Proton Beam Therapy without Fiducial Markers Using Four-Dimensional CT Planning for Large Hepatocellular Carcinomas

Cancers

Satoshi Kobayashi¹  Toshifumi Gabata¹  Mariko Kawamura²  Satoko Asahi³  Tomoyasu Kumano⁴  Satoshi Shibata⁵  Makoto Sasaki⁵  Kazutaka Yamamoto⁵  Yoshikazu Maeda⁵  Sayuri Bou⁵  Hiroyasu Tamamura⁵  Yuji Tameshige⁵  Miu Mizuhata⁵  Yoshitaka Sato⁵  Shigeyuki Takamatsu⁵ 

[1] Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa 920-8641, Japan;Department of Radiology, Nagoya University Hospital, Nagoya, Aichi 466-8560, Japan;Department of Radiology, University of Fukui Hospital, Eiheiji, Fukui 910-1193, Japan;Department of Radiotherapy, Kanazawa University Hospital, Kanazawa, Ishikawa 920-8641, Japan;Proton Therapy Center, Fukui Prefectural Hospital, Fukui 910-8526, Japan;

关键词: hepatocellular carcinoma;    4-dimensional CT planning;    respiratory-gated irradiation;    proton beam therapy;   

DOI  :  10.3390/cancers10030071

来源: DOAJ

【 摘 要 】

We evaluated the effectiveness and toxicity of proton beam therapy (PBT) for hepatocellular carcinomas (HCC) >5 cm without fiducial markers using four-dimensional CT (4D-CT) planning. The subjects were 29 patients treated at our hospital between March 2011 and March 2015. The median total dose was 76 Cobalt Gray Equivalents (CGE) in 20 fractions (range; 66–80.5 CGE in 10–32 fractions). Therapy was delivered with end-expiratory phase gating. An internal target volume (ITV) margin was added through the analysis of respiratory movement with 4D-CT. Patient age ranged from 38 to 87 years (median, 71 years). Twenty-four patients were Child–Pugh class A and five patients were class B. Tumor size ranged from 5.0 to 13.9 cm (median, 6.9 cm). The follow-up period ranged from 2 to 72 months (median; 27 months). All patients completed PBT according to the treatment protocol without grade 4 (CTCAE v4.03 (draft v5.0)) or higher adverse effects. The two-year local tumor control (LTC), progression-free survival (PFS), and overall survival (OS) rates were 95%, 22%, and 61%, respectively. The LTC was not inferior to that of previous reports using fiducial markers. Respiratory-gated PBT with 4D-CT planning without fiducial markers is a less invasive and equally effective treatment for large HCCs as PBT with fiducial markers.

【 授权许可】

Unknown