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Abstract
Background: Since December 2015, the Proton Beam Therapy (PBT) center at Samsung Medical Center has treated 2000 cases involving 1823 patients with HCC who were ineligible for Barcelona Clinic Liver Cancer (BCLC) guideline-recommended standard treatments. This study evaluated clinical outcomes and explored the potential role of PBT as an alternative local modality.

Methods: We retrospectively reviewed patients with HCC treated with PBT. The primary endpoint was freedom from local progression (FFLP), and the secondary endpoints were overall survival (OS) and toxicity.

Results: The annual number of PBT cases increased, among all cases, 93.0 % targeted intrahepatic lesions, while 7.0 % targeted extrahepatic lesions. FFLP was evaluated in intrahepatic cases with a median follow-up of 19.5 months (interquartile range [IQR], 8.5-39.7). The 2-year FFLP exceeded 90 % across the treatment periods without significant differences (P = 0.51). According to the BCLC stages (0, A, B, and C), the 2-year FFLP rates were 95.5 %, 93.9 %, 98.5 %, and 87.6 %, respectively, and the 3-year FFLP rates were 91.1 %, 91.3 %, 95.0 %, and 83.3 %, respectively (P < 0.001). The median OS follow-up was 18.7 months (IQR 7.9-38.6). The 3-year OS rates were 81.1 % in BCLC stage 0; 65.5 %, stage A; 45.5 %, stage B; and 37.2 %, stage C, respectively (P < 0.001).

Conclusion: This large, single-center study demonstrated that PBT provided favorable local control and survival outcomes, supporting its role as a promising local ablative modality to address the unmet therapeutic needs in HCC.

그림 1. 환자 흐름도: 2,000례의 치료 케이스를 간내/간외 병변, 치료 목적(완치/완화), 그리고 BCLC 병기별로 분류하여 분석 구조를 보여주는 도표입니다.

그림 2. 국소 종양 제어율 (FFLP) 곡선: 병기(BCLC 0, A, B, C) 및 종양 크기별로 양성자 치료 후 국소 재발 없이 유지되는 비율을 시각화한 그래프로, 진행성 병기에서도 우수한 제어 효과를 확인할 수 있습니다.

Affiliations

Jeong Ha Lee 1, Nalee Kim 1, Jeong Il Yu 2, Hee Chul Park 3, Sungkoo Cho 1, Byeong Geun Song 4, Myung Ji Goh 4, Wonseok Kang 4, Dong Hyun Sinn 4, Geum-Youn Gwak 4, Joon Hyeok Lee 4, Yong-Han Paik 4, Moon Seok Choi 4, Minsuk Kwon 4, Jung Yong Hong 4, Gyu-Seong Choi 5, Woo Kyoung Jeong 6, Min Woo Lee 6, Dong Ho Hyun 6, Sang Yun Ha 7
1Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
2Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. Electronic address: jeongil.yu@samsung.com.
3Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. Electronic address: hee.ro.park@samsung.com.
4Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
5Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
6Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
7Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.