Nina N Sanford1, Jennifer Pursley2, Bridget Noe2, Beow Y Yeap3, Lipika Goyal4, Jeffrey W Clark4, Jill N Allen4, Lawrence S Blaszkowsky4, David P Ryan4, Cristina R Ferrone5, Kenneth K Tanabe5, Motaz Qadan5, Christopher H Crane6, Eugene J Koay7, Christine Eyler2, Thomas F DeLaney2, Andrew X Zhu4, Jennifer Y Wo2, Clemens Grassberger2, Theodore S Hong8. 1. Harvard Radiation Oncology Program, Massachusetts General Hospital, Boston, Massachusetts; Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts. 2. Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts. 3. Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts. 4. Department of Medical Oncology, Massachusetts General Hospital, Boston, Massachusetts. 5. Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts. 6. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York. 7. Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas. 8. Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts. Electronic address: tshong1@mgh.harvard.edu.
Abstract
PURPOSE: Ablative radiation therapy is increasingly being used for hepatocellular carcinoma (HCC) resulting in excellent local control rates; however, patients without evidence of disease progression often die from liver failure. The clinical benefit of proton- over photon-based radiation therapy is unclear. We therefore sought to compare clinical outcomes of proton versus photon ablative radiation therapy in patients with unresectable HCC. METHODS AND MATERIALS: This is a single-institution retrospective study of patients treated during 2008 to 2017 with nonmetastatic, unresectable HCC not previously treated with liver-directed radiation therapy and who did not receive further liver-directed radiation therapy within 12 months after completion of index treatment. The primary outcome, overall survival (OS), was assessed using Cox regression. Secondary endpoints included incidence of non-classic radiation-induced liver disease (defined as increase in baseline Child-Pugh score by ≥2 points at 3 months posttreatment), assessed using logistic regression, and locoregional recurrence, assessed using Fine-Gray regression for competing risks. All outcomes were measured from radiation start date. RESULTS: The median follow-up was 14 months. Of 133 patients with median age 68 years and 75% male, 49 (37%) were treated with proton radiation therapy. Proton radiation therapy was associated with improved OS (adjusted hazard ratio, 0.47; P = .008; 95% confidence interval [CI], 0.27-0.82). The median OS for proton and photon patients was 31 and 14 months, respectively, and the 24-month OS for proton and photon patients was 59.1% and 28.6%, respectively. Proton radiation therapy was also associated with a decreased risk of non-classic radiation-induced liver disease (odds ratio, 0.26; P = .03; 95% CI, 0.08-0.86). Development of nonclassic RILD at 3 months was associated with worse OS (adjusted hazard ratio, 3.83; P < .001; 95% CI, 2.12-6.92). There was no difference in locoregional recurrence, including local failure, between protons and photons. CONCLUSIONS: Proton radiation therapy was associated with improved survival, which may be driven by decreased incidence of posttreatment liver decompensation. Our findings support prospective investigations comparing proton versus photon ablative radiation therapy for HCC.
PURPOSE: Ablative radiation therapy is increasingly being used for hepatocellular carcinoma (HCC) resulting in excellent local control rates; however, patients without evidence of disease progression often die from liver failure. The clinical benefit of proton- over photon-based radiation therapy is unclear. We therefore sought to compare clinical outcomes of proton versus photon ablative radiation therapy in patients with unresectable HCC. METHODS AND MATERIALS: This is a single-institution retrospective study of patients treated during 2008 to 2017 with nonmetastatic, unresectable HCC not previously treated with liver-directed radiation therapy and who did not receive further liver-directed radiation therapy within 12 months after completion of index treatment. The primary outcome, overall survival (OS), was assessed using Cox regression. Secondary endpoints included incidence of non-classic radiation-induced liver disease (defined as increase in baseline Child-Pugh score by ≥2 points at 3 months posttreatment), assessed using logistic regression, and locoregional recurrence, assessed using Fine-Gray regression for competing risks. All outcomes were measured from radiation start date. RESULTS: The median follow-up was 14 months. Of 133 patients with median age 68 years and 75% male, 49 (37%) were treated with proton radiation therapy. Proton radiation therapy was associated with improved OS (adjusted hazard ratio, 0.47; P = .008; 95% confidence interval [CI], 0.27-0.82). The median OS for proton and photon patients was 31 and 14 months, respectively, and the 24-month OS for proton and photon patients was 59.1% and 28.6%, respectively. Proton radiation therapy was also associated with a decreased risk of non-classic radiation-induced liver disease (odds ratio, 0.26; P = .03; 95% CI, 0.08-0.86). Development of nonclassic RILD at 3 months was associated with worse OS (adjusted hazard ratio, 3.83; P < .001; 95% CI, 2.12-6.92). There was no difference in locoregional recurrence, including local failure, between protons and photons. CONCLUSIONS: Proton radiation therapy was associated with improved survival, which may be driven by decreased incidence of posttreatment liver decompensation. Our findings support prospective investigations comparing proton versus photon ablative radiation therapy for HCC.
Authors: Jennifer Pursley; Issam El Naqa; Nina N Sanford; Bridget Noe; Jennifer Y Wo; Christine E Eyler; Matthew Hwang; Kristy K Brock; Beow Y Yeap; John A Wolfgang; Theodore S Hong; Clemens Grassberger Journal: Int J Radiat Oncol Biol Phys Date: 2020-04-27 Impact factor: 7.038
Authors: Saleh A Alqahtani; Faisal M Sanai; Ashwaq Alolayan; Faisal Abaalkhail; Hamad Alsuhaibani; Mazen Hassanain; Waleed Alhazzani; Abdullah Alsuhaibani; Abdullah Algarni; Alejandro Forner; Richard S Finn; Waleed K Al-Hamoudi Journal: Saudi J Gastroenterol Date: 2020-10 Impact factor: 2.485
Authors: Kimberly L Shampain; Caitlin E Hackett; Sohrab Towfighi; Anum Aslam; William R Masch; Alison C Harris; Silvia D Chang; Kanika Khanna; Vivek Mendiratta; Ahmed M Gabr; Dawn Owen; Mishal Mendiratta-Lala Journal: Abdom Radiol (NY) Date: 2021-05-07
Authors: Ibrahim Chamseddine; Yejin Kim; Brian De; Issam El Naqa; Dan G Duda; John Wolfgang; Jennifer Pursley; Harald Paganetti; Jennifer Wo; Theodore Hong; Eugene J Koay; Clemens Grassberger Journal: JCO Clin Cancer Inform Date: 2022-02