In patients with hepatocellular carcinoma (HCC) and intrahepatic cholangiocarcinoma (ICC), high-dose hypofractionated proton therapy may demonstrate high local control rates, according to a recent study published online ahead of print in the Journal of Clinical Oncology.1

Researchers led by Theodore Hong, MD, of the Massachusetts General Hospital in Boston, conducted a single-arm, phase 2, multi-institutional study of 83 patients with biopsy-confirmed HCC or ICC that was determined to be unresectable.  They received 15 fractions of proton therapy to a maximum total dose of 67.5 Gy equivalent.

Observed patients had a Child-Turcotte-Pugh (CTP) score of A or B, an Eastern Cooperative Oncology Group (ECOG) performance status of 0 to 2, no extrahepatic disease, and no prior radiation. They calculated for patients who were able to demonstrate at least 80% local control as defined by the Response Evaluation Criteria in Solid Tumors (RECIST) 1.0 criteria.

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They found that CTP score was A for 79.5% of patients and B for 15.7%, while 4.8% of patients had no cirrhosis. Prior treatment was given to 31.8% of patients with HCC and 61.5% of those with ICC. Multiple tumors were present in 27.3% of patients with HCC and 12.8% of those with ICC.

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With a median dose delivered at 58.0 Gy and a median-follow-up among survivors at 19.5 months, local control at 2 years was 94.8% for patients with HCC and 94.1% for those with ICC. Overall survival rate was found to be 63.2% for HCC and 46.5% for ICC.


  1. Hong TS, Wo JY, Yeap BY, et al. Multi-institutional phase II study of high-dose hypofractionated proton beam therapy in patients with localized, unresectable hepatocellular carcinoma and intrahepatic cholangiocarcinoma [published online ahead of print December 14, 2015]. J Clin Oncol. doi: 10.1200/JCO.2015.64.2710.