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BMC Cancer
Published in: BMC Cancer 1/2024

Open Access 01-12-2024 | Hepatocellular Carcinoma | Research

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

Authors: Takashi Kaneko, Hirokazu Makishima, Masaru Wakatsuki, Yuichi Hiroshima, Toshiaki Matsui, Shigeo Yasuda, Naomi Nagatake Okada, Kenji Nemoto, Hiroshi Tsuji, Shigeru Yamada, Masaru Miyazaki

Published in: BMC Cancer | Issue 1/2024

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Abstract

Background

Macroscopic vascular invasion (MVI) significantly impacts survival in patients with hepatocellular carcinoma (HCC), warranting systemic therapy over locoregional therapy. Despite novel approaches, HCC with MVI has a poor prognosis compared to early-to intermediate-stage HCC. This study aimed to evaluate the safety and efficacy of carbon-ion radiotherapy (C-ion RT) for HCC characterized by MVI.

Methods

This retrospective cohort study evaluated HCC patients with MVI treated using C-ion RT with a dose of 45.0–48.0 Gy/2 fractions or 52.8–60.0 Gy/4 fractions between 1995 and 2020 at our institution in Japan. We analyzed the prognostic factors and rates of local recurrence, survival, and adverse events. The local recurrence rate was determined using the cumulative incidence function, with death as a competing event. Survival rates were determined using the Kaplan–Meier method. The log-rank test for univariate analysis and the Cox proportional hazards model for multivariate analysis were used to compare subgroups.

Results

In total, 76 patients with a median age of 71 years (range, 45–86 years) were evaluated. Among them, 68 had Child–Pugh grade A while eight had grade B disease. In 17 patients, the vascular tumor thrombus reached the inferior vena cava or main trunk of the portal vein. Over a median follow-up period of 27.9 months (range, 1.5–180.4 months), the 2-year overall survival, progression-free survival, and local recurrence rates were 70.0% (95% confidence interval [CI]: 57.7–79.4%), 32.7% (95% CI: 22.0–43.8%), and 8.9% (95% CI: 1.7–23.5%), respectively. A naïve tumor and a single lesion were significant prognostic factors for overall survival in the univariate analysis. Albumin-bilirubin grade 1 and a single lesion were independent prognostic factors in the multivariate analysis. Overall, four patients (5%) experienced grade 3 late adverse events, with no observed grade 4 or 5 acute or late adverse events.

Conclusions

C-ion RT for HCC with MVI showed favorable local control and survival benefits with minimal toxicity.
Appendix
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Metadata
Title
Carbon-ion radiotherapy for hepatocellular carcinoma with major vascular invasion: a retrospective cohort study
Authors
Takashi Kaneko
Hirokazu Makishima
Masaru Wakatsuki
Yuichi Hiroshima
Toshiaki Matsui
Shigeo Yasuda
Naomi Nagatake Okada
Kenji Nemoto
Hiroshi Tsuji
Shigeru Yamada
Masaru Miyazaki
Publication date
01-12-2024
Publisher
BioMed Central
Published in
BMC Cancer / Issue 1/2024
Electronic ISSN: 1471-2407
DOI
https://doi.org/10.1186/s12885-024-12154-4

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