Executive summary

Published in the Red Journal, this study from Taiwan retrospectively analyzed the outcomes of 159 patients with >5 cm non-metastatic HCC who underwent definitive radiotherapy using either protons (N=105) or photons (N=54). After a median follow-up of 47 months, this study reported that patients with biologically effective dose (BED10) ≥75 Gy exhibited significantly better local control (LC, 2-year: 85.6% vs. 20.5%, P<0.001), progression-free survival (PFS, median 7.4 vs. 3.2 months, P<0.001), and overall survival (OS, median 18.1 vs. 7.3 months, P<0.001) compared to those with BED10 <75 Gy. Proton-treated patients had a significantly higher BED10 (96 vs. 67 Gy, P<0.001) and improved LC (2-year: 88.5% vs. 33.8%, P<0.001), PFS (median 7.4 vs. 3.3 months, P=0.001), and OS (median 18.9 vs. 8.3 months, P<0.001) than those undergoing photon radiotherapy. Patients treated with protons had significantly lower V1 of the liver (P<0.001), mean upper gastrointestinal (UGI) tract dose (P<0.001), and mean splenic dose (P<0.001), with significantly decreased incidences of radiation-induced liver disease (P=0.007), grade ≥3 UGI bleeding (P=0.001), and grade ≥3 lymphopenia (P=0.003).

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