Top Line: The optimally safe and effective treatment for hepatocellular carcinoma remains a topic of vigorous debate across specialties.
The Study:A prospective cohort study spanning 12 Japanese centers delves into outcomes following definitive proton therapy for HCC across 576 patients. The prescription was uniform: 76 Gy in 38 fractions (91.2 Gy RBE) when <1 cm from GI tract, 72.6 Gy in 22 fractions (96.6 Gy RBE) when <1 cm of porta hepatis, and 66.0 Gy in 10 fractions (109.6 Gy RBE) otherwise. Median progression-free survival was 15 months and overall survival just over 4 years. Predictable predictors of longer survival included Child-Pugh score A/B, tumor size <5 cm, and tumor location >1 cm from bowel—the latter likely representing easier ability to dose-escalate. Late grade 3+ events occurred in 27 patients (5%) including liver failure (n=7, 4 with recurrent disease) and dermatitis (n=7).
TBL: The unique anatomic challenges of delivering maximally effective definitive radiation doses for HCC may make this a space ripe for capitalizing on proton dosimetry. | Misumoto, Int J Radiat Oncol Biol Phys 2023
The Study:A prospective cohort study spanning 12 Japanese centers delves into outcomes following definitive proton therapy for HCC across 576 patients. The prescription was uniform: 76 Gy in 38 fractions (91.2 Gy RBE) when <1 cm from GI tract, 72.6 Gy in 22 fractions (96.6 Gy RBE) when <1 cm of porta hepatis, and 66.0 Gy in 10 fractions (109.6 Gy RBE) otherwise. Median progression-free survival was 15 months and overall survival just over 4 years. Predictable predictors of longer survival included Child-Pugh score A/B, tumor size <5 cm, and tumor location >1 cm from bowel—the latter likely representing easier ability to dose-escalate. Late grade 3+ events occurred in 27 patients (5%) including liver failure (n=7, 4 with recurrent disease) and dermatitis (n=7).
TBL: The unique anatomic challenges of delivering maximally effective definitive radiation doses for HCC may make this a space ripe for capitalizing on proton dosimetry. | Misumoto, Int J Radiat Oncol Biol Phys 2023