Cargando…

Hypofractionated proton beam radiotherapy in patients with unresectable liver tumors: multi-institutional prospective results from the Proton Collaborative Group

BACKGROUND: Recent advances in radiotherapy techniques have allowed ablative doses to be safely delivered to inoperable liver tumors. In this setting, proton beam radiotherapy (PBT) provides the means to escalate radiation dose to the target volume while sparing the uninvolved liver. This study eval...

Descripción completa

Detalles Bibliográficos
Autores principales: Parzen, Jacob S., Hartsell, William, Chang, John, Apisarnthanarax, Smith, Molitoris, Jason, Durci, Michael, Tsai, Henry, Urbanic, James, Ashman, Jonathan, Vargas, Carlos, Stevens, Craig, Kabolizadeh, Peyman
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7643436/
https://www.ncbi.nlm.nih.gov/pubmed/33148296
http://dx.doi.org/10.1186/s13014-020-01703-3
_version_ 1783606278632767488
author Parzen, Jacob S.
Hartsell, William
Chang, John
Apisarnthanarax, Smith
Molitoris, Jason
Durci, Michael
Tsai, Henry
Urbanic, James
Ashman, Jonathan
Vargas, Carlos
Stevens, Craig
Kabolizadeh, Peyman
author_facet Parzen, Jacob S.
Hartsell, William
Chang, John
Apisarnthanarax, Smith
Molitoris, Jason
Durci, Michael
Tsai, Henry
Urbanic, James
Ashman, Jonathan
Vargas, Carlos
Stevens, Craig
Kabolizadeh, Peyman
author_sort Parzen, Jacob S.
collection PubMed
description BACKGROUND: Recent advances in radiotherapy techniques have allowed ablative doses to be safely delivered to inoperable liver tumors. In this setting, proton beam radiotherapy (PBT) provides the means to escalate radiation dose to the target volume while sparing the uninvolved liver. This study evaluated the safety and efficacy of hypofractionated PBT for liver tumors, predominantly hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC). METHODS: We evaluated the prospective registry of the Proton Collaborative Group for patients undergoing definitive PBT for liver tumors. Demographic, clinicopathologic, toxicity, and dosimetry information were compiled. RESULTS: To date, 63 patients have been treated at 9 institutions between 2013 and 2019. Thirty (48%) had HCC and 25 (40%) had ICC. The median dose and biological equivalent dose (BED) delivered was 58.05 GyE (range 32.5–75) and 80.5 GyE (range 53.6–100), respectively. The median mean liver BED was 13.9 GyE. Three (4.8%) patients experienced at least one grade ≥ 3 toxicity. With median follow-up of 5.1 months (range 0.1–40.8), the local control (LC) rate at 1 year was 91.2% for HCC and 90.9% for ICC. The 1-year LC was significantly higher (95.7%) for patients receiving BED greater than 75.2 GyE than for patients receiving BED of 75.2 GyE or lower (84.6%, p = 0.029). The overall survival rate at 1 year was 65.6% for HCC and 81.8% for ICC. CONCLUSIONS: Hypofractionated PBT results in excellent LC, sparing of the uninvolved liver, and low toxicity, even in the setting of dose-escalation. Higher dose correlates with improved LC, highlighting the importance of PBT especially in patients with recurrent or bulky disease.
format Online
Article
Text
id pubmed-7643436
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-76434362020-11-06 Hypofractionated proton beam radiotherapy in patients with unresectable liver tumors: multi-institutional prospective results from the Proton Collaborative Group Parzen, Jacob S. Hartsell, William Chang, John Apisarnthanarax, Smith Molitoris, Jason Durci, Michael Tsai, Henry Urbanic, James Ashman, Jonathan Vargas, Carlos Stevens, Craig Kabolizadeh, Peyman Radiat Oncol Research BACKGROUND: Recent advances in radiotherapy techniques have allowed ablative doses to be safely delivered to inoperable liver tumors. In this setting, proton beam radiotherapy (PBT) provides the means to escalate radiation dose to the target volume while sparing the uninvolved liver. This study evaluated the safety and efficacy of hypofractionated PBT for liver tumors, predominantly hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC). METHODS: We evaluated the prospective registry of the Proton Collaborative Group for patients undergoing definitive PBT for liver tumors. Demographic, clinicopathologic, toxicity, and dosimetry information were compiled. RESULTS: To date, 63 patients have been treated at 9 institutions between 2013 and 2019. Thirty (48%) had HCC and 25 (40%) had ICC. The median dose and biological equivalent dose (BED) delivered was 58.05 GyE (range 32.5–75) and 80.5 GyE (range 53.6–100), respectively. The median mean liver BED was 13.9 GyE. Three (4.8%) patients experienced at least one grade ≥ 3 toxicity. With median follow-up of 5.1 months (range 0.1–40.8), the local control (LC) rate at 1 year was 91.2% for HCC and 90.9% for ICC. The 1-year LC was significantly higher (95.7%) for patients receiving BED greater than 75.2 GyE than for patients receiving BED of 75.2 GyE or lower (84.6%, p = 0.029). The overall survival rate at 1 year was 65.6% for HCC and 81.8% for ICC. CONCLUSIONS: Hypofractionated PBT results in excellent LC, sparing of the uninvolved liver, and low toxicity, even in the setting of dose-escalation. Higher dose correlates with improved LC, highlighting the importance of PBT especially in patients with recurrent or bulky disease. BioMed Central 2020-11-04 /pmc/articles/PMC7643436/ /pubmed/33148296 http://dx.doi.org/10.1186/s13014-020-01703-3 Text en © The Author(s) 2020 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Parzen, Jacob S.
Hartsell, William
Chang, John
Apisarnthanarax, Smith
Molitoris, Jason
Durci, Michael
Tsai, Henry
Urbanic, James
Ashman, Jonathan
Vargas, Carlos
Stevens, Craig
Kabolizadeh, Peyman
Hypofractionated proton beam radiotherapy in patients with unresectable liver tumors: multi-institutional prospective results from the Proton Collaborative Group
title Hypofractionated proton beam radiotherapy in patients with unresectable liver tumors: multi-institutional prospective results from the Proton Collaborative Group
title_full Hypofractionated proton beam radiotherapy in patients with unresectable liver tumors: multi-institutional prospective results from the Proton Collaborative Group
title_fullStr Hypofractionated proton beam radiotherapy in patients with unresectable liver tumors: multi-institutional prospective results from the Proton Collaborative Group
title_full_unstemmed Hypofractionated proton beam radiotherapy in patients with unresectable liver tumors: multi-institutional prospective results from the Proton Collaborative Group
title_short Hypofractionated proton beam radiotherapy in patients with unresectable liver tumors: multi-institutional prospective results from the Proton Collaborative Group
title_sort hypofractionated proton beam radiotherapy in patients with unresectable liver tumors: multi-institutional prospective results from the proton collaborative group
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7643436/
https://www.ncbi.nlm.nih.gov/pubmed/33148296
http://dx.doi.org/10.1186/s13014-020-01703-3
work_keys_str_mv AT parzenjacobs hypofractionatedprotonbeamradiotherapyinpatientswithunresectablelivertumorsmultiinstitutionalprospectiveresultsfromtheprotoncollaborativegroup
AT hartsellwilliam hypofractionatedprotonbeamradiotherapyinpatientswithunresectablelivertumorsmultiinstitutionalprospectiveresultsfromtheprotoncollaborativegroup
AT changjohn hypofractionatedprotonbeamradiotherapyinpatientswithunresectablelivertumorsmultiinstitutionalprospectiveresultsfromtheprotoncollaborativegroup
AT apisarnthanaraxsmith hypofractionatedprotonbeamradiotherapyinpatientswithunresectablelivertumorsmultiinstitutionalprospectiveresultsfromtheprotoncollaborativegroup
AT molitorisjason hypofractionatedprotonbeamradiotherapyinpatientswithunresectablelivertumorsmultiinstitutionalprospectiveresultsfromtheprotoncollaborativegroup
AT durcimichael hypofractionatedprotonbeamradiotherapyinpatientswithunresectablelivertumorsmultiinstitutionalprospectiveresultsfromtheprotoncollaborativegroup
AT tsaihenry hypofractionatedprotonbeamradiotherapyinpatientswithunresectablelivertumorsmultiinstitutionalprospectiveresultsfromtheprotoncollaborativegroup
AT urbanicjames hypofractionatedprotonbeamradiotherapyinpatientswithunresectablelivertumorsmultiinstitutionalprospectiveresultsfromtheprotoncollaborativegroup
AT ashmanjonathan hypofractionatedprotonbeamradiotherapyinpatientswithunresectablelivertumorsmultiinstitutionalprospectiveresultsfromtheprotoncollaborativegroup
AT vargascarlos hypofractionatedprotonbeamradiotherapyinpatientswithunresectablelivertumorsmultiinstitutionalprospectiveresultsfromtheprotoncollaborativegroup
AT stevenscraig hypofractionatedprotonbeamradiotherapyinpatientswithunresectablelivertumorsmultiinstitutionalprospectiveresultsfromtheprotoncollaborativegroup
AT kabolizadehpeyman hypofractionatedprotonbeamradiotherapyinpatientswithunresectablelivertumorsmultiinstitutionalprospectiveresultsfromtheprotoncollaborativegroup