Proton Beam Therapy without Fiducial Markers Using Four-Dimensional CT Planning for Large Hepatocellular Carcinomas

We evaluated the effectiveness and toxicity of proton beam therapy (PBT) for hepatocellular carcinomas (HCC) >5 cm without fiducial markers using four-dimensional CT (4D-CT) planning. The subjects were 29 patients treated at our hospital between March 2011 and March 2015. The median total dose was 76 Cobalt Gray Equivalents (CGE) in 20 fractions (range; 66–80.5 CGE in 10–32 fractions). Therapy was delivered with end-expiratory phase gating. An internal target volume (ITV) margin was added through the analysis of respiratory movement with 4D-CT. Patient age ranged from 38 to 87 years (median, 71 years). Twenty-four patients were Child–Pugh class A and five patients were class B. Tumor size ranged from 5.0 to 13.9 cm (median, 6.9 cm). The follow-up period ranged from 2 to 72 months (median; 27 months). All patients completed PBT according to the treatment protocol without grade 4 (CTCAE v4.03 (draft v5.0)) or higher adverse effects. The two-year local tumor control (LTC), progression-free survival (PFS), and overall survival (OS) rates were 95%, 22%, and 61%, respectively. The LTC was not inferior to that of previous reports using fiducial markers. Respiratory-gated PBT with 4D-CT planning without fiducial markers is a less invasive and equally effective treatment for large HCCs as PBT with fiducial markers.

Download Full-text

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.

Download Full-text

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.

Download Full-text

Erratum: Shibata S.; et al. Proton Beam Therapy without Fiducial Markers Using Four-Dimensional CT Planning for Large Hepatocellular Carcinomas. Cancers 2018, 10, 71

Cancers ◽

10.3390/cancers10120508 ◽

2018 ◽

Vol 10 (12) ◽

pp. 508

Author(s):

Satoshi Shibata ◽

Shigeyuki Takamatsu ◽

Kazutaka Yamamoto ◽

Miu Mizuhata ◽

Sayuri Bou ◽

...

Keyword(s):

Proton Beam ◽

Proton Beam Therapy ◽

Fiducial Markers ◽

Hepatocellular Carcinomas

The authors wish to make the following corrections to this paper [...]

Download Full-text

Proton Beam Therapy without Fiducial Markers using 4-Dimensional CT Planning for Large Hepatocellular Carcinomas

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2018.07.494 ◽

2018 ◽

Vol 102 (3) ◽

pp. e62

Author(s):

S. Shibata ◽

S. Takamatsu ◽

K. Yamamoto ◽

M. Mizuhata ◽

Y. Sato ◽

...

Keyword(s):

Proton Beam ◽

Proton Beam Therapy ◽

Fiducial Markers ◽

Hepatocellular Carcinomas

Download Full-text

Photons or Protons for Non–Central Nervous System Solid Malignancies in Children: A Historical Perspective and Important Highlights

American Society of Clinical Oncology Educational Book ◽

10.14694/edbook_am.2013.33.e354 ◽

2013 ◽

pp. e354-e359

Author(s):

Najat C. Daw ◽

Anita Mahajan

Keyword(s):

Proton Beam ◽

External Beam Radiotherapy ◽

Intensity Modulated Radiotherapy ◽

Proton Beam Therapy ◽

Target Volume ◽

Secondary Malignancy ◽

Tumor Control ◽

Proton Beam Radiotherapy ◽

Pediatric Solid Tumors

Over the years, major advances have occurred in radiotherapy techniques, delivery, and treatment planning. Although radiotherapy is an integral treatment component of pediatric solid tumors, it is associated with potential acute and long-term untoward effects and risk of secondary malignancy particularly in growing children. Two major advances in external beam radiotherapy are intensity-modulated radiotherapy (IMRT) and proton beam radiotherapy. Their use in the treatment of children with cancer has been steadily increasing. IMRT uses multiple modulated radiation fields that enhance the conformality of the dose distribution to the target volume and avoid high doses to normal tissues. However, IMRT may be associated with increased volume of normal tissue that receives low doses and potential risk of secondary malignancy. Contrary to IMRT, proton beam radiotherapy uses a few beams and a fast dose fall-off distal to the target volume. Although both modalities require substantial personnel time and effort, the very high cost and limited availability of proton radiotherapy have constrained its widespread use. It is anticipated that both modalities may markedly improve tumor control and quality of life for long-term cancer survivors. Clinical trials with long-term follow-up are needed to confirm the premise that proton beam therapy will decrease late effects and secondary malignancies without compromising local control in pediatric patients with cancer.

Download Full-text

Impact of 4D CT for treatment planning of moving targets: a computer-based biological evaluation

Current Directions in Biomedical Engineering ◽

10.1515/cdbme-2017-0140 ◽

2017 ◽

Vol 3 (2) ◽

pp. 665-668

Author(s):

Eike Helf ◽

Oliver Waletzko ◽

Christian Mehrens ◽

Ralf Rohn ◽

Andreas Block

Keyword(s):

Treatment Plan ◽

Tumour Volume ◽

Target Volume ◽

Biological Evaluation ◽

Internal Target Volume ◽

4D Ct ◽

Tumour Control ◽

Ct Data ◽

Conventional Ct ◽

The Impact

AbstractThis study deals with comparison of conventional and 4D CT (GE Lightspeed) planning on the tumour control probability (TCP), using the TCP model of the AAPM-Report Task Group 166. In the first step a VMAT treatment plan was calculated (Varian Eclipse 13.7) on basis of conventional CT data. This treatment plan was transferred to the complete 4D CT, which represents the tumour volume in motion. Due to the increased volume and the resulting decrease of tumour coverage the TCP went down from 97,6% to 91,2%. After adding an internal target volume (ITV, ICRU 62) to the conventional CT according to our clinical protocols (1,0 cm cc and 0,3 cm axial plane) the TCP increased to 98,0% when applying the conventional plan to the 4D CT. This finding demonstrates the need of 4D CT for moving tumours in chest and abdomen region.Average IPs with increasing width have been created to evaluate the impact on the TCP and the non-malignant tissue. Our observations had shown that heart, lung and spinal cord radiation exposure did not correlate to chosen respiration segment. This could be explained by the extremely slight ratio of the planning target volume and the irradiated normal tissue.This procedure enables us to evaluate the efficacy of treatment plans. Furthermore, optimizing trials like the influence of respiration-gated RT, setting individual margins and fitting planning objectives and parameters are still under investigation.

Download Full-text