with EMP between 1983 and 2017. Baseline characteristics and progression data were collected to calculate the incidence of progression to multiple myeloma (MM) and to analyze survival rates and outcomes. Previous major cohort studies were reviewed and compared with this study. Extramedullary plasmacytomas were located in the head and neck in 17 (77%) of the 22 patients. The median time between onset and diagnosis was 7 months, and the median age at diagnosis was 52.5 years (range 15-72 years). Extramedullary plasmacytoma occurred more frequently in men with an approximate ratio of 2.1:1. The majority of patients underwent surgery (13/22, 59.1%) and half received radiation (11/22, 50%). A small proportion of patients received chemotherapy (2/22, 9.1%). There was a median follow-up time of 98.5 months. The 5-year overall survival, progression-free survival, and MM-free survival rates were 84.2%, 67.3% and 75.9%, respectively. Complete resection without major functional damage is a promising option that can favorably improve prognosis in patients with resectable disease. Patients with regional lymph node metastasis or positive immunoelectrophoresis results require more aggressive treatment and may have poorer prognosis.

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Long-term single-institute experience with trimodal bladder-preserving therapy with proton beam therapy for muscle-invasive bladder cancer

Japanese Journal of Clinical Oncology ◽

10.1093/jjco/hyw151 ◽

2016 ◽

Vol 47 (1) ◽

pp. 67-73 ◽

Cited By ~ 3

Author(s):

Ei-ichiro Takaoka ◽

Jun Miyazaki ◽

Hitoshi Ishikawa ◽

Koji Kawai ◽

Tomokazu Kimura ◽

...

Keyword(s):

Bladder Cancer ◽

Survival Rate ◽

Proton Beam ◽

Progression Free Survival ◽

Proton Beam Therapy ◽

Invasive Bladder Cancer ◽

Muscle Invasive Bladder Cancer ◽

Free Survival ◽

Grade 3 ◽

Muscle Invasive

Objective We retrospectively elucidated the oncological outcomes, prognostic factors and toxicities of proton beam therapy in trimodal bladder-preserving therapy for muscle-invasive bladder cancer at our institution. Methods From 1990 to 2015, 70 patients with cT2–3N0M0 muscle-invasive bladder cancer underwent trimodal bladder-preserving therapy consisting of maximal transurethral resection of the bladder tumor, small pelvis photon irradiation, intra-arterial chemotherapy and proton beam therapy. The overall survival rate, progression-free survival rate, time to progression, predictive factors for progression and toxicities were analyzed. Progression was defined as when muscle-invasive recurrence, distant metastasis or upper urinary tract recurrence was observed. Results The patients’ median age was 65 (range 36–85) years. The median follow-up period was 3.4 (range 0.6–19.5) years. The 5-year cumulative overall survival rate, progression-free survival rate and time to progression rate were 82%, 77%, and 82%, respectively. In univariate and multivariate analyses, tumor multiplicity and tumor size (≥5 cm) were significant and independent factors associated with progression (hazard ratio 3.5, 95% confidence interval 1.1–12; hazard ratio 5.0, 95% confidence interval 1.3–17; P < 0.05 for all). As for toxicity, 26 (18%) patients had grade 3–4 acute hematologic toxicities and 2 (3%) patients had grade 3 late genitourinary toxicity. No patient had to discontinue the treatment due to acute toxicity. Conclusions Our bladder-preserving therapy with proton beam therapy was well tolerated and achieved a favorable mortality rate. Tumor multiplicity and tumor size were important risk factors for progression. Our findings indicate that this therapy can be an effective treatment option for selected muscle-invasive bladder cancer patients.

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The effectiveness of proton beam therapy for liver metastatic recurrence in gastric cancer patients

Japanese Journal of Clinical Oncology ◽

10.1093/jjco/hyaa052 ◽

2020 ◽

Vol 50 (8) ◽

pp. 903-908

Author(s):

Hisashi Yamaguchi ◽

Michitaka Honda ◽

Koichi Hamada ◽

Hiroshi Kobayashi ◽

Yukitoshi Todate ◽

...

Keyword(s):

Gastric Cancer ◽

Overall Survival ◽

Proton Beam ◽

Local Control ◽

Survival Rates ◽

Progression Free Survival ◽

Proton Beam Therapy ◽

Free Survival ◽

Metastatic Recurrence ◽

Gastric Cancer Patients

Abstract Objective The purpose of this cross-sectional study was to evaluate the efficacy and safety of proton beam therapy for liver metastatic recurrence in gastric cancer patients. Methods Consecutive patients who underwent proton beam therapy from 2010 to 2015 were isolated from our institutional database. Patients with extrahepatic metastatic lesions were excluded. Seven patients were enrolled. The median diameter of target lesions was 31 mm (13–68 mm). The most frequent dosage was 72.6 Gy equivalent in 22 fractions. The effectiveness was assessed based on the local control, overall survival and progression-free survival rates. The local control, overall survival and progression-free survival rates were calculated using the Kaplan–Meier method. Adverse events were described according to the patients’ medical records. Results The median follow-up period was 41.7 months (20.7–66.3 months). The 3-year local control, overall survival and progression-free survival rates were 85.7, 68.6 and 43%, respectively. All patients completed proton beam therapy without interruption. No grade ≥3 adverse events were observed. Conclusions Proton beam therapy might be a treatment option for patients with liver metastasis of gastric cancer.

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