Proton Beam Therapy for Hepatocellular Carcinoma Associated with Inferior Vena Cava Tumor Thrombus

Overview

Journal J Cancer Res Clin Oncol

Specialty Oncology

Date 2019 Nov 29

PMID 31776663

Citations 12

Authors

Yuta Sekino

Toshiyuki Okumura

Nobuyoshi Fukumitsu

Takashi Iizumi

Haruko Numajiri

Masashi Mizumoto

Kei Nakai

Tetsuo Nonaka

Hitoshi Ishikawa

Hideyuki Sakurai

Affiliations

Soon will be listed here.

Abstract

Purpose: Hepatocellular carcinoma (HCC) with inferior vena cava tumor thrombus (IVCTT) is rare and regarded as an advanced disease stage with poor prognosis. Treatment effect data regarding HCC with IVCTT is scarce and clear evidence has not been established. This study, therefore, aims to examine the safety and effectiveness of proton beam therapy (PBT) for HCC patients with IVCTT.

Methods: From January 2005 to December 2014, a total of 21 HCC patients with IVCTT were analyzed. The total irradiation doses ranged from 50 to 74 (median 72.6) gray relative biological effectiveness.

Results: The follow-up period was 4-120 (median 21) months. Regarding acute toxicities, dermatitis of grade 1-2 was observed in all patients, while no grade 3 or higher late toxicity events were encountered. The overall survival (OS) rates for all patients were 62%, 33%, and 19% at 1, 2, and 3 years, respectively. No local recurrences for the treated lesions, including IVCTT, were observed. According to univariate analysis, IVCTT extension type was not associated with prognosis, but only tumor number significantly affected the OS rate (p = 0.003). For 10 single lesion patients, the longest survival time was 120 months with OS rates of 82%, 64%, and 36% at 1, 2, and 3 years, respectively.

Conclusion: PBT is safe and effective for HCC patients with IVCTT, especially those with single lesion status. PBT is an important treatment option for HCC patients with IVCTT.

Citing Articles

Proton-beam Therapy for Locally Advanced Hepatocellular Carcinoma With Inferior Vena Cava Tumor Thrombus: Case Report.

Shiba S, Shiraishi S, Tokuuye K, Shirata R, Omura M In Vivo. 2024; 38(4):2080-2084.

PMID: 38936928 PMC: 11215571. DOI: 10.21873/invivo.13667.

Carbon-ion radiotherapy for hepatocellular carcinoma with major vascular invasion: a retrospective cohort study.

Kaneko T, Makishima H, Wakatsuki M, Hiroshima Y, Matsui T, Yasuda S BMC Cancer. 2024; 24(1):383.

PMID: 38532338 PMC: 10964684. DOI: 10.1186/s12885-024-12154-4.

Current perspectives on radiotherapy in hepatocellular carcinoma management: a comprehensive review.

Kim D, Kim J J Liver Cancer. 2024; 24(1):33-46.

PMID: 38523467 PMC: 10990664. DOI: 10.17998/jlc.2024.02.26.

Triplet regimen as a novel modality for advanced unresectable hepatocellular carcinoma: A case report and review of literature.

Zhao Y, He G, Li G World J Clin Cases. 2023; 11(27):6558-6564.

PMID: 37900216 PMC: 10601001. DOI: 10.12998/wjcc.v11.i27.6558.

Proton beam therapy for hepatocellular carcinoma with bile duct invasion.

Iizumi T, Okumura T, Hasegawa N, Ishige K, Fukuda K, Seo E BMC Gastroenterol. 2023; 23(1):267.

PMID: 37537527 PMC: 10401805. DOI: 10.1186/s12876-023-02897-y.

References

Eisenhauer E, Therasse P, Bogaerts J, Schwartz L, Sargent D, Ford R . New response evaluation criteria in solid tumours: revised RECIST guideline (version 1.1). Eur J Cancer. 2008; 45(2):228-47. DOI: 10.1016/j.ejca.2008.10.026. View

Cheng A, Kang Y, Chen Z, Tsao C, Qin S, Kim J . Efficacy and safety of sorafenib in patients in the Asia-Pacific region with advanced hepatocellular carcinoma: a phase III randomised, double-blind, placebo-controlled trial. Lancet Oncol. 2008; 10(1):25-34. DOI: 10.1016/S1470-2045(08)70285-7. View

Sakamoto K, Nagano H . Outcomes of surgery for hepatocellular carcinoma with tumor thrombus in the inferior vena cava or right atrium. Surg Today. 2017; 48(9):819-824. DOI: 10.1007/s00595-017-1619-2. View

Kokudo T, Hasegawa K, Yamamoto S, Shindoh J, Takemura N, Aoki T . Surgical treatment of hepatocellular carcinoma associated with hepatic vein tumor thrombosis. J Hepatol. 2014; 61(3):583-8. DOI: 10.1016/j.jhep.2014.04.032. View

Mizumoto M, Okumura T, Hashimoto T, Fukuda K, Oshiro Y, Fukumitsu N . Proton beam therapy for hepatocellular carcinoma: a comparison of three treatment protocols. Int J Radiat Oncol Biol Phys. 2010; 81(4):1039-45. DOI: 10.1016/j.ijrobp.2010.07.015. View

