Journal of Liver Cancer

Original Article

Recent update of proton beam therapy for hepatocellular carcinoma: a systematic review and meta-analysis: Sun Hyun Bae, Won Il Jang, Hanna Rahbek Mortensen, Britta Weber, Mi Sook Kim, Morten Høyer; J Liver Cancer. 2024;24(2):286-302. Published online July 4, 2024; DOI: https://doi.org/10.17998/jlc.2024.06.26

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Backgrounds/Aims
Although access to proton beam therapy (PBT) is limited worldwide, its use for the treatment of hepatocellular carcinoma (HCC) is gradually increasing with the expansion of new facilities. Therefore, we conducted a systematic review and metaanalysis to investigate the updated evidence of PBT for HCC.
Methods
The MEDLINE, EMBASE, Cochrane Library, and Web of Science databases were systematically searched for studies that enrolled patients with liver-confined HCC that were treated with PBT for a cure up to February 2024.
Results
A total of 1,858 HCC patients receiving PBT from 22 studies between 2004 and 2023 were selected for this meta-analysis. The median proportion of Child-Pugh class A was 86% (range, 41-100), and the median tumor size was 3.6 cm (range, 1.2-9.0). The median total dose ranged from 55 GyE to 76 GyE (median, 69). The pooled rates of 3- and 5-year local progression-free survival after PBT were 88% (95% confidence interval [CI], 85-91) and 86% (95% CI, 82-90), respectively. The pooled 3- and 5-year overall rates were 60% (95% CI, 54-66) and 46% (95% CI, 38-54), respectively. The pooled rates of grade 3 hepatic toxicity, classic radiationinduced liver disease (RILD), and non-classic RILD were 1%, 2%, and 1%, respectively.
Conclusions
The current study supports PBT for HCC and demonstrates favorable long-term survival and low hepatic toxicities compared with other published studies on other radiotherapy modalities. However, further studies are needed to identify the subgroups that will benefit from PBT.

Citations

Citations to this article as recorded by

A concise review of updated global guidelines for the management of hepatocellular carcinoma: 2017-2024
Hyunjae Shin, Su Jong Yu
Journal of Liver Cancer.2025; 25(1): 19. CrossRef
Radiotherapy for Locally Advanced Pancreatic Cancer in the Modern Era: A Systematic Review and Meta-Analysis
Sun Hyun Bae, Won Il Jang, Jeong Il Yu, Hee Chul Park, Ji Eun Moon, Karin Haustermans, Marta Scorsetti, Morten Høyer, Mi Sook Kim
Cancers.2025; 17(18): 2959. CrossRef
CAPG Regulates Doxorubicin Resistance in Hepatocellular Carcinoma Cells via TGFB1/Smad/Nrf2 Signalling Pathway
Yue Shang, Jun Zhang, Tingting Liu
Journal of Cellular and Molecular Medicine.2025;[Epub] CrossRef

Case Report

A Case of Paraplegia after Successful Treatment of Cyberknife for Hepatocellular Carcinoma: Geum Youb Noh, Chul Ju Han, Youn Joo Kim, Ki Young Yang, Su Cheol Park, Jin Kim, Yu Cheol Kim, Mi Sook Kim; Journal of the Korean Liver Cancer Study Group. 2011;11(2):165-171. Published online September 30, 2011

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Abstract PDF: Radiation therapy (RT) is one of the managements for unresectable hepatocellular carcinoma (HCC). Traditionally, RT has played only a limited role in HCC treatment because of its low efficacy and the low tolerance of the liver for this modality. However, as the technology of RT grows rapidly in recent years, indication of RT for HCC has been extended remarkably. Stereotactic body radiation therapy (SBRT) is a technique that allows precise delivery of a large ablative radiation dose to the tumor while sparing normal surrounding tissue in 1 to 5 fractions. As RT becomes useful therapeutic strategy, the important problem is that there could be serious complication after RT. Here we present a case of 54 years old male with advanced stage of HCC, who underwent a serious neurologic complication of paraplegia following Cyberknife (CK) treatment. He had a huge HCC in right lobe of the liver, and initially transarterial chemoembolization (TACE) was performed with an unsatisfactory response. Therefore, CK was performed, and another TACE was done for a new lesion, which was followed by remarkable complete remission of the tumor. However, paraplegia developed in both of his lower extremities a year after CK. Investigation has shown radiation myelitis as the cause of paralysis. Three and a half years have passed since CK treatment, and HCC is still in complete remission state, however, paraplegia is persistent now. Radiation myelitis should be considered as a complication, when CK is applied to treatment of HCC.

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