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Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 28, 2018; 24(28): 3090-3100
Published online Jul 28, 2018. doi: 10.3748/wjg.v24.i28.3090
Proton therapy for hepatocellular carcinoma: Current knowledges and future perspectives
Gyu Sang Yoo, Jeong Il Yu, Hee Chul Park
Gyu Sang Yoo, Jeong Il Yu, Hee Chul Park, Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, South Korea
Hee Chul Park, Department of Medical Device Management and Research, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul 06351, South Korea
Author contributions: Yoo GS, Yu JI and Park HC contributed equally to this manuscript, including design of the study and literature review; Park HC supervised the project.
Supported by a Grant from the Marine Biotechnology Program funded by the Ministry of Oceans and Fisheries, South Korea, No. 20150220.
Conflict-of-interest statement: No potential conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Hee Chul Park, MD, PhD, Professor, Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul 06351, South Korea. hee.ro.park@samsung.com
Telephone: +82-2-34102612 Fax: +82-2-34102619
Received: March 28, 2018
Peer-review started: March 28, 2018
First decision: May 9, 2018
Revised: May 28, 2018
Accepted: June 25, 2018
Article in press: June 25, 2018
Published online: July 28, 2018
Processing time: 121 Days and 6.2 Hours
Abstract

Hepatocellular carcinoma (HCC) is the second leading cause of cancer-related death, as few patients can be treated with currently available curative local modalities. In patients with HCC where curative modalities are not feasible, radiation therapy (RT) has emerged as an alternative or combination therapy. With the development of various technologies, RT has been increasingly used for the management of HCC. Among these advances, proton beam therapy (PBT) has several unique physical properties that give it a finite range in a distal direction, and thus no exit dose along the beam path. Therefore, PBT has dosimetric advantages compared with X-ray therapy for the treatment of HCC. Indeed, various reports in the literature have described the favorable clinical outcomes and improved safety of PBT for HCC patients compared with X-ray therapy. However, there are some technical issues regarding the use of PBT in HCC, including uncertainty of organ motion and inaccuracy during calculation of tissue density and beam range, all of which may reduce the robustness of a PBT treatment plan. In this review, we discuss the physical properties, current clinical data, technical issues, and future perspectives on PBT for the treatment of HCC.

Keywords: Radiation therapy; Hepatocellular carcinoma; Proton beam therapy; X-ray therapy

Core tip: Radiation therapy (RT) is being increasingly utilized for the treatment of hepatocellular carcinoma (HCC). As RT technology develops, proton beam therapy (PBT) has emerged as a method that affords dosimetric advantages compared with X-ray therapy due to its physical properties, including lack of an exit dose along the beam path. Clinical experience with PBT for HCC is accumulating rapidly, and the effectiveness and safety of PBT has been validated. In this review, we discuss the physical properties, current clinical data, technical issues, and future perspectives on PBT for the treatment of HCC.