Proton beam therapy outcomes for localized unresectable hepatocellular carcinoma

Awalpreet S. Chadha; Jillian R. Gunther; Cheng En Hsieh; Maureen Aliru; Lakshmi S. Mahadevan; Bhanu P. Venkatesulu; Christopher H. Crane; Prajnan Das; Joseph M. Herman; Eugene J. Koay; Cullen Taniguchi; Emma B. Holliday; Bruce D. Minsky; Yelin Suh; Peter Park; Gabriel Sawakuchi; Sam Beddar; Bruno C. Odisio; Sanjay Gupta; Evelyne Loyer; Harmeet Kaur; Kanwal Raghav; Milind M. Javle; Ahmed O. Kaseb; Sunil Krishnan

doi:10.1016/j.radonc.2018.10.041

Proton beam therapy outcomes for localized unresectable hepatocellular carcinoma

Awalpreet S. Chadha, Jillian R. Gunther, Cheng En Hsieh, Maureen Aliru, Lakshmi S. Mahadevan, Bhanu P. Venkatesulu, Christopher H. Crane, Prajnan Das, Joseph M. Herman, Eugene J. Koay, Cullen Taniguchi, Emma B. Holliday, Bruce D. Minsky, Yelin Suh, Peter Park, Gabriel Sawakuchi, Sam Beddar, Bruno C. Odisio, Sanjay Gupta, Evelyne LoyerHarmeet Kaur, Kanwal Raghav, Milind M. Javle, Ahmed O. Kaseb, Sunil Krishnan

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34 Scopus citations

Abstract

Background and purpose: This study documents the utilization and efficacy of proton beam therapy (PBT) in western patients with localized unresectable hepatocellular carcinoma (HCC). Methods and methods: Forty-six patients with HCC, Child-Pugh class of A or B, no prior radiotherapy history, and ECOG performance status 0–2 received PBT at our institution from 2007 to 2016. Radiographic control within the PBT field (local control, LC) and overall survival (OS) were calculated from the start of PBT. Results: Most (83%) patients had Child-Pugh class A. Median tumor size was 6 cm (range, 1.5–21.0 cm); 22% of patients had multiple tumors and 28% had tumor vascular thrombosis. Twenty-five (54%) patients received prior treatment. Median biologically effective dose (BED) was 97.7 GyE (range, 33.6–144 GyE) administered in 15 fractions. Actuarial 2-year LC and OS rates were 81% and 62% respectively; median OS was 30.7 months. Out-of-field intrahepatic failure was the most common site of disease progression. Patients receiving BED ≥90 GyE had a significantly better OS than those receiving BED <90 GyE (49.9 vs. 15.8 months, p = 0.037). A trend toward 2-year LC improvement was observed in patients receiving BED ≥90 GyE compared with those receiving BED <90 GyE (92% vs. 63%, p = 0.096). On multivariate analysis, higher BED (p = 0.023; hazard ratio = 0.308) significantly predicted improved OS. Six (13%) patients experienced acute grade 3 toxicity. Conclusions: High-dose PBT is associated with high rates of LC and OS for unresectable HCC. Dose escalation may further improve outcomes.

Original language	English (US)
Pages (from-to)	54-61
Number of pages	8
Journal	Radiotherapy and Oncology
Volume	133
DOIs	https://doi.org/10.1016/j.radonc.2018.10.041
State	Published - Apr 2019

Keywords

Dose escalation
Primary liver cancer
Proton radiation

ASJC Scopus subject areas

Hematology
Oncology
Radiology Nuclear Medicine and imaging

MD Anderson CCSG core facilities

Clinical Trials Office

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10.1016/j.radonc.2018.10.041

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Chadha, A. S., Gunther, J. R., Hsieh, C. E., Aliru, M., Mahadevan, L. S., Venkatesulu, B. P., Crane, C. H., Das, P., Herman, J. M., Koay, E. J., Taniguchi, C., Holliday, E. B., Minsky, B. D., Suh, Y., Park, P., Sawakuchi, G., Beddar, S., Odisio, B. C., Gupta, S., ... Krishnan, S. (2019). Proton beam therapy outcomes for localized unresectable hepatocellular carcinoma. Radiotherapy and Oncology, 133, 54-61. https://doi.org/10.1016/j.radonc.2018.10.041

