Proton versus photon radiotherapy for primary hepatocellular carcinoma: a propensity-matched analysis

Jen Yu Cheng, Chieh Min Liu, Yu Ming Wang, Yu Ming Wang, Hsuan Chih Hsu, Eng Yen Huang, Eng Yen Huang, Tzu Ting Huang, Ching Hsin Lee, Sheng Ping Hung, Bing Shen Huang, Bing Shen Huang, Bing Shen Huang

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13 Scopus citations

Abstract

Background: Proton radiotherapy has a dosimetric advantage over photon radiotherapy. Many retrospective studies have shown promising results with proton radiotherapy in treating hepatocellular carcinoma (HCC). However, clinical evidence demonstrating the benefit of protons over photons is still limited. We therefore compared the clinical outcomes of the two modalities using medical research databases from our medical foundation. Methods: We conducted a propensity score-matched cohort study based on our multi-institution medical organization research database. From January 2007 to January 2018, a total of 413 patients (photon: 349; proton: 64) who were diagnosed with HCC and primarily treated with radiotherapy with curative intent were enrolled. Overall survival (OS) and radiation-induced liver disease (RILD) were assessed. Stratified analysis was also performed to evaluate the heterogeneous effects of the two arms. Results: A total of 110 patients (photon: 55; proton: 55) were analyzed in the propensity-matched series. The matched groups were balanced for baseline tumor risk factors. Cox regression analysis revealed a significant survival benefit in the proton group (p = 0.032, HR 0.56, 95% CI 0.33-0.96). The median overall survival in the proton group was not reached and that in the photon group was 17.4 months. The biological equivalent dose of radiotherapy was significantly higher in the proton group than in the photon group (median, 96.56 Gray [relative biological effectiveness] vs. 62.5 Gray, p < 0.001). The risk of RILD was significantly lower in the proton group (11.8% vs. 36%, p = 0.004). Conclusions: Proton radiotherapy could deliver a higher radiation dose than photon radiotherapy without increasing the risk of RILD and result in a better overall survival rate for those diagnosed with HCC and treated with radiotherapy with curative intent.

Original languageEnglish
Article number159
JournalRadiation Oncology
Volume15
Issue number1
DOIs
StatePublished - 30 Jun 2020

Keywords

  • Hepatocellular carcinoma
  • Photon
  • Proton
  • Radiotherapy

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