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Erratum published on 11 December 2018, see Cancers 2018, 10(12), 508.

Open AccessArticle
Cancers 2018, 10(3), 71; https://doi.org/10.3390/cancers10030071

Proton Beam Therapy without Fiducial Markers Using Four-Dimensional CT Planning for Large Hepatocellular Carcinomas

1
Proton Therapy Center, Fukui Prefectural Hospital, Fukui 910-8526, Japan
2
Department of Radiotherapy, Kanazawa University Hospital, Kanazawa, Ishikawa 920-8641, Japan
3
Department of Radiology, Nagoya University Hospital, Nagoya, Aichi 466-8560, Japan
4
Department of Radiology, University of Fukui Hospital, Eiheiji, Fukui 910-1193, Japan
5
Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa 920-8641, Japan
*
Author to whom correspondence should be addressed.
Received: 30 January 2018 / Revised: 7 March 2018 / Accepted: 12 March 2018 / Published: 14 March 2018
(This article belongs to the Special Issue Proton and Carbon Ion Therapy)
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Abstract

We evaluated the effectiveness and toxicity of proton beam therapy (PBT) for hepatocellular carcinomas (HCC) >5 cm without fiducial markers using four-dimensional CT (4D-CT) planning. The subjects were 29 patients treated at our hospital between March 2011 and March 2015. The median total dose was 76 Cobalt Gray Equivalents (CGE) in 20 fractions (range; 66–80.5 CGE in 10–32 fractions). Therapy was delivered with end-expiratory phase gating. An internal target volume (ITV) margin was added through the analysis of respiratory movement with 4D-CT. Patient age ranged from 38 to 87 years (median, 71 years). Twenty-four patients were Child–Pugh class A and five patients were class B. Tumor size ranged from 5.0 to 13.9 cm (median, 6.9 cm). The follow-up period ranged from 2 to 72 months (median; 27 months). All patients completed PBT according to the treatment protocol without grade 4 (CTCAE v4.03 (draft v5.0)) or higher adverse effects. The two-year local tumor control (LTC), progression-free survival (PFS), and overall survival (OS) rates were 95%, 22%, and 61%, respectively. The LTC was not inferior to that of previous reports using fiducial markers. Respiratory-gated PBT with 4D-CT planning without fiducial markers is a less invasive and equally effective treatment for large HCCs as PBT with fiducial markers. View Full-Text
Keywords: hepatocellular carcinoma; 4-dimensional CT planning; respiratory-gated irradiation; proton beam therapy hepatocellular carcinoma; 4-dimensional CT planning; respiratory-gated irradiation; proton beam therapy
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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited (CC BY 4.0).
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Shibata, S.; Takamatsu, S.; Yamamoto, K.; Mizuhata, M.; Bou, S.; Sato, Y.; Kawamura, M.; Asahi, S.; Tameshige, Y.; Maeda, Y.; Sasaki, M.; Kumano, T.; Kobayashi, S.; Tamamura, H.; Gabata, T. Proton Beam Therapy without Fiducial Markers Using Four-Dimensional CT Planning for Large Hepatocellular Carcinomas. Cancers 2018, 10, 71.

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