Chadha, AS, Gunther, JR, Hsieh, CE, Aliru, M, Mahadevan, LS, Venkatesulu, BP, Crane, CH, Das, P, Herman, JM, Koay, EJ, Taniguchi, C, Holliday, EB, Minsky, BD, Suh, Y, Park, P, Sawakuchi, G , Beddar, S , Odisio, BC , Gupta, S , Loyer, E , Kaur, H , Raghav, K , Javle, MM , Kaseb, AO & Krishnan, S 2019, 'Proton beam therapy outcomes for localized unresectable hepatocellular carcinoma', Radiotherapy and Oncology, vol. 133, pp. 54-61. https://doi.org/10.1016/j.radonc.2018.10.041

@article{1b13004f4cb344a2ba14a43026bd97b6,

title = "Proton beam therapy outcomes for localized unresectable hepatocellular carcinoma",

abstract = "Background and purpose: This study documents the utilization and efficacy of proton beam therapy (PBT) in western patients with localized unresectable hepatocellular carcinoma (HCC). Methods and methods: Forty-six patients with HCC, Child-Pugh class of A or B, no prior radiotherapy history, and ECOG performance status 0–2 received PBT at our institution from 2007 to 2016. Radiographic control within the PBT field (local control, LC) and overall survival (OS) were calculated from the start of PBT. Results: Most (83%) patients had Child-Pugh class A. Median tumor size was 6 cm (range, 1.5–21.0 cm); 22% of patients had multiple tumors and 28% had tumor vascular thrombosis. Twenty-five (54%) patients received prior treatment. Median biologically effective dose (BED) was 97.7 GyE (range, 33.6–144 GyE) administered in 15 fractions. Actuarial 2-year LC and OS rates were 81% and 62% respectively; median OS was 30.7 months. Out-of-field intrahepatic failure was the most common site of disease progression. Patients receiving BED ≥90 GyE had a significantly better OS than those receiving BED <90 GyE (49.9 vs. 15.8 months, p = 0.037). A trend toward 2-year LC improvement was observed in patients receiving BED ≥90 GyE compared with those receiving BED <90 GyE (92% vs. 63%, p = 0.096). On multivariate analysis, higher BED (p = 0.023; hazard ratio = 0.308) significantly predicted improved OS. Six (13%) patients experienced acute grade 3 toxicity. Conclusions: High-dose PBT is associated with high rates of LC and OS for unresectable HCC. Dose escalation may further improve outcomes.",

keywords = "Dose escalation, Primary liver cancer, Proton radiation",

author = "Chadha, {Awalpreet S.} and Gunther, {Jillian R.} and Hsieh, {Cheng En} and Maureen Aliru and Mahadevan, {Lakshmi S.} and Venkatesulu, {Bhanu P.} and Crane, {Christopher H.} and Prajnan Das and Herman, {Joseph M.} and Koay, {Eugene J.} and Cullen Taniguchi and Holliday, {Emma B.} and Minsky, {Bruce D.} and Yelin Suh and Peter Park and Gabriel Sawakuchi and Sam Beddar and Odisio, {Bruno C.} and Sanjay Gupta and Evelyne Loyer and Harmeet Kaur and Kanwal Raghav and Javle, {Milind M.} and Kaseb, {Ahmed O.} and Sunil Krishnan",

note = "Publisher Copyright: {\textcopyright} 2019 Elsevier B.V.",

year = "2019",

month = apr,

doi = "10.1016/j.radonc.2018.10.041",

language = "English (US)",

volume = "133",

pages = "54--61",

journal = "Radiotherapy and Oncology",

issn = "0167-8140",

publisher = "Elsevier Ireland Ltd",

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TY - JOUR

T1 - Proton beam therapy outcomes for localized unresectable hepatocellular carcinoma

AU - Chadha, Awalpreet S.

AU - Gunther, Jillian R.

AU - Hsieh, Cheng En

AU - Aliru, Maureen

AU - Mahadevan, Lakshmi S.

AU - Venkatesulu, Bhanu P.

AU - Crane, Christopher H.

AU - Das, Prajnan

AU - Herman, Joseph M.

AU - Koay, Eugene J.

AU - Taniguchi, Cullen

AU - Holliday, Emma B.

AU - Minsky, Bruce D.

AU - Suh, Yelin

AU - Park, Peter

AU - Sawakuchi, Gabriel

AU - Beddar, Sam

AU - Odisio, Bruno C.

AU - Gupta, Sanjay

AU - Loyer, Evelyne

AU - Kaur, Harmeet

AU - Raghav, Kanwal

AU - Javle, Milind M.

AU - Kaseb, Ahmed O.

AU - Krishnan, Sunil

PY - 2019/4

Y1 - 2019/4

N2 - Background and purpose: This study documents the utilization and efficacy of proton beam therapy (PBT) in western patients with localized unresectable hepatocellular carcinoma (HCC). Methods and methods: Forty-six patients with HCC, Child-Pugh class of A or B, no prior radiotherapy history, and ECOG performance status 0–2 received PBT at our institution from 2007 to 2016. Radiographic control within the PBT field (local control, LC) and overall survival (OS) were calculated from the start of PBT. Results: Most (83%) patients had Child-Pugh class A. Median tumor size was 6 cm (range, 1.5–21.0 cm); 22% of patients had multiple tumors and 28% had tumor vascular thrombosis. Twenty-five (54%) patients received prior treatment. Median biologically effective dose (BED) was 97.7 GyE (range, 33.6–144 GyE) administered in 15 fractions. Actuarial 2-year LC and OS rates were 81% and 62% respectively; median OS was 30.7 months. Out-of-field intrahepatic failure was the most common site of disease progression. Patients receiving BED ≥90 GyE had a significantly better OS than those receiving BED <90 GyE (49.9 vs. 15.8 months, p = 0.037). A trend toward 2-year LC improvement was observed in patients receiving BED ≥90 GyE compared with those receiving BED <90 GyE (92% vs. 63%, p = 0.096). On multivariate analysis, higher BED (p = 0.023; hazard ratio = 0.308) significantly predicted improved OS. Six (13%) patients experienced acute grade 3 toxicity. Conclusions: High-dose PBT is associated with high rates of LC and OS for unresectable HCC. Dose escalation may further improve outcomes.

AB - Background and purpose: This study documents the utilization and efficacy of proton beam therapy (PBT) in western patients with localized unresectable hepatocellular carcinoma (HCC). Methods and methods: Forty-six patients with HCC, Child-Pugh class of A or B, no prior radiotherapy history, and ECOG performance status 0–2 received PBT at our institution from 2007 to 2016. Radiographic control within the PBT field (local control, LC) and overall survival (OS) were calculated from the start of PBT. Results: Most (83%) patients had Child-Pugh class A. Median tumor size was 6 cm (range, 1.5–21.0 cm); 22% of patients had multiple tumors and 28% had tumor vascular thrombosis. Twenty-five (54%) patients received prior treatment. Median biologically effective dose (BED) was 97.7 GyE (range, 33.6–144 GyE) administered in 15 fractions. Actuarial 2-year LC and OS rates were 81% and 62% respectively; median OS was 30.7 months. Out-of-field intrahepatic failure was the most common site of disease progression. Patients receiving BED ≥90 GyE had a significantly better OS than those receiving BED <90 GyE (49.9 vs. 15.8 months, p = 0.037). A trend toward 2-year LC improvement was observed in patients receiving BED ≥90 GyE compared with those receiving BED <90 GyE (92% vs. 63%, p = 0.096). On multivariate analysis, higher BED (p = 0.023; hazard ratio = 0.308) significantly predicted improved OS. Six (13%) patients experienced acute grade 3 toxicity. Conclusions: High-dose PBT is associated with high rates of LC and OS for unresectable HCC. Dose escalation may further improve outcomes.

KW - Dose escalation

KW - Primary liver cancer

KW - Proton radiation

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M3 - Article

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AN - SCOPUS:85059945470

SN - 0167-8140

VL - 133

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JO - Radiotherapy and Oncology

JF - Radiotherapy and Oncology

ER -

Proton beam therapy outcomes for localized unresectable hepatocellular carcinoma

Abstract

Keywords

ASJC Scopus subject areas

MD Anderson CCSG core facilities

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