Dose-Volume Histogram Analysis of the Safety of Proton Beam Therapy for Unresectable Hepatocellular Carcinoma

Journal Article · Fri Apr 01 00:00:00 EDT 2011 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2009.12.048· OSTI ID:21491690

Kawashima, Mitsuhiko ^[1]; Kohno, Ryosuke ^[1]; Nakachi, Kohei ^[2]; Nishio, Teiji ^[1]; Mitsunaga, Shuichi; Ikeda, Masafumi ^[2]; Konishi, Masaru; Takahashi, Shinichiro; Gotohda, Naoto ^[3]; Arahira, Satoko ^[4]; Zenda, Sadamoto; Ogino, Takashi ^[1]; Kinoshita, Taira ^[3]

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1. Division of Particle Therapy and Radiation Oncology, Research Center for Innovative Oncology, National Cancer Center Hospital East, Kashiwa (Japan)
2. Division of Hepatobiliary and Pancreatic Medical Oncology, National Cancer Center Hospital East, Kashiwa (Japan)
3. Division of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital East, Kashiwa (Japan)
4. Division of Radiation Oncology, National Cancer Center Hospital East, Kashiwa (Japan)

Purpose: To evaluate the safety and efficacy of radiotherapy using proton beam (PRT) for unresectable hepatocellular carcinoma. Methods and Materials: Sixty consecutive patients who underwent PRT between May 1999 and July 2007 were analyzed. There were 42 males and 18 females, with a median age of 70 years (48-92 years). All but 1 patient had a single lesion with a median diameter of 45 mm (20-100 mm). Total PRT dose/fractionation was 76-cobalt Gray equivalent (CGE)/20 fractions in 46 patients, 65 CGE/26 fractions in 11 patients, and 60 CGE/10 fractions in 3 patients. The risk of developing proton-induced hepatic insufficiency (PHI) was estimated using dose-volume histograms and an indocyanine-green retention rate at 15 minutes (ICG R15). Results: None of the 20 patients with ICG R15 of less than 20% developed PHI, whereas 6 of 8 patients with ICG R15 values of 50% or higher developed PHI. Among 32 patients whose ICG R15 ranged from 20% to 49.9%, PHI was observed only in patients who had received 30 CGE (V30) to more than 25% of the noncancerous parts of the liver (n = 5) Local progression-free and overall survival rates at 3 years were 90% (95% confidence interval [CI], 80-99%) and 56% (95% CI, 43-69%), respectively. A gastrointestinal toxicity of Grade {>=}2 was observed in 3 patients. Conclusions: ICG R15 and V30 are recommended as useful predictors for the risk of developing PHI, which should be incorporated into multidisciplinary treatment plans for patients with this disease.

• OSTI ID: 21491690
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Vol. 79, Issue 5; Other Information: DOI: 10.1016/j.ijrobp.2009.12.048; PII: S0360-3016(09)03729-8; Copyright (c) 2011 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
EFFICIENCY
HEPATOMAS
INDOCYANINE GREEN
LIVER
PROTON BEAMS
RADIATION DOSES
RADIATION HAZARDS
RADIOTHERAPY
RETENTION
SAFETY
TOLERANCE
AROMATICS
AZAARENES
AZOLES
BEAMS
BODY
CARCINOMAS
CONDENSED AROMATICS
DIGESTIVE SYSTEM
DISEASES
DOSES
DYES
GLANDS
HAZARDS
HEALTH HAZARDS
HETEROCYCLIC COMPOUNDS
INDICATORS
INDOLES
MEDICINE
NEOPLASMS
NUCLEAR MEDICINE
NUCLEON BEAMS
ORGANIC COMPOUNDS
ORGANIC NITROGEN COMPOUNDS
ORGANIC SULFUR COMPOUNDS
ORGANS
PARTICLE BEAMS
PYRROLES
RADIOLOGY
SULFONATES
THERAPY