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Bing-Shen Huang
Chang Gung Memorial Hospital
Corresponding Author
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Background Proton radiotherapy has a dosimetric advantage over photon radiotherapy. Many retrospective studies have shown promising results with proton radiotherapy for treating hepatocellular carcinoma (HCC). However, clinical evidence demonstrating the benefit of protons over photons is still limited. We therefore compared clinical outcomes for 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 and photon group was not reached and 17.4 months, respectively. The biological equivalent dose for radiotherapy was significantly higher in the proton group than the photon group (median, 96.56 Gray 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 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.
Keywords
Hepatocellular carcinoma, Proton, Photon, Radiotherapy
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View the published article at Radiation Oncology.
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Editorial decision: Accept
On 22 Jun, 2020
Reviewer #1 agreed
On 19 Jun, 2020
Review #1 received
Received 19 Jun, 2020
Reviewers invited
Invitations sent on 17 Jun, 2020
Editor assigned
On 14 Jun, 2020
Submission checks complete
On 13 Jun, 2020
Editor invited
On 13 Jun, 2020
Version 1
Posted 13 May, 2020
No comments provided
Editorial decision: Minor revision
On 03 Jun, 2020
Review #1 received
Received 18 May, 2020
Reviewers invited
Invitations sent on 12 May, 2020
Reviewer #1 agreed
On 12 May, 2020
First submitted
On 06 May, 2020
Editor assigned
On 06 May, 2020
Submission checks complete
On 05 May, 2020
Editor invited
On 05 May, 2020
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Subject Areas
Oncology
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A new preprint design is coming!
We have improved readability, clarity, accessibility, and opportunities for engagement.
See the published version of this preprint at Radiation Oncology.
This is a preprint, a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research
Bing-Shen Huang
Chang Gung Memorial Hospital
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
View the published article at Radiation Oncology.
No community comments so far
Editorial decision: Accept
On 22 Jun, 2020
Reviewer #1 agreed
On 19 Jun, 2020
Review #1 received
Received 19 Jun, 2020
Reviewers invited
Invitations sent on 17 Jun, 2020
Editor assigned
On 14 Jun, 2020
Submission checks complete
On 13 Jun, 2020
Editor invited
On 13 Jun, 2020
Version 1
Posted 13 May, 2020
No comments provided
Editorial decision: Minor revision
On 03 Jun, 2020
Review #1 received
Received 18 May, 2020
Reviewers invited
Invitations sent on 12 May, 2020
Reviewer #1 agreed
On 12 May, 2020
First submitted
On 06 May, 2020
Editor assigned
On 06 May, 2020
Submission checks complete
On 05 May, 2020
Editor invited
On 05 May, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Oncology
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published article at Radiation Oncology.
Background Proton radiotherapy has a dosimetric advantage over photon radiotherapy. Many retrospective studies have shown promising results with proton radiotherapy for treating hepatocellular carcinoma (HCC). However, clinical evidence demonstrating the benefit of protons over photons is still limited. We therefore compared clinical outcomes for 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 and photon group was not reached and 17.4 months, respectively. The biological equivalent dose for radiotherapy was significantly higher in the proton group than the photon group (median, 96.56 Gray 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 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.
Figure 1
Figure 2
Figure 3
Figure 4
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