Nagasue N, Yukaya H, Hamada T, Hirose S, Kanashima R, Inokuchi K . The natural history of hepatocellular carcinoma. A study of 100 untreated cases. Cancer. 1984; 54(7):1461-5. DOI: 10.1002/1097-0142(19841001)54:7<1461::aid-cncr2820540740>3.0.co;2-7. View

Lee S, Park J, Kim T, Kim Y, Woo S, Koh Y . Effectiveness and safety of proton beam therapy for advanced hepatocellular carcinoma with portal vein tumor thrombosis. Strahlenther Onkol. 2014; 190(9):806-14. DOI: 10.1007/s00066-014-0604-6. View

Sugahara S, Nakayama H, Fukuda K, Mizumoto M, Tokita M, Abei M . Proton-beam therapy for hepatocellular carcinoma associated with portal vein tumor thrombosis. Strahlenther Onkol. 2009; 185(12):782-8. DOI: 10.1007/s00066-009-2020-x. View

Kawashima M, Furuse J, Nishio T, Konishi M, Ishii H, Kinoshita T . Phase II study of radiotherapy employing proton beam for hepatocellular carcinoma. J Clin Oncol. 2005; 23(9):1839-46. DOI: 10.1200/JCO.2005.00.620. View

10.

Koo J, Kim J, Lim Y, Park S, Won H, Sung K . Combination of transarterial chemoembolization and three-dimensional conformal radiotherapy for hepatocellular carcinoma with inferior vena cava tumor thrombus. Int J Radiat Oncol Biol Phys. 2009; 78(1):180-7. DOI: 10.1016/j.ijrobp.2009.07.1730. View

11.

Fukumitsu N, Ishida M, Terunuma T, Mizumoto M, Hashimoto T, Moritake T . Reproducibility of image quality for moving objects using respiratory-gated computed tomography: a study using a phantom model. J Radiat Res. 2012; 53(6):945-53. PMC: 3483843. DOI: 10.1093/jrr/rrs039. View

12.

Pawlik T, Poon R, Abdalla E, Ikai I, Nagorney D, Belghiti J . Hepatectomy for hepatocellular carcinoma with major portal or hepatic vein invasion: results of a multicenter study. Surgery. 2005; 137(4):403-10. DOI: 10.1016/j.surg.2004.12.012. View

13.

Kokudo T, Hasegawa K, Matsuyama Y, Takayama T, Izumi N, Kadoya M . Liver resection for hepatocellular carcinoma associated with hepatic vein invasion: A Japanese nationwide survey. Hepatology. 2017; 66(2):510-517. DOI: 10.1002/hep.29225. View

14.

Okuda K, Ohtsuki T, Obata H, Tomimatsu M, Okazaki N, Hasegawa H . Natural history of hepatocellular carcinoma and prognosis in relation to treatment. Study of 850 patients. Cancer. 1985; 56(4):918-28. DOI: 10.1002/1097-0142(19850815)56:4<918::aid-cncr2820560437>3.0.co;2-e. View

15.

Wakayama K, Kamiyama T, Yokoo H, Kakisaka T, Kamachi H, Tsuruga Y . Surgical management of hepatocellular carcinoma with tumor thrombi in the inferior vena cava or right atrium. World J Surg Oncol. 2013; 11:259. PMC: 3851861. DOI: 10.1186/1477-7819-11-259. View

16.

Kouloulias V, Mosa E, Georgakopoulos J, Platoni K, Brountzos I, Zygogianni A . Three-dimensional conformal radiotherapy for hepatocellular carcinoma in patients unfit for resection, ablation, or chemotherapy: a retrospective study. ScientificWorldJournal. 2014; 2013:780141. PMC: 3863543. DOI: 10.1155/2013/780141. View

17.

Llovet J, Ricci S, Mazzaferro V, Hilgard P, Gane E, Blanc J . Sorafenib in advanced hepatocellular carcinoma. N Engl J Med. 2008; 359(4):378-90. DOI: 10.1056/NEJMoa0708857. View

18.

Liu J, Wang Y, Zhang D, Liu B, Ou Q . Comparison of survival and quality of life of hepatectomy and thrombectomy using total hepatic vascular exclusion and chemotherapy alone in patients with hepatocellular carcinoma and tumor thrombi in the inferior vena cava and hepatic vein. Eur J Gastroenterol Hepatol. 2011; 24(2):186-94. DOI: 10.1097/MEG.0b013e32834dda64. View

19.

Kasai Y, Hatano E, Seo S, Taura K, Yasuchika K, Okajima H . Proposal of selection criteria for operative resection of hepatocellular carcinoma with inferior vena cava tumor thrombus incorporating hepatic arterial infusion chemotherapy. Surgery. 2017; 162(4):742-751. DOI: 10.1016/j.surg.2017.05.011. View

20.

LAWRENCE J, TOBIAS C, BORN J, LINFOOT J, Kling R, Gottschalk A . Alpha and Proton Heavy Particles and the Bragg Peak in Therapy. Trans Am Clin Climatol Assoc. 2011; 75:111-6. PMC: 2279335. View