Simultaneous integrated boost and protection proton beam therapy approach for hepatocellular carcinoma

IF 2.7 3区医学 Q3 ONCOLOGY

Clinical and Translational Radiation Oncology Pub Date : 2025-07-01 DOI:10.1016/j.ctro.2025.101008

Kanokphorn Thonglert , Matthew D. Greer , Stephanie K. Schaub , Stephen R. Bowen , Anthony M. Menghini , Matthew J. Nyflot , Clemens Grassberger , Joseph Tsai , Peter Zaki , Edward Y. Kim , Tony Wong , Smith Apisarnthanarax

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Abstract

Purpose

Although simultaneous integrated boost and protection with proton beam therapy (SIB-PBT) facilitates tumor dose escalation while maintaining organ-at-risk (OAR) dose constraints, clinical outcomes are limited. This study assessed the safety and efficacy of using the SIB-PBT technique in hepatocellular carcinoma (HCC) patients.

Methods

We reviewed 47 patients with HCC who underwent SIB-PBT between 2014–2021. The radiation dose ranged from 36-67.5 Gy(RBE) in 15 fractions. SIB-PBT was used for the following reasons: minimize high-dose exposure to organs-at-risk (OARs) (n = 22, 47 %), treat targets with different dose levels (n = 6, 13 %), or both (n = 19, 40 %). Survival, local control, and toxicities were assessed using Kaplan-Meier, Fine-Gray cumulative incidence, and descriptive statistics, respectively.

Results

Forty-one patients (87 %) had tumors located ≤2 cm from luminal gastrointestinal (GI) OARs. The median tumor diameter was 9.2 cm (range, 2.0–21.5 cm). The median EQD2 D50%, D95% and D99% of gross tumor volume were 79.8 (range, 51.1–85.9), 66.7 (range, 36.9–84.6) and 50.2 (range, 34.1–83.6) Gy(RBE)₁₀, respectively. Most patients (91 %) received a D0.5 cc of <45 Gy(RBE) to luminal GI OARs. At a median follow-up of 22 months (range, 0.8–77.0 months), the 2-year cumulative incidence of local failure was 12 %. The 2-year progression-free survival and overall survival rates were 12 % (95 % CI 4.7–23.4 %), and 49 % (95 % CI, 33.2–63.2 %), respectively. One patient experienced grade 3 acute nausea/vomiting. No GI bleeding/ulcers or grade 4 + toxicity were observed. CP + 2 occurred in 5 patients.

Conclusion

SIB-PBT enables OAR protection along with heterogeneous tumor dose escalation and is a safe and effective treatment for HCC tumors.

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质子束增强与保护同步一体化治疗肝癌的研究

目的：虽然质子束治疗（sibb - pbt）的同时整合增强和保护促进了肿瘤剂量的增加，同时维持了器官危险（OAR）的剂量限制，但临床结果有限。本研究评估了在肝细胞癌（HCC）患者中使用sibb - pbt技术的安全性和有效性。方法回顾了2014-2021年间47例接受ib - pbt治疗的HCC患者。辐射剂量从36 ~ 67.5 Gy（RBE）分为15个分量。使用sibb - pbt的原因如下：尽量减少高剂量暴露于危险器官（OARs）（n = 22,47 %），用不同剂量水平治疗目标（n = 6,13 %），或两者兼而有之（n = 19,40 %）。生存率、局部控制和毒性分别采用Kaplan-Meier、Fine-Gray累积发生率和描述性统计进行评估。结果41例（87%）患者肿瘤位于距肠管腔（GI） OARs≤2 cm处。中位肿瘤直径9.2 cm（范围2.0 ~ 21.5 cm）。总肿瘤体积中EQD2 D50%、D95%和D99%的中位值分别为79.8 Gy（51.1-85.9）、66.7 Gy（36.9-84.6）和50.2 Gy(34.1-83.6) Gy(RBE)10。大多数患者（91%）接受了0.5 cc的45 Gy（RBE）腹腔胃肠道OARs。中位随访22个月（0.8-77.0个月），2年累积局部失败发生率为12%。2年无进展生存率和总生存率分别为12% （95% CI 4.7 - 23.4%）和49% （95% CI, 33.2 - 63.2%）。1例患者出现3级急性恶心/呕吐。未观察到胃肠道出血/溃疡或4 +级毒性。5例出现CP + 2。结论：sibb - pbt具有OAR保护作用，同时具有肿瘤剂量递增的异质性，是一种安全有效的肝癌治疗方法。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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