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Abstract

PURPOSE:

To evaluate clinical effectiveness and safety of simultaneous integrated boost-proton beam therapy (SIB-PBT) in hepatocellular carcinoma (HCC) patients with tumour vascular thrombosis (TVT).

MATERIAL AND METHODS:

Forty-one HCC patients with TVT underwent SIB-PBT using three dose-fractionation schemes: if gross tumour volume <1cm (n=27), 1-1.9cm (n=7), and ⩾2cm (n=7) from gastrointestinal structures, 50GyE (EQD2, 62.5GyE10), 60Gy (EQD2, 80GyE10), 66Gy (EQD2, 91.3GyE10), respectively, in 10 fractions was prescribed to planning target volume 1 (PTV1), and 30GyE (EQD2, 32.5GyE10) in 10 fractions was prescribed to PTV2.

RESULTS:

Overall, treatment was well tolerated, with no grade toxicity ⩾3. Median overall survival (OS) was 34.4months and 2-year local progression-free survival (LPFS), relapse free survival (RFS), and OS rates were 88.1%, 25%, and 51.1%, respectively. Patients treated with EQD2 of ⩾80GyE10 tended to show better TVT response (92.8% vs. 55.5%, p=0.002) 2-year LPFS (92.9% vs. 82.5%, p=0.463), RFS (28.8% vs. 19%, p=0.545), and OS (58.4% vs. 46.8%, p=0.428) rates than those with EQD2 of <80GyE10. Multivariate analysis showed that TVT response and Child Pugh classification were independent prognostic factors for OS.

CONCLUSIONS:

SIB-PBT is feasible and promising for HCC patients with TVT.​ 

Fig. 1. 

Definition of target volumes according to the closeness of gastrointestinal structures: (A) in the patients with gross tumour volume (GTV) <1 cm from gastrointestinal (GI) structures; (B) in the patients with GTV within 1–1.9 cm from GI structures; and (C) in the patients with GTV ⩾2 cm from GI structures, and partial response of a primary tumour and tumour vascular thrombosis (TVT) to simultaneous integrated boost-proton beam therapy (SIB-PBT). D, E, and F: Pretreatment CT scans showing the primary tumour and TVT (arrow). G, H, and I: The patient underwent SIB-PBT (50 GyE/10Fx to PTV1 and 30 GyE/10Fx to PTV2, respectively; 60 GyE/10Fx to PTV1 and 30 GyE/10Fx to PTV1; and 66 GyE/10Fx to PTV1, respectively). J, K, and L: CT scans 3 months after SIB-PBT. Note shrinkage of both the primary tumour and TVT (arrow). Abbreviations: ITV, internal target volume; and PTV, planning target volume. 

Author information​

Kim DY1, Park JW1, Kim TH2, Kim BH1, Moon SH1, Kim SS1, Woo SM1, Koh YH1, Lee WJ1, Kim CM1.