Proton Beam Therapy for the Treatment of Hepatocellular Carcinoma (HCC)

Reviewer: James M. Metz, MD
Abramson Cancer Center of the University of Pennsylvania
Last Modified: May 22, 2007

Presenter: Jiamin Li
Presenter's Affiliation: Wanjie Proton Therapy Center, Zibo, China
Type of Session: Scientific


Hepatocellur Carcinoma (HCC) is one of the most common cancers in China and the 4th leading cause of cancer death world wide.  Most patients present with advanced stage and 80% are not eligible for surgery at the time of presentation.  Conventional radiation therapy is difficult to adminster due to the sensitivity of the normal liver to radiation which reduces the ability to deliver doses high enough to kill the HCC.  Radiation induced liver damage (RILD) and destruction of large amounts of normal liver are common with conventional radiation, which has limited its utilzation.  Protons can significantly spare normal tissue radiation exposure and may be a viable treatment for these patients with HCC.

Materials and Methods

  • Between 12/04 and 3/07 39 patients with HCC were treated with proton therapy at the Wanjie Proton Therapy Center in Zibo, China
  • 37 patients were male and the median age was 58 years.
  • The median tumor size was 7 cm
  • Patients were either medically inoperable or refused surgical resection
  • 23/37 patients had a solitary HCC in the liver
  • 17 patients were stage I and II, while 20 were stage III
  • Child-Pugh liver status was A (25 pts), B (12 pts), or C (2 pts)
  • Patients were treated in a variety of fractionation les ranging from 2.0-4.0 CGE fractions and a total of 13-28 fractions. 
  • The total dose ranged from 52-72 CGE


  • The median follow up was 12 months
  • The complete response rate by imaging was 35% for the stage I and II patients
  • For the stage I and II patients the 1 year local control rate was 94% and the 1 year survival rate was 88%
  • For the stage III patients the overall survival was 59% at 6 months.
  • For the early stage patients, toxicity was mild with skin and GI toxicity
  • The two patients with Child-Pugh C liver disease both died within 2 months of completion of treatment from liver failure

Author's Conclusions

  • The initial results for treatment of HCC with proton therapy at our institution are encouraging
  • Proton therapy may play an important role in the treatment of early stage HCC
  • Proton therapy offers a signicantly reduced dose to normal liver in advanced HCC

Clinical/Scientific Implications

As the authors state, HCC is a huge problem world wide and many patients are not candidates for surgical resection.  Proton therapy may offer an important option for these patients with localized disease.  The data presented in this study are consistent with those presented from other centers, particularly in Japan, where proton therapy is offering encouraging results and is becoming a standard treatment option offerered at these centers.  Future studies need to better establish the fractionation schedule and total dose most effective for treatment.  Efforts should be made towards the earlier stage patients that are not resectable, but still have reasonable liver function.