Efficacy and Safety of 4 Fractions of Carbon-Ion Radiation Therapy for Hepatocellular Carcinoma: A Prospective Study

Kei Shibuya; Hiroyuki Katoh; Yoshinori Koyama; Shintaro Shiba; Masahiko Okamoto; Shohei Okazaki; Kenichiro Araki; Satoru Kakizaki; Ken Shirabe; Tatsuya Ohno

doi:10.1159/000520277

Efficacy and Safety of 4 Fractions of Carbon-Ion Radiation Therapy for Hepatocellular Carcinoma: A Prospective Study

Liver Cancer. 2021 Dec 17;11(1):61-74. doi: 10.1159/000520277. eCollection 2022 Jan.

Authors

Kei Shibuya^{1

2}, Hiroyuki Katoh³, Yoshinori Koyama⁴, Shintaro Shiba^{1

2}, Masahiko Okamoto^{1

2}, Shohei Okazaki^{1

2}, Kenichiro Araki⁵, Satoru Kakizaki^{6

7}, Ken Shirabe⁵, Tatsuya Ohno^{1

2}

Affiliations

¹ Gunma University Heavy Ion Medical Center, Maebashi, Japan.
² Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Japan.
³ Department of Radiation Oncology, Kanagawa Cancer Center, Yokohama, Japan.
⁴ Department of Diagnostic Radiology, Shibukawa Medical Center, Shibukawa, Japan.
⁵ Division of Hepatobiliary and Pancreatic Surgery, Department of General Surgical Science, Gunma University Graduate School of Medicine, Maebashi, Japan.
⁶ Department of Gastroenterology and Hepatology, Gunma University Graduate School of Medicine, Maebashi, Japan.
⁷ Department of Clinical Research, National Hospital Organization Takasaki General Medical Center, Takasaki, Japan.

Abstract

Introduction: Prospective evidence supporting the safety and efficacy of carbon-ion radiotherapy (C-ion RT) for hepatocellular carcinoma (HCC) remains lacking. This prospective study aimed to evaluate the safety and efficacy of hypofractionated C-ion RT in patients with HCC.

Methods: The inclusion criteria were as follows: (1) pathologically or clinically diagnosed HCC; (2) measurable tumor and tumor size ≤10 cm; (3) absence of major vascular invasion; (4) no extrahepatic metastasis; (5) the alimentary tract was not adjacent to the target lesion (>1 cm); (6) not suitable for or refusal to undergo surgery or local ablative therapies; (7) an interval ≥4 weeks from previous therapy; (8) no other intrahepatic lesion or at least 2 years after the previous curative therapy; (9) performance status score, 0-2; and (10) Child-Pugh score, 5-9. The prescribed C-ion RT dose was 52.8 Gy (relative biological effectiveness [RBE]) or 60.0 Gy (RBE) in 4 fractions.

Results: In total, 35 patients with HCC were enrolled between October 2010 and May 2016. The median follow-up durations in the survivor group (n = 23) and in the whole cohort were 55.1 and 49.0 months, respectively. The 2-, 3-, and 4-year overall survival rates were 82.8%, 76.7%, and 69.4%, respectively. The 2-, 3-, and 4-year local control (LC) rates were 92.6%, 76.5%, and 76.5%, respectively. The median time-to-progression was 25.6 months (95% confidence interval, 13.7-37.5 months). Grade 4 or 5 toxicities were not observed. Grade 3 acute and late toxicities were observed in 2 patients. There was no significant deterioration in serum albumin, bilirubin, prothrombin time-international normalized ratio, platelet count, or Child-Pugh score after C-ion RT.

Conclusion: Four fractions of C-ion RT for HCC did not yield serious adverse events and showed promising LC, thus making it a safe and effective modality for this type of malignancy.

Keywords: Carbon-ion radiotherapy; Heavy ion radiotherapy; Hepatocellular carcinoma; Prospective.