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Proton versus photon radiotherapy for hepatocellular carcinoma: Current data and technical considerations
Hannah J Roberts1, Theodore S Hong1
1Department of Radiation Oncology, Massachusetts General Hospital, 55 Fruit St., Boston, MA 02114, USA.
Journal of Radiosurgery and SBRT
|November 29, 2023
Summary
Proton beam radiotherapy (PBT) may improve outcomes for unresectable hepatocellular carcinoma (HCC) by better sparing healthy liver tissue compared to traditional photon radiation. Ongoing trials are investigating its clinical effectiveness and safety.
Area of Science:
- Radiation Oncology
- Hepatocellular Carcinoma (HCC) Treatment
- Medical Physics
Background:
- Hepatocellular carcinoma (HCC) management often involves radiation therapy, with photon radiation being the current standard.
- Patients with HCC frequently have underlying liver disease, making liver function a critical factor in survival, often independent of tumor progression.
- Photon radiotherapy for HCC shows local control but carries a risk of radiation-induced liver disease (RILD), potentially impacting patient outcomes.
Purpose of the Study:
- To review the technical differences between proton beam radiotherapy (PBT) and photon radiation for unresectable HCC.
- To examine the existing literature on the individual outcomes associated with PBT and photon radiation in HCC.
- To discuss the comparative data and ongoing clinical trials, such as NRG Oncology GI003, evaluating PBT versus photons for HCC.
Main Methods:
- Review of technical aspects of PBT and photon radiotherapy, including image guidance, motion management, and conformality.
- Analysis of published literature on the outcomes of PBT and photon radiation for HCC.
- Discussion of data from comparative studies and the design of the NRG Oncology GI003 trial comparing PBT and photons.
Main Results:
- PBT offers a theoretical advantage in sparing uninvolved liver parenchyma, potentially allowing for dose escalation in HCC treatment.
- Technical considerations for optimizing radiation delivery are critical for both PBT and photon radiotherapy.
- The NRG Oncology GI003 trial is actively investigating whether PBT improves clinical outcomes compared to photon radiation in HCC patients.
Conclusions:
- PBT presents a promising alternative to photon radiation for unresectable HCC due to its superior tissue-sparing capabilities.
- Further research and clinical trials are essential to confirm the benefits of PBT and establish its role in HCC treatment paradigms.
- Optimizing radiation techniques for both modalities is crucial for maximizing efficacy and minimizing toxicity in HCC management